AccountId: 011433970860
ContactId: 82daa935-382f-4830-8ec0-abe86dbdd9d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265640 ms
Total Talk Time (AGENT): 98873 ms
Total Talk Time (CUSTOMER): 82258 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/82daa935-382f-4830-8ec0-abe86dbdd9d7_20250320T13:22_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, I'm trying to verify patients eligibility and benefits.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the eligibility and benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and [PII] option two.
[AGENT][NEUTRAL] Thank you for that and [PII]. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 02475736
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing that the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, their dental benefits, can I get the deductible and max?
[AGENT][NEUTRAL] Hold on one moment, let me pull up the fax back.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for this policy, the calendar year max is $500 per insured.
[AGENT][NEUTRAL] The deductible is $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] Any auto coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And then preventative 100 basic 80 major 50.
[AGENT][NEUTRAL] Major isn't covered on this um policy. Major for us includes endodontic, periodontic, proteodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about the preventative and basic, is that covered at 180?
[AGENT][NEUTRAL] Yes, preventative 100, basic 80, um, radiographs and FMX are also 80% in its own category.
[CUSTOMER][NEUTRAL] OK, so pretty much it's only like.
[CUSTOMER][NEGATIVE] The maintenance isn't covered. SRP not covered, dentures, bridges, and crowns not covered.
[AGENT][NEUTRAL] Correct, that's all under major.
[CUSTOMER][NEUTRAL] OK, um, and then can I just get the frequencies let me give you, give them to you one at a time?
[AGENT][NEUTRAL] Frequencies, like, do you have particular codes you want to go over?
[CUSTOMER][POSITIVE] Yes ma'am, I'll give them to you. I uh first one.
[AGENT][NEUTRAL] Or you just need like pro fees?
[CUSTOMER][NEUTRAL] Yeah, the first one's exams and then, uh, second one's cleaning.
[AGENT][NEUTRAL] Alright, so exams are 2 for 12 month period.
[AGENT][NEUTRAL] Cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] And for bite wings and FMX.
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] Is it once every 5 years for bite wings as well?
[AGENT][NEUTRAL] 5 wings is once per 12-month period.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK and then um is fluoride covered?
[AGENT][NEUTRAL] Um, yes, fluoride is under preventative.
[AGENT][NEUTRAL] At 100.
[CUSTOMER][NEUTRAL] OK, and is that 1 in 6 months as well?
[AGENT][NEUTRAL] Uh, let me see what the frequency is an adult. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Max 1 procedure per 12 months.
[CUSTOMER][NEUTRAL] OK, and just to make sure I heard you correctly, they, uh, maximum for the plan was $500.
[AGENT][NEUTRAL] Yes, per calendar year.
[CUSTOMER][POSITIVE] OK, alright, that's all the questions I have for today, thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, no, ma'am, that was all.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.