AccountId: 011433970860
ContactId: 89bd868b-c981-4cda-ae7c-1bbbb535c59a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311739 ms
Total Talk Time (AGENT): 148781 ms
Total Talk Time (CUSTOMER): 68139 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/89bd868b-c981-4cda-ae7c-1bbbb535c59a_20250512T13:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning [PII]. I was going to get eligibility and a breakdown of benefits.
[AGENT][POSITIVE] All right. I'm happy to check eligibility and benefits. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02451876.
[AGENT][NEUTRAL] Alright, thank you. And then for documentation, can I grab your first name?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Alright, thank you so much. So patient is active, effective date on here is [PII].
[AGENT][POSITIVE] And happy to give you a verbal breakdown or I can also send you a fax back with a breakdown, whatever works best.
[CUSTOMER][NEUTRAL] OK, um, am I able to do both?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, did you just need the calendar, your maximum deductible, claims information? What do you need first?
[CUSTOMER][NEUTRAL] Yes, please, um, all of the above.
[AGENT][NEUTRAL] OK, so patients calendar year maximum is going to be 1500.
[AGENT][NEUTRAL] And then it looks like their calendar year deductible is going to be 50.
[AGENT][NEUTRAL] Uh, let me see what they've used to date here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, looks like.
[CUSTOMER][NEUTRAL] I'm sorry, can I place you on a brief hold?
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK sorry about that thank you for holding.
[AGENT][NEUTRAL] No, no problem. So it looks like the patient [PII] has the $50 deductible remaining, also the full amount of $1500 for the calendar year.
[CUSTOMER][NEUTRAL] OK, and for the deductible, does it apply to all services or just basic and major?
[AGENT][NEUTRAL] Um, everything except for preventative, so patient has basic and major on here which would apply. Preventative does not apply towards deductible.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Um, as far as our payer ID goes for claims, that's gonna be 60801.
[AGENT][NEUTRAL] And then the claims mailing address is gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and do you guys um accept electronic attachments?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright perfect and is there um a waiting period or missing tooth louses?
[AGENT][NEUTRAL] Let's see. Policy does have a missing tooth clause. Uh, there is a 12 month waiting period for any major that would include also there's endodontic, periodontic, and oral surgery expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Our composite downgrade to amalgam.
[AGENT][NEGATIVE] They are not downgraded, no.
[CUSTOMER][NEUTRAL] OK, what about um crowns?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and our crowns paid on prep or seat date?
[AGENT][NEUTRAL] It's either, it doesn't matter.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], if you wanna give me a fax, I'll also prepare that and get that sent over to you.
[CUSTOMER][NEUTRAL] Yes, it is um 470.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 545.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1064.
[AGENT][NEUTRAL] OK, and then what else can I get for you?
[AGENT][NEUTRAL] that
[CUSTOMER][NEUTRAL] Um, can I also have the, uh, group name and group number?
[AGENT][POSITIVE] Absolutely, let's see.
[AGENT][NEUTRAL] Uh, group name is Universal Trucking.
[AGENT][NEUTRAL] And then the group number is gonna be 261.
[AGENT][NEUTRAL] 07.
[CUSTOMER][POSITIVE] All right perfect thank you.
[AGENT][POSITIVE] No problem. And that pack should be there in about 5 minutes, OK?
[CUSTOMER][POSITIVE] OK perfect have a nice day.
[AGENT][NEUTRAL] You too bye bye.