AccountId: 011433970860
ContactId: 910a636d-f635-49d9-af1c-695addb3f135
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313459 ms
Total Talk Time (AGENT): 113428 ms
Total Talk Time (CUSTOMER): 119405 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/910a636d-f635-49d9-af1c-695addb3f135_20250527T20:27_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. Good afternoon. My name is [PII] calling on behalf of a dental provider to check benefits for a patient. Please help me with that.
[AGENT][POSITIVE] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient name and or the policy number of the patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 02564938
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, so uh policies effective 11-11-2024.
[AGENT][NEUTRAL] Um, I can send over a fax back that outlines everything covered under the policy, including all codes.
[AGENT][NEUTRAL] Do you have a fax number I can send that to, or is there something we need to go over on the phone?
[CUSTOMER][NEUTRAL] Uh, or on the phone actually, uh, if you can provide me the group number, group name for the plan.
[AGENT][NEUTRAL] My group number is
[CUSTOMER][NEUTRAL] 51 John farm 5463 2014 Texas 75126.
[AGENT][NEUTRAL] Number 70087.
[AGENT][NEUTRAL] Group name is Partners Personnel Management Services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And uh what is the uh maximum deductible and used to benefit out of it?
[AGENT][NEUTRAL] Not a guarantee of payment basic outline of the policy calendar year maximum is 500.
[AGENT][NEUTRAL] Deductible is 50, which applies to radiographs, FMX basics and basic restorative.
[AGENT][NEUTRAL] And they have used
[AGENT][NEUTRAL] Haven't used anything for [PII] yet.
[CUSTOMER][NEGATIVE] Nothing use, nothing that, OK. Waiting period applies for any service?
[CUSTOMER][NEUTRAL] No waiting period and do we have coverage for orthodontics on this plan?
[AGENT][NEUTRAL] There's no waiting period.
[AGENT][NEGATIVE] No, there's no coverage for Ortho.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Not the contacts not covered. OK, got it. And how about uh the history for this patient?
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Uh, they had a cleaning and exam on [PII].
[CUSTOMER][NEUTRAL] Cleaning exam, OK.
[AGENT][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] Any x-rays by doing several next panel.
[AGENT][NEUTRAL] No, none of that.
[CUSTOMER][NEUTRAL] And for fluoride and sealants, is this patient eligible or we have age limit?
[AGENT][NEUTRAL] Over age limit.
[CUSTOMER][NEUTRAL] OK, over the age, got it. And the co-insurances on the plan for preventive basic measure.
[AGENT][NEUTRAL] Uh, the co-insurance is 80%. We pay 80% for FMX, X-rays, and basic restorative.
[AGENT][NEUTRAL] And then they pay 20%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Another preventive is 100% exam profy.
[AGENT][NEUTRAL] Examine profies.
[CUSTOMER][NEUTRAL] Chloride sealants.
[AGENT][POSITIVE] Yes, correct. 100%.
[CUSTOMER][NEUTRAL] OK. And other basic services?
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] So the only basic services they have would be for fillings.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, oral surgery code 7140.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEGATIVE] There's no coverage for or there's no coverage.
[CUSTOMER][NEUTRAL] OK. Everything else not covered?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK. So endoperio.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] And major services, they are not covered. OK.
[AGENT][NEUTRAL] Not covered, correct.
[CUSTOMER][NEUTRAL] Got it. Thank you, [PII]. And now what are the claim's mailing address?
[AGENT][NEUTRAL] mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do we have a
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, got it. And your name is spelled, spelled [PII]?
[AGENT][NEUTRAL] That's [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And the reference number for our conversation will be?
[AGENT][NEUTRAL] A reference number is my name and today's date.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much for your help, [PII]. Hope you have a wonderful day. Bye, take care.
[AGENT][POSITIVE] Thanks for calling APL you as well. Bye bye.