AccountId: 011433970860
ContactId: 918b4683-0ca6-4479-81b9-c12378283802
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477279 ms
Total Talk Time (AGENT): 222545 ms
Total Talk Time (CUSTOMER): 217680 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/918b4683-0ca6-4479-81b9-c12378283802_20250505T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, my name is Doctor [PII], and um I was calling uh about a [PII], and I was wondering if I can get his um.
[CUSTOMER][NEUTRAL] eligibility and benefits, um.
[AGENT][NEUTRAL] Of course, yeah.
[CUSTOMER][NEUTRAL] OK, uh-huh, OK.
[AGENT][POSITIVE] Yes, I can check eligibility and benefits for you. Um, Doctor [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's area code [PII] mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 025.
[CUSTOMER][NEUTRAL] 682-888
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, um, I'm gonna, I don't think I heard that policy number correctly. I'm so sorry, um, did you say that was 02568288?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what was the member's name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, no, so this, this, um, that number is not listed under this policy. I have somebody completely different, um.
[CUSTOMER][NEUTRAL] is it a female name? Maybe his wife.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, it is a family, uh, but it's a totally different last names as well. It's a
[AGENT][NEUTRAL] To the member, their spouse, and then the dependent. uh, do you maybe have his social? I could search for him that way.
[CUSTOMER][NEUTRAL] OK. Do you want
[CUSTOMER][NEUTRAL] Uh, no, I don't have a.
[CUSTOMER][NEUTRAL] Uh, he just called me up with this number and I'm not at my office. OK, can you, can you use his date of birth?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, I could search, not, not his date of birth, but I can start using his name. Um, so that was [PII], um and the last name was that just [PII]?
[CUSTOMER][NEUTRAL] [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yeah, [PII], uh-huh, yeah.
[AGENT][NEUTRAL] OK and then uh what state uh does this member live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you give me just a moment let me see if I can find him this way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then was this for uh medical or dental?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] It was dental, OK.
[CUSTOMER][NEUTRAL] Mm yeah. Mhm.
[AGENT][NEUTRAL] All right. I think I might have found him. Uh, what was that date of birth, please?
[CUSTOMER][NEUTRAL] Um, date of birth is um [PII].
[AGENT][POSITIVE] Perfect. OK, I did find this number alright um and then I've got that policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, let me see this OK, policy number.
[CUSTOMER][NEUTRAL] Let's see, OK, OK, you go ahead with it.
[AGENT][NEUTRAL] OK, that is 02.
[AGENT][NEUTRAL] 5692.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 88.
[CUSTOMER][NEUTRAL] Wait, 92?
[CUSTOMER][NEUTRAL] 9288 huh?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEGATIVE] It wasn't 8, he, he, he couldn't see good. He said he didn't have his glasses, yeah.
[AGENT][NEUTRAL] We're just a little off, we were just a little off.
[CUSTOMER][NEGATIVE] It was 0.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] OK, so it's 0025.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] 02569288, OK.
[AGENT][NEUTRAL] That is correct, yes, um, OK, and then of course it, it's just a little off, that's OK.
[CUSTOMER][NEUTRAL] He, he was, he was just.
[AGENT][NEUTRAL] Oh, so that effective date the policy is active, um, effective date was [PII], and if you would like, Dr. [PII], I can send you a fax back that shows all of the covered procedures and that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. The one thing about that is I switched over my from Comcast to another uh thing in my office and it didn't, I, I don't have the um.
[CUSTOMER][NEUTRAL] The text, uh, the fax machine hooked up just yet, is that OK? OK, so can you just, can you keep me on the phone real quick if you don't mind, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Email? Oh, no, no, that's for sure, yeah, I can definitely check it over the phone, um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, give me just a moment, of course I will let you know verification of coverage is not a guarantee of payment for claims. um, so in short, uh, this policy does not have a, it's not a network uh plan, it just goes off of UCR, um, so their calendar year maximum is $1500. There is a $50 deductible that does not apply to preventative expenses, um, preventative, uh, is at 100% of UCR.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiographs and basic expenses are at 80% and then all major expenses including uh endodontic, oral surgery, periodontic uh that is all at 40%.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And those uh major expenses you have a waiting period of 12 months. Nothing else does.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Waiting 12 months, waiting, yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 12 months. So this was just active.
[AGENT][NEUTRAL] January
[CUSTOMER][NEUTRAL] Uh, this in January, so.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So major is so major is uh uh is considered a perio, oral surgery, crown and bridge.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I know, I know maybe you can consider the crown and bridges, dentures and stuff like that, right?
[AGENT][NEUTRAL] And the Dante
[AGENT][POSITIVE] We do have that coverage, yes.
[AGENT][NEUTRAL] Crowns and bridges and
[CUSTOMER][NEUTRAL] But you said there's a waiting period.
[AGENT][NEUTRAL] Yes, there is a waiting period for all major expenses.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK, so he, he's not, well, he ain't gonna be able to get none of that done then. And, and basic is a.
[AGENT][NEUTRAL] Oh, is that what he was being seen for?
[CUSTOMER][NEUTRAL] Well, OK. Well, you know.
[CUSTOMER][NEUTRAL] Uh, well, you know, the cleaning everything, the preventive is, you know, we can do the preventive, uh, but, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, fillings, fillings are basic also, right? Basic. Say, say, let me know what the basic is again one more time.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Basic is the 80% um and then if you have those specific procedure codes, Doctor [PII], I can search uh just to make sure um that those are indeed through either basic or major.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, 4341.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4341 is covered under periodontic, so that is at um 40% with that waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the waiting period, OK, what about um.
[CUSTOMER][NEUTRAL] Yeah, OK, what about uh uh 23.
[CUSTOMER][NEUTRAL] 2392.
[AGENT][NEUTRAL] 2392 is at basic, uh, so 80%, no waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then, so, um, a 2751 would be.
[CUSTOMER][NEUTRAL] Major, but let me see what 2751 is, mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 2751 is major, yes, so that 40% and that 12 month waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Mhm. And he has uh.
[CUSTOMER][NEUTRAL] $1500 with a $50 deductible, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, so that's it. Well, OK, that's, that's, that's good.
[AGENT][NEUTRAL] OK, you didn't have any other questions for me?
[CUSTOMER][POSITIVE] Um, no, not really, no, no, you did good you did good, excellent, excellent.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh well thank you. Well thanks for giving us a call, Doctor [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, you too, sweetie. Thank you. Mhm.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.