AccountId: 011433970860
ContactId: 630f53f2-15b3-44d2-833e-28c70d23c5a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482190 ms
Total Talk Time (AGENT): 234667 ms
Total Talk Time (CUSTOMER): 161350 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/630f53f2-15b3-44d2-833e-28c70d23c5a0_20250219T17:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the dental office to check the eligibility and benefit for a member on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify eligibility and benefits for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02134438.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] I'm fine.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, and see, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] And, well, I think I put in the wrong number. You said 213443-8, correct?
[CUSTOMER][NEUTRAL] So there's a 0 on the start.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Um, well, I show this policy was effective [PII], but it terminated on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], any other active plan for the member?
[AGENT][NEUTRAL] OK. Looks like they do have another policy. Give me one moment.
[AGENT][NEUTRAL] OK, uh, when you're ready, I can give you that policy number.
[CUSTOMER][POSITIVE] Sure, I'm ready for that.
[AGENT][NEUTRAL] OK, it's 254-6491.
[AGENT][NEUTRAL] And effective date is [PII] and it's active. And you need a general breakdown of benefits or I can send you a fax back.
[CUSTOMER][POSITIVE] OK, amazing.
[CUSTOMER][NEUTRAL] Alright, so I need general breakdown of benefit, but before that I'm having a few questions which I need to ask for. So is the member to subscribe on this plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, they're dependent.
[CUSTOMER][NEUTRAL] OK, and what kind of plan it is? Is it a PPO plan, HMO plan?
[AGENT][NEUTRAL] Uh, it's not a neither. It's just a group dental policy. There's no preferred provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So no network required?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what about the group name?
[AGENT][NEUTRAL] Uh, the group name is Universal Trucking US One Logistics.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] 15799.
[CUSTOMER][NEUTRAL] And you said uh patient is not the subscriber, right?
[AGENT][NEUTRAL] Correct, they are dependent on the policy.
[CUSTOMER][NEUTRAL] And [PII] would be the subscriber, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about the claiming address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Amazing.
[CUSTOMER][NEUTRAL] And what about the deductible, the max on this plan?
[AGENT][NEUTRAL] Uh, not a.
[CUSTOMER][POSITIVE] You can give me the breakdown of benefits now.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] You can give the breakdown of benefit now.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1500 per calendar year, and they have a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] That is applied to preventative or it's not applied to preventative?
[AGENT][NEUTRAL] Uh, deductible does not apply to preventative, everything else but preventative.
[CUSTOMER][NEUTRAL] OK, great. Anything used on it?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, give me a moment.
[AGENT][NEUTRAL] Uh, no, not for this year.
[CUSTOMER][NEUTRAL] OK. Is orthodontic service covered?
[AGENT][NEGATIVE] Uh, ortho is not covered.
[CUSTOMER][NEUTRAL] What about the coverage for preventative, basic and major?
[AGENT][NEUTRAL] Uh, it pays by UCR preventive it's 100% of UCR. Basic, basic restorative FMX panoramic pays at 80%, and major services pay at 40% of UCR.
[CUSTOMER][POSITIVE] Amazing. What about endodontic, periodontic, and oral surgery?
[AGENT][NEUTRAL] Oh, that's all falls under major.
[CUSTOMER][NEUTRAL] What about implant is it covered?
[AGENT][NEUTRAL] Uh, implants are not covered under the policy.
[CUSTOMER][NEUTRAL] Crown residential is also on the major right.
[AGENT][POSITIVE] Correct, crowns, dentures, partials, those all follow on the major.
[CUSTOMER][NEUTRAL] Can I get the frequency for preventative services?
[AGENT][NEUTRAL] Um, exams are 2 for 12 month period. All exams share the same frequency, cleanings once every 6 months, fight wings once every 12 months. Fluoride is under the age of [PII], once every 3 years, oh no sorry, once every 12.
[AGENT][NEUTRAL] Months and sealants under the age of [PII] once every 3 years, permanent molars only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Amazing. What about FMX andpano?
[AGENT][NEUTRAL] Uh, FMX panel once every 5 years.
[CUSTOMER][NEUTRAL] What about PO maintenance and PU SRP frequency?
[AGENT][NEGATIVE] Uh, pair maintenance is once every 6 months and it does not share frequency with the regular cleaning and what was the other?
[CUSTOMER][NEUTRAL] PSRP.
[AGENT][NEUTRAL] A full mouth environment or scale and root planning?
[CUSTOMER][NEUTRAL] Scaling and route planning.
[AGENT][NEUTRAL] Uh, it's once every 24 months.
[CUSTOMER][NEUTRAL] OK, PO maintenance and simple extraction under which category?
[AGENT][NEUTRAL] Uh, simple extractions, uh, that falls on our basic para maintenance falls on her major.
[CUSTOMER][POSITIVE] Amazing. And any waiting period or missing tooth louses?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There is a 12-month waiting period for major, but let me double check. Give me one moment.
[AGENT][NEUTRAL] OK, yeah, there is a 12-month waiting period for majors, so they won't be eligible until [PII] of this year for major.
[CUSTOMER][NEUTRAL] OK. OK. But endoperio oral surgery and major, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] And no missing tooth loss.
[AGENT][NEGATIVE] Uh, there is a missing tooth cloth.
[CUSTOMER][POSITIVE] OK. Amazing.
[CUSTOMER][NEUTRAL] What about oral cancer screening, is it covered?
[AGENT][NEUTRAL] Uh, no, sir, it's not covered.
[CUSTOMER][NEUTRAL] OK, the replacement cost for is a service like Venture Business and crowns.
[AGENT][NEUTRAL] Uh, uh, let me double check. I believe it's once every 7. Give me a moment. Uh, well, crowns, bridges every 7, partial dentures every 5.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Crown and bridges every 7 years. Any downgrade on this plan?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][POSITIVE] No downgrade. Alright, amazing. Thank you for the information and thank you for your help. And can I get to know the reference number and your name for today's call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date, and it's [PII], last initial [PII]
[CUSTOMER][POSITIVE] OK, [PII], amazing. Thank you for the information you provided and thank you for your help.
[AGENT][POSITIVE] Alright, you're welcome, Mr. [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You too as well. Bye-bye. Take care.
[AGENT][NEUTRAL] Bye.