AccountId: 011433970860
ContactId: 971ad2fc-4e23-4572-a0d1-b642385e3a5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353290 ms
Total Talk Time (AGENT): 189552 ms
Total Talk Time (CUSTOMER): 79504 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/971ad2fc-4e23-4572-a0d1-b642385e3a5e_20250619T13:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um yeah, I was just calling about benefits for a patient.
[AGENT][NEUTRAL] OK. Did you say you were needing benefits for a patient? Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. Do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Um, both.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02494913
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Thank you, and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII], um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and this is on a dental policy that you're needing this information, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so again, any information provided would be a verification of benefits and not a guarantee of payment. I do show that she is the spouse of the subscriber and yes ma'am, this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] And [PII], for our dental policies, we do have facts facts of the members' benefits that I'll be happy to send to you that has all of that information on there for their covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it pretty detailed or?
[AGENT][POSITIVE] It's very detailed. Anything not on the fact that is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And there is also no history on file for her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you need my fax number?
[AGENT][NEUTRAL] And what is, I do, yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment for me to get that fax back pulled up, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And will it need to be put to your attention camera or is that not necessary?
[CUSTOMER][NEUTRAL] Um, it's not necessary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm just gonna repeat your fax um number again to make sure that I heard you correctly. So that was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that has just been sent to you, so provided there's not any type of technical issue, you should be receiving that very soon and also [PII], if you all end up filing a claim with us for her once the claim has been processed by APO we do have a portal in which you should be able to check her claim status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And the website that you would go to for that is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, do you accept electronic claims?
[AGENT][NEUTRAL] Yes, and the payer ID is on the fax back as well, along with our claims mailing address and claims fax number, but I can give it to you verbally if you want that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, whenever you're so it'll have like the title of where we're sending the claims like as far as how to put this insurance in and all that, OK, and are is there a waiting period at all on this plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct. Yes, ma'am. Uh.
[AGENT][NEUTRAL] 12 months for major endoperontic, prosthodontic, or oral surgery covered services.
[CUSTOMER][NEUTRAL] And that's almost been met it looks like.
[AGENT][NEUTRAL] Correct. This policy again went into effect on [PII].
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEUTRAL] There is, and that all of that information is also on the fact that.
[CUSTOMER][POSITIVE] Is it? OK, that would be great. OK, well if I have any other questions after I get it, I'll give you a call.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am yes.
[AGENT][NEUTRAL] Yes, ma'am. Actually, everything that you just asked me is on page one of the fact that, and then the rest of it lists out the different procedure codes and the categories along with limitations.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That are covered.
[CUSTOMER][NEUTRAL] And if it's not on there it's not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] All right. Well, is there any, yes, and you're very welcome. Can I help you with anything else, [PII]?
[CUSTOMER][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope you have a great day.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.