AccountId: 011433970860
ContactId: 606e46d8-efa6-489b-9f72-81528d0df1c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447380 ms
Total Talk Time (AGENT): 161788 ms
Total Talk Time (CUSTOMER): 128376 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/606e46d8-efa6-489b-9f72-81528d0df1c6_20250310T13:08_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Patients dental eligibility and benefits on a recorded line. Can you please help me with that?
[AGENT][NEUTRAL] OK, [PII], and you're needing dental eligibility and benefit information?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], on our dental policies, we have 5 backs of the members of benefits that has all of the information on there that I'll be happy to send to you. But first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 6,072,900.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Member is [PII], [PII] for date of birth.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so he is a subscriber, [PII], on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK. Now, is this for
[AGENT][NEUTRAL] And what is
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I was going to ask you for your fax number so that I can send you all of this benefit information.
[CUSTOMER][NEUTRAL] No, actually, I do have a fax pack. I just have to need to verify some information. Can you please confirm if this, the group name is still revenue and taxation department with the group number LA 0565?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the annual maximum 1000 deductibles, 50 and 150?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and member has used anything out of his maximum deductible amounts?
[AGENT][NEUTRAL] For this calendar year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] No, ma'am, as of now, he has not.
[CUSTOMER][NEUTRAL] And then, is there any dental history for this member that can affect the eligibility?
[AGENT][NEUTRAL] What code?
[AGENT][NEUTRAL] What is the first
[CUSTOMER][NEUTRAL] Preventive services.
[AGENT][NEUTRAL] OK, you would need to provide the codes.
[CUSTOMER][NEUTRAL] OK, good. 0120?
[AGENT][NEUTRAL] 9 16 2024.
[CUSTOMER][NEUTRAL] OK. 0210?
[AGENT][NEUTRAL] 102306.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 0330
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] OK. And on this plan, implants and orthodonics, is it covered?
[AGENT][NEGATIVE] I do not believe so.
[AGENT][NEUTRAL] one of the codes.
[CUSTOMER][NEUTRAL] 6059.
[AGENT][NEUTRAL] 6059, is that correct?
[CUSTOMER][NEUTRAL] Yes, 6059.
[AGENT][NEUTRAL] No, ma'am. That's not covered.
[CUSTOMER][NEUTRAL] And then 9223.
[AGENT][NEUTRAL] No, ma'am. That is not
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. And then on this plan, preventive basic and major services, they are covered at how much co-insurance percentages?
[AGENT][NEUTRAL] These are listed in benefit amounts on the fax back.
[AGENT][NEUTRAL] The benefit amount has all of this, all of, excuse me, the fact fact has all of the benefit amount information on each code that is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Because uh for the previous year, it, it was like 100% of the fee schedule. So that's why I'm asking, is it same still?
[AGENT][NEUTRAL] This fee schedule has not changed. 0120, the benefit amount on this plan is $15.
[CUSTOMER][NEUTRAL] OK, co-pays are there, right?
[AGENT][NEUTRAL] There are, is it, OK, there are no co-pays.
[CUSTOMER][NEUTRAL] OK. And then coverage frequency is 1 in 6 months, 40,120.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It does state that on page one of the facts back.
[AGENT][NEUTRAL] It lists the different frequencies for the different services and the frequency.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It states once every 6 months.
[CUSTOMER][NEUTRAL] Great. OK, [PII], and then [PII] is also the subscriber as you told me before. Just can you assist me with the call reference and spelling of your name? Is it [PII]?
[AGENT][NEUTRAL] [PII] My name in today's date would be your call reference number and then if you all do file a claim with APO once it has been processed, [PII], we do have a portal that you should be able to check claim status and by going to [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for all your help and assistance. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. And can I help you with anything else?
[CUSTOMER][POSITIVE] No, there is nothing else. You have yourself a wonderful day ahead then. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I, uh, yes, ma'am. I hope you have a nice day too, and thank you again for calling ATL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Uh-huh, mhm. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.