AccountId: 011433970860
ContactId: 72c61513-3694-4885-bced-31f8669fb58b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442200 ms
Total Talk Time (AGENT): 162887 ms
Total Talk Time (CUSTOMER): 151769 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/72c61513-3694-4885-bced-31f8669fb58b_20250331T21:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII] calling from a dental office, and I was just trying to get some benefit details for a patient.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits. Can I please get your call back number and the name of the dental office you're calling from?
[CUSTOMER][NEUTRAL] Yes ma'am. Phone number is [PII] and we're at Austin Family Dental Spa.
[AGENT][NEUTRAL] OK, thank you, ma'am. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Uh name is [PII]. Last name [PII] Her date of birth is [PII], and then her policy number is 02555478.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us and her effective date is [PII]. And if you give me your fax number, I can send you a fax back with her benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] I, um, I, I requested one twice now, um, with another representative that I, I still haven't received, um, do you guys by chance email those?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] We, uh, we
[AGENT][NEUTRAL] We don't email them, but what I can do is I can put a tag on it so I can watch it and make sure that it gets to you, OK? And I'll keep an eye on it and if your fax line is busy or anything like that happens, I'll just keep trying to resend it until I see it goes through.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] OK, you're welcome. I don't mind doing that to help you. And what is your fax number?
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] OK, let me repeat it because you've already had trouble getting it, so I want to make sure I've got the number right. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get the facts ready and I'll be right back. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII]. I just wanted to let you know I've got that fax on its way to you now, and I am gonna keep an eye on it for you, OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] Thank you so much. Would you be able to just give me the overall percentages for his preventative or I'm sorry, their preventative basic and major?
[AGENT][POSITIVE] Yeah, I can give you a preventative, basic and major.
[CUSTOMER][NEUTRAL] was for.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Uh, let's look.
[AGENT][NEUTRAL] OK, and this is just to verify benefits, it's not a guarantee of payment. So preventative is 100% of allowable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Basic is.
[AGENT][NEUTRAL] 80% of allowable and this policy does not have major.
[CUSTOMER][NEUTRAL] No major and then so in that case would endoperio oral surgery fall under major with no coverage or basic?
[AGENT][NEUTRAL] What is the um procedure code?
[CUSTOMER][NEUTRAL] Let me start with the 4341.
[AGENT][NEUTRAL] OK. Because when you get your facts back, if you don't see the procedure code on there, then it's not a covered procedure, just so you know when you get it.
[CUSTOMER][NEUTRAL] Um insurance pay list, yeah, insurance payless.
[CUSTOMER][NEUTRAL] Oh, OK, oh easy.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Yeah, we try to make it simple.
[AGENT][NEUTRAL] OK, 4241. I do not see that procedure code.
[CUSTOMER][NEUTRAL] Oh, OK. And then for the rest of the codes I have in mind, I'll just keep an eye out for that fact since it sounds lovely. Can I, can I have her, um, max and deductible while I have you though?
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. The maximum is $500 and the deductible is $50.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 50 and then do you show any history on file for this patient?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] No, ma'am, I don't see that she's ever filed a claim with us on this policy.
[CUSTOMER][NEUTRAL] No history.
[CUSTOMER][POSITIVE] Beautiful and just because I know the patient wanted me to reach out, um, I assume there would be coverage for exams, x-rays, and cleanings most likely under a preventative diagnostic.
[CUSTOMER][POSITIVE] Like the pano, the bite wings.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, that's on here.
[CUSTOMER][NEUTRAL] OK perfect she just wanted me to confirm that so I think I have everything that I need for now. Is there a reference number by chance?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect thank you so much you have a nice evening.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a blessed one and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you thank you bye bye.
[AGENT][NEUTRAL] Mm. Bye-bye, ma'am.