AccountId: 011433970860
ContactId: 70eaecb7-c1f0-4072-ba2e-6803f47818d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440600 ms
Total Talk Time (AGENT): 182676 ms
Total Talk Time (CUSTOMER): 142534 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/70eaecb7-c1f0-4072-ba2e-6803f47818d6_20250102T15:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I need to verify patients benefits.
[CUSTOMER][POSITIVE] Actually get their benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're wanting to know if they're active or not or their actual benefits.
[CUSTOMER][NEUTRAL] This is you said this is APL.
[CUSTOMER][NEUTRAL] Uh, the benefits.
[AGENT][NEUTRAL] Both.
[AGENT][NEUTRAL] OK, well.
[CUSTOMER][NEUTRAL] Yeah, you said this is APL and it's OK.
[AGENT][NEUTRAL] Yes, this is APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Policy number is 02554.
[CUSTOMER][NEUTRAL] 088.
[AGENT][POSITIVE] Thank you, and I'll be more than happy to help you with both the eligibility and the benefits. I'm just pulling up the policy now.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII]. And what type of benefits or did you need like a fax back or you have particular questions?
[CUSTOMER][NEUTRAL] Yeah, um, so, uh, is this like.
[CUSTOMER][NEUTRAL] The TRC Staffing, is that the group name?
[CUSTOMER][NEUTRAL] For some reason I
[AGENT][NEUTRAL] Um, let me look for the group. Hold on one second.
[AGENT][NEUTRAL] Yes, TRC Staffing Services is the group name.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and this one runs from, is it a calendar year or policy year and what's the max?
[AGENT][NEUTRAL] This is a calendar year.
[CUSTOMER][NEUTRAL] OK and then uh what's the max on it?
[AGENT][NEUTRAL] Um, the max is $500 and there is a $50 deductible.
[CUSTOMER][NEUTRAL] Has she used it? Well, it's actually the new year, so no, um.
[CUSTOMER][NEUTRAL] The coverage for preventative is that at 100.
[AGENT][NEUTRAL] Yes, preventative is at 100%. Radiographs, FMX expenses, basic expenses and basic restorative expenses are all at 80%. This policy doesn't cover any major expenses, which includes endodontic, periodontic, prosodontic, and oral surgery, um, so there's no waiting period on this policy.
[CUSTOMER][NEUTRAL] What about simple extraction?
[CUSTOMER][NEUTRAL] What about simple extractions?
[AGENT][NEUTRAL] Um, if it's using 07140, that is a covered code on this policy for basic extraction.
[CUSTOMER][NEUTRAL] 7140 is uh.
[CUSTOMER][NEUTRAL] It's it's covered.
[AGENT][NEUTRAL] Yes, ma'am, that's the uh extraction code on this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's the only one, OK, that, uh, and no other like 49 10s, nothing like that covered.
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What's the no well there's no missing tooth cloth because doesn't cover.
[CUSTOMER][NEUTRAL] Uh, OK, so then, um.
[CUSTOMER][NEUTRAL] What's the frequency for exams?
[AGENT][NEUTRAL] Um, 2 for 12 month period.
[CUSTOMER][NEUTRAL] 2 and 12 months is the patient OK that's does that share with all exams including 0 140.
[AGENT][NEUTRAL] Yes, um, hold on one second, let me go to that code.
[AGENT][NEUTRAL] Um, 01, 2040, 50, and 60.
[CUSTOMER][NEUTRAL] OK, got it, so this.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, and then pro fee what's the uh frequency?
[AGENT][NEUTRAL] Um, I believe it's once every 6 months.
[CUSTOMER][NEUTRAL] And bite wings.
[AGENT][NEUTRAL] Is once per 12-month period.
[CUSTOMER][NEUTRAL] Does that share with any other codes?
[AGENT][NEUTRAL] Um, let me see by wings.
[AGENT][NEUTRAL] No, it is, hold on, let me make sure.
[AGENT][NEUTRAL] I mean, they're all biting cold, so like 02700272 and 0274.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] What about Pan FMX?
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] A fluoride
[AGENT][NEUTRAL] Fluorine.
[AGENT][NEUTRAL] It's under preventative, um, if it's for a, is it, hold on.
[AGENT][NEUTRAL] She's an adult. So,
[CUSTOMER][NEUTRAL] Is there an age limit?
[AGENT][NEUTRAL] Maximum of 1 procedure per 12 months and limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 9110 is that covered?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Yes, under basic.
[CUSTOMER][NEUTRAL] Uh, 80%. Is there a frequency?
[AGENT][NEUTRAL] Um, no, there's no frequency.
[CUSTOMER][NEUTRAL] And fillings, are they downgraded?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] And is there a frequency for fillings?
[AGENT][NEUTRAL] Um, do you have a code for that?
[CUSTOMER][NEUTRAL] 2392.
[AGENT][NEUTRAL] 2392, hold on one moment.
[AGENT][NEUTRAL] Replace only if replace existing only if in place for 24 months and maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Alright, and then OK, I believe that should do it um.
[CUSTOMER][NEUTRAL] I just need a reference number.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, great, I believe that should do it. I am all set. Oh, does she have any history?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Is she used anything or well not this year but.
[AGENT][NEUTRAL] Uh, no, there's no history. We haven't, um, processed any claims for her yet.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] I believe that should do it. I am all set. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Uh, no, that'll do it.
[AGENT][POSITIVE] All right, well, thanks for calling APL and I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] Thanks, happy new year to you thanks bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.