AccountId: 011433970860
ContactId: 90c7a636-4322-45e1-916c-d9b26307b449
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219100 ms
Total Talk Time (AGENT): 114756 ms
Total Talk Time (CUSTOMER): 79788 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/90c7a636-4322-45e1-916c-d9b26307b449_20250326T12:52_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Uh yes, this is [PII]. I'm calling um to get benefits on a patient.
[AGENT][NEUTRAL] OK, is this for service in the doctor's office?
[CUSTOMER][NEUTRAL] Yes, and dental.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Dental OK and what's the policy number [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 603-008.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Would you like the, um, schedule of benefits faxed to you?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] And that number, fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So I'm showing an effective date of [PII]. Uh, this policy is active at this time.
[AGENT][NEUTRAL] And on the schedule of benefits, um, it will include the calendar year maximum and deductible information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the percentage, um, level of coverage, the common limitations and exclusions, uh, frequencies, um, it will list the claims mailing address, payer ID number, and fax number, um, as well as each code that's covered under this policy, and it's gonna be about 6 pages including the cover page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] And let me see if they have any history.
[CUSTOMER][NEUTRAL] OK, do you think I will receive it quickly?
[AGENT][POSITIVE] Yes, you should receive it within the next 2 to 5 within the next 2 to 5 minutes. I'm preparing it now.
[CUSTOMER][POSITIVE] And yeah I do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and we are out of network. Does that matter? I mean, is it, it's just like a fee schedule?
[AGENT][NEUTRAL] Um, actually, under this policy it pays a certain benefit amount per procedure code and that'll be listed on the schedule of, um, the fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is on its way.
[CUSTOMER][POSITIVE] Perfect all right.
[AGENT][NEUTRAL] And any other questions you wanna ask?
[CUSTOMER][NEUTRAL] Well, can you give me just a general breakdown real quick, like maximum deductible?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. So the calendar year maximum is $1000 per covered person with a $50 deductible. Um, this is an individual policy, um, the deductible will apply to basic services and major services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what were the percentages for?
[AGENT][NEUTRAL] It's not paid by percentage. It pays a certain benefit amount, a dollar amount for each code.
[CUSTOMER][NEUTRAL] Preventative basic and.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, and that's what you're faxing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. It'll be on the schedule.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK perfect alright well I will just wait for the fax.
[AGENT][POSITIVE] OK, it is on its way. I just sent it and you should be receiving it here shortly. Anything else?
[CUSTOMER][POSITIVE] All right appreciate it that's it thank you.
[AGENT][POSITIVE] Alright, alright, [PII], thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.