AccountId: 011433970860
ContactId: 8b8aaf98-53bd-40ce-8472-a2fb7ab3e7ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360160 ms
Total Talk Time (AGENT): 101771 ms
Total Talk Time (CUSTOMER): 126505 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/8b8aaf98-53bd-40ce-8472-a2fb7ab3e7ad_20250424T14:12_UTC.wav
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[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes, I had a question about patient benefits.
[AGENT][POSITIVE] OK, I can help you with benefits. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] OK, [PII], do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, the only, let me see, I don't know if it's the policy number, but she gave 02596316.
[AGENT][NEUTRAL] OK, and the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, I've got the policy effective [PII]. It's currently active. Um, I can send a fax back if you'd like, or we can go over information on the phone.
[CUSTOMER][NEUTRAL] Um, over the phone, please see here 2 1025. OK, perfect. Um, is this, is there a group number with it?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Group number is 70052.
[CUSTOMER][NEUTRAL] OK perfect and then is there a plan name?
[AGENT][NEUTRAL] Uh, plan name is get that.
[AGENT][NEUTRAL] That's D as in dog, 4 F F S B as in boy.
[CUSTOMER][NEUTRAL] OK perfect alright and then is this a calendar year plan or a fiscal year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK, and then what is the maximum and deductible?
[AGENT][NEUTRAL] A calendar year max is 500 and then deductible is 50.
[CUSTOMER][NEUTRAL] Alrighty and then no family deductible?
[AGENT][NEUTRAL] Uh family deductible is 150.
[CUSTOMER][NEUTRAL] 150 OK got you alright and then is there a missing tooth cause or waiting period?
[AGENT][NEUTRAL] There is a missing tooth clauses and there's no waiting periods.
[CUSTOMER][NEUTRAL] OK, and then what would be the co-insurance?
[AGENT][NEUTRAL] Um, for radiographs, FMX, basic expenses, and basic restorative, the policy pays 80%.
[AGENT][NEUTRAL] And this is not a guarantee, it's a basic outline of the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Here
[CUSTOMER][NEUTRAL] Oh, it's 80 for uh everything.
[AGENT][NEUTRAL] He's 100% for preventive.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 100% percent.
[CUSTOMER][NEUTRAL] OK, um, let me see, and perio endo and oral surgery is at 80% as well?
[AGENT][NEUTRAL] Um, I don't think they cover perio. Do you have a code?
[CUSTOMER][NEUTRAL] Uh, we can do 4341.
[AGENT][NEUTRAL] Yeah, they don't have any perio coverage. Um, the only oral surgery would be 7140.
[CUSTOMER][NEGATIVE] Oh darn
[CUSTOMER][NEUTRAL] OK, only covered and then what about Indo?
[AGENT][NEUTRAL] Um, do you have a code for that?
[CUSTOMER][NEUTRAL] Um, let's do a 3310.
[AGENT][NEGATIVE] Yeah, no coverage for Endo.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so, um, let me see, and then what about crowns, do they have major coverage I should say?
[AGENT][NEGATIVE] No, no coverage for major endopario.
[CUSTOMER][NEUTRAL] Oh got you OK, alrighty, um, and then I think that was actually all I needed, um, do they have any history on file that could affect frequencies?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Uh, let's see, so it looks like.
[AGENT][NEUTRAL] They had an oral evaluation on 327 25.
[CUSTOMER][NEUTRAL] 327 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what was that code?
[AGENT][NEUTRAL] 00140, but it does say they do get two for a 12 month period, so it should be fine if she had them.
[CUSTOMER][NEUTRAL] OK, and then, um, out of her 500, how much does she have remaining?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, she's got 407-20 left to utilize.
[CUSTOMER][NEUTRAL] OK perfect and um I just wanted to make sure for that day of service [PII] that was all she's got on file for this year, right?
[AGENT][POSITIVE] Uh yes, that's correct.
[CUSTOMER][POSITIVE] OK perfect thank you that was all I needed can I have a reference number please?
[AGENT][NEUTRAL] That's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.