AccountId: 011433970860
ContactId: 872f5a08-3561-4c3f-a892-08edee6a9bb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334130 ms
Total Talk Time (AGENT): 188123 ms
Total Talk Time (CUSTOMER): 76472 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/872f5a08-3561-4c3f-a892-08edee6a9bb7_20250303T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I was calling to verify a patient's uh dental benefits.
[AGENT][POSITIVE] Yes, ma'am, I'll be glad to help you. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Um, the, is the policy number the member ID number?
[AGENT][NEUTRAL] Uh, yes, ma'am it's gonna be a certificate number.
[CUSTOMER][NEUTRAL] Um, I see it is 018.
[CUSTOMER][NEUTRAL] 99832
[AGENT][NEUTRAL] That sounds like it, [PII]. OK, thank you for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 867-1399
[AGENT][POSITIVE] Alrighty, [PII], now thank you so much for all that information. Now, what is your patient's name and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Uh looks like [PII] is dependent on this dental plan. I do show her original effective date is [PII]. She is still current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim. But you did say you want benefits. We do a fax back of benefits. Would you like that?
[CUSTOMER][NEGATIVE] Um, I need a verbal breakdown. Our fax machine isn't working.
[AGENT][POSITIVE] OK, be glad to do that as well. Alright, let's get that benefits pulled up.
[AGENT][NEUTRAL] Alright, let's see. OK, they have the uh maximum benefit of $1500 payable per calendar year.
[AGENT][NEUTRAL] There is no PPO plan. It is strictly paid on UCR.
[AGENT][NEUTRAL] And the benefits are preventative, paid at 100%, no deductible.
[AGENT][NEUTRAL] Of UCR.
[AGENT][NEUTRAL] Then your Class B Basic has a $50 deductible then payable at 80% of UCR.
[AGENT][NEUTRAL] And then the major is has the same $50 deductible that is combined with the pre I mean with the basic, um, and under the major is paid at 40% of UCR up to the $1500 benefit payable per calendar year.
[CUSTOMER][NEUTRAL] OK, and you said you we use, so do we use the UCR fee schedule or what fee schedule?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You see her
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does she have any missing two causes or waiting periods?
[AGENT][NEUTRAL] There is a waiting period for major, but she's been covered more than 1 year, 12 months, so she's, she, she's OK as far as that goes. Um, missing tooth cloths, they do have, yes, ma'am.
[CUSTOMER][NEUTRAL] So for the waiting period, has that already passed?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] So she can get major services done without the waiting period.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][POSITIVE] No problem at all, [PII], take your time.
[CUSTOMER][NEUTRAL] Does she have any auto benefits?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and as far as you guys' uh, what's you guys' claimed address?
[AGENT][NEUTRAL] Our claims mailing address is to APL claims department.
[AGENT][NEUTRAL] And that is at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip is [PII].
[AGENT][NEUTRAL] And would you like that electronic payer ID number as well?
[CUSTOMER][NEUTRAL] Yes, but give me the zip code one more time. I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am. That's no problem. Our zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and I'm ready for the payer ID.
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] Alright, and is there a reference number for this call?
[AGENT][NEUTRAL] No, ma'am, we don't give reference number, [PII], but you can use my name in today's date and my name is [PII], spelled [PII] And is that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, I have a question. As far as is this in in network benefits or out of network?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's not no network, they're paid by UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not a network. They can go to any dentist anywhere in any state. Yes, ma'am.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright, that's all I needed.
[AGENT][POSITIVE] All right. Well, yes, ma'am. Well, thank you, [PII], for calling APO and you have a great rest of your day, OK?
[CUSTOMER][POSITIVE] You you too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.