AccountId: 011433970860
ContactId: 8ce75ebb-3cdc-4c2a-893c-33471331d515
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300220 ms
Total Talk Time (AGENT): 102690 ms
Total Talk Time (CUSTOMER): 94726 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/8ce75ebb-3cdc-4c2a-893c-33471331d515_20250331T21:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Jefferson Dental. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good. I'm calling for dental eligibility and benefits. Could you please help me with that?
[AGENT][POSITIVE] I'm happy to check on eligibility and benefits. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, so,
[CUSTOMER][NEUTRAL] Yeah, one second, I'll provide you with the policy number. It's 02574652.
[AGENT][NEUTRAL] Thank you. And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Patient's name.
[CUSTOMER][NEUTRAL] Yeah, oh
[CUSTOMER][NEUTRAL] Yeah, patient's name, it's uh [PII] and the date of birth [PII].
[AGENT][POSITIVE] Thank you so much. So the patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] And can I get the deductibles and uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And early max of the patient?
[AGENT][NEUTRAL] So the calendar year max for the patient is 1500.
[AGENT][NEUTRAL] Calendar year deductible is 50 per covered up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can I get the two basic and major coincidence?
[AGENT][NEUTRAL] Preventative is covered at 100% of UCR. Basic is at 80% of UCR.
[AGENT][NEUTRAL] And majors at 40.
[CUSTOMER][NEUTRAL] OK. And can I get the group name and the group number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Group name is Universal Trucking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Group number is 14564.
[CUSTOMER][NEUTRAL] OK. And the patient is a policyholder, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and uh is there an issue on the file that affects the frequency?
[AGENT][NEUTRAL] Uh, let me see one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh uh just one second, ma'am. Coming to the fee schedule, what will be the fee schedule for this?
[AGENT][NEUTRAL] Uh, this plan pays by UCR fee schedule.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No history on file for the patient.
[CUSTOMER][NEUTRAL] OK. Just confirm it's 6104 and 7953 is a covered benefit?
[AGENT][NEUTRAL] I'm sorry, repeat that one more time.
[CUSTOMER][NEUTRAL] Yes, 6104 and 7953.
[AGENT][NEUTRAL] Let me check on that. One moment, please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] 610
[AGENT][NEGATIVE] Do not show 6104 listed, therefore, it would not be covered.
[CUSTOMER][NEUTRAL] OK. And is there any missing two clause?
[AGENT][NEUTRAL] Uh, let me check one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] This policy does have a missing tooth clause, yes.
[CUSTOMER][NEUTRAL] OK. And is there any waiting period for this, ma'am?
[AGENT][NEUTRAL] Uh, waiting period applies to major endoperio and oral surgery, which is 12 months.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Yeah. Uh so I have provided 02574652. It's the correct member ID, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. So, can I get your name, ma'am, and could you spell that?
[AGENT][NEUTRAL] My name is [PII], that is spelled [PII].
[CUSTOMER][NEUTRAL] OK, that's it, ma'am. I'm done with this patient. So last but not least, so is there any other coverage for this plan?
[AGENT][NEGATIVE] No ortho coverage on this plan.
[CUSTOMER][POSITIVE] OK. Thank you. That's it, ma'am. I'm done with this question, so thanks for assisting me. Have a nice day. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.