AccountId: 011433970860
ContactId: 987b444c-93ea-4e67-a5d5-8e326ca7e5ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 675320 ms
Total Talk Time (AGENT): 165538 ms
Total Talk Time (CUSTOMER): 101328 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/987b444c-93ea-4e67-a5d5-8e326ca7e5ec_20250331T15:53_UTC.wav
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[CUSTOMER][NEUTRAL] If you know
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I need to check, uh, eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Page [PII].
[AGENT][NEUTRAL] Do you have the policy number page?
[CUSTOMER][NEUTRAL] 01899832
[AGENT][NEUTRAL] And what's the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] She.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, just a basic outline of the policy. I showed he's active and effective [PII].
[AGENT][NEUTRAL] And this is a
[CUSTOMER][NEUTRAL] OK, do they have a group number? Oh sorry.
[AGENT][NEUTRAL] Uh yes, group number is.
[AGENT][NEUTRAL] 19205.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I can send you a fax back of the benefits. This was for dental, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is there any way I can get it over the phone?
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Yeah, absolutely. Let me pull it up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So their appointments today, so.
[AGENT][POSITIVE] Oh, no, no worries.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] So for this plan, they have a $1500 calendar year maximum benefit.
[CUSTOMER][NEUTRAL] You said 1000?
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] OK, have they used any of that?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Let's see uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] So you can.
[AGENT][NEGATIVE] Uh, don't show he's used anything.
[CUSTOMER][NEUTRAL] OK, uh, does he have a deductible?
[AGENT][NEUTRAL] There is a deductible for basic and major services, which is $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what's the fee schedule?
[AGENT][NEUTRAL] Um, so it looks like.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] Uh, it's just based on UCR, so it just it it will pay 100% for preventative.
[AGENT][NEUTRAL] 80 for basic.
[AGENT][NEUTRAL] And then major expenses, 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and you said it was UCR?
[AGENT][POSITIVE] Yes, based on what's reasonable and customary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I need to look up a few codes.
[AGENT][NEUTRAL] Um, so it's, it's gonna pay what it doesn't have like a dollar amount, it's just gonna pay what's reasonable and cust like the ADA schedule of what's reasonable and customary.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So what services are they having?
[CUSTOMER][NEUTRAL] Um, so they're coming in for wisdom teeth.
[AGENT][NEUTRAL] OK, so oral surgery?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that will fall under major.
[AGENT][NEUTRAL] It's only gonna pay 40% up to that maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for a simple extraction, is it major too, or is that one basic?
[AGENT][NEUTRAL] Um, let's see that one.
[AGENT][NEUTRAL] OK just a moment.
[AGENT][POSITIVE] Yeah, that one's gonna be major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] What about 9222?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Is that like um for anesthesia or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Uh, that will also fall under major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is the anesthesia criteria?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] I don't see a uh criteria listed um it just gives the code and that it's covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, would have been a panoramic X-ray?
[AGENT][NEUTRAL] Uh, pano will be.
[AGENT][NEUTRAL] Um, it's limited to one per 5 year period.
[AGENT][NEUTRAL] And that's gonna be under.
[AGENT][NEUTRAL] Uh, it looks like that's actually under basic, so it pays 80% after that $50 deductible.
[CUSTOMER][NEUTRAL] OK, have they used or or do they have any history with that?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, I don't show anything on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what about 0140?
[AGENT][NEUTRAL] Is that an exam or the queen? I can't remember which one that is.
[CUSTOMER][NEUTRAL] Exam.
[AGENT][NEUTRAL] Uh, it's a preventative service, 100%.
[CUSTOMER][NEUTRAL] What's the frequency?
[AGENT][NEUTRAL] Uh, frequency is.
[AGENT][NEUTRAL] Uh, limited to 2 in a 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] 0150, it's, it's another exam.
[AGENT][NEUTRAL] It's the same frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, 9310 consultation.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, I don't show a frequency on that. It is covered under the basic benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can I get a reference number?
[AGENT][NEUTRAL] Uh, reference number is my first name, [PII], last initial [PII] as [PII], and then today's date. Is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] No ma'am, that was it.
[AGENT][POSITIVE] OK, well thanks thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Right