AccountId: 011433970860
ContactId: 77e242c6-5b87-4a53-aaa7-48d8d1b35ba1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454579 ms
Total Talk Time (AGENT): 159230 ms
Total Talk Time (CUSTOMER): 176971 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/77e242c6-5b87-4a53-aaa7-48d8d1b35ba1_20250217T22:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Jefferson Dental. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Thanks for asking.
[AGENT][POSITIVE] Yeah, what can we help you with today?
[CUSTOMER][NEUTRAL] So I'm calling to verify the eligibility and benefits for the patient. So could you please help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I could check eligibility benefits for you. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] It's 02013730.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII], with date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] so this policy is active effective date was [PII].
[AGENT][NEUTRAL] And if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] No, no. I just have only, I have only a few questions.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So could you please provide me the frequency and percentage for 1208?
[AGENT][NEUTRAL] Could you repeat that code, I'm sorry.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, 1208 is not going to be a covered procedure under this policy.
[CUSTOMER][NEGATIVE] Not covered. And uh uh
[CUSTOMER][NEUTRAL] Just a moment. Um, and 4346?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was that number? Sorry.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] 4346 is also not going to be a covered procedure.
[CUSTOMER][NEUTRAL] OK. And is there any history on the file that affecting the frequencies?
[AGENT][NEUTRAL] Uh, let me see if I've got any history. Give me just a moment.
[AGENT][NEUTRAL] This was for [PII] correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The last uh
[AGENT][NEUTRAL] Let's see, last procedures I have most recent are from [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 44 was procedure code?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is 0230.
[AGENT][NEUTRAL] For 219.
[CUSTOMER][NEUTRAL] 023.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0230 for 214.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0220 for 23.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 23924212.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, for 212.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 2392425.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is all from that date of service.
[CUSTOMER][NEUTRAL] OK. Uh, this all kind of courses, uh, got service on [PII], right?
[AGENT][POSITIVE] Say that again, I'm so sorry.
[CUSTOMER][NEUTRAL] This all courts got serviced on [PII], right?
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] [PII] or [PII]?
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII]. So, yeah, the codes are [PII], right?
[AGENT][NEUTRAL] Yes, and uh yeah, 2392 yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So apart from this, is there any other history that affecting the frequencies?
[AGENT][NEUTRAL] What did I see that would affect frequencies. Let's see, I don't see any.
[AGENT][NEUTRAL] FMX or radiographs.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And uh yeah.
[CUSTOMER][NEUTRAL] A. OK. OK.
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And other missing too cloth supply.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] That's missing two cloth supply.
[AGENT][NEGATIVE] Yes, there is a missing teeth cloth.
[CUSTOMER][NEUTRAL] There is a missing tooth loss?
[AGENT][NEUTRAL] There is a a missing tooth clause, yes.
[CUSTOMER][NEUTRAL] OK. Are major services paid on pre pre date or date?
[AGENT][NEUTRAL] Either one
[CUSTOMER][NEUTRAL] Cate?
[AGENT][NEUTRAL] Either one
[CUSTOMER][NEUTRAL] OK. And uh uh is there any waiting period?
[CUSTOMER][NEUTRAL] For the policy?
[AGENT][NEUTRAL] Um, not that is currently in effect, no, um, there was a waiting period for major expenses for 12 months, but as this policy has been effective since [PII], there are no waiting periods at this time.
[CUSTOMER][POSITIVE] So they are, they are satisfied, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. No waiting periods.
[CUSTOMER][NEUTRAL] And uh is there any used amount from the deductibles and the max amount?
[AGENT][NEUTRAL] Uh, let me check that. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] None has been used so far this year.
[CUSTOMER][NEUTRAL] OK, and is the author cover benefit?
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] Is the orthodontics is a cover benefit?
[AGENT][NEUTRAL] I'm so sorry I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] Is orthodontics is a covered benefit?
[AGENT][NEUTRAL] No orthodontics is not covered.
[CUSTOMER][NEUTRAL] OK, yeah, that's it. OK, could you please give your name and call reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII], was there anything else I can help you with?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I I.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So I have one more code, uh 5 uh 55,510 and 5760. Could you please provide me the coverage percentage for these codes?
[AGENT][NEUTRAL] Could you repeat those codes?
[CUSTOMER][NEUTRAL] 551,095,760.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK 5510 is under precedented, so that is uh 40%.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5760 is also at 40%.
[CUSTOMER][POSITIVE] OK, thank you. Thank you. So yeah, this is all the information I needed for today. Yeah, thanks for helping me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day thank you.
[CUSTOMER][POSITIVE] Have a nice day. Bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.