AccountId: 011433970860
ContactId: 99516595-423c-4b08-b97c-a2256df3ff9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314420 ms
Total Talk Time (AGENT): 125788 ms
Total Talk Time (CUSTOMER): 119617 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/99516595-423c-4b08-b97c-a2256df3ff9e_20250514T15:40_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office. I need dental benefit details.
[AGENT][NEUTRAL] OK, I can verify benefits for you, [PII] and what is the policy number, please?
[CUSTOMER][NEUTRAL] Sure. The number is 02558130.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh yeah, sure. I have the contact number and the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're needing benefits, um, if you like, do you, are you needing benefits verbally or I can send you a fax back?
[CUSTOMER][NEUTRAL] Uh, I need facts. And also I have some specific questions for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, shall we proceed for the questions?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Shall we proceed for the questions?
[AGENT][NEUTRAL] Yes, what questions do you have?
[CUSTOMER][POSITIVE] Uh, thank you for giving the opportunity and the treating provider, Doctor [PII].
[CUSTOMER][NEUTRAL] [PII] is in-network or out of network participation?
[AGENT][NEUTRAL] We don't have a network.
[CUSTOMER][NEUTRAL] OK. And uh what are the annual maximum benefits for this patient?
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification coverage. The patient has a benefit max up to $1500 per calendar year, and there is a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] And so from $1500 only $50 has been used, right?
[AGENT][NEUTRAL] No, as I stated, they have a $50 deductible that applies to everything but but preventative. I didn't say that they have met their deductible.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Yeah, I got the answer. And there is any deductibles for family?
[AGENT][NEUTRAL] A $150 deductible for family.
[CUSTOMER][NEUTRAL] OK. And anything just from $1500?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Anything made or anything has been used for $1500.
[AGENT][NEUTRAL] No, she hasn't used her benefit nor met her deductible for the year.
[CUSTOMER][NEUTRAL] OK. And could you please verify me the coinsurance percentage for preventive basic and major?
[AGENT][NEUTRAL] Uh, the UCR amount for preventive is 100% UCR. Basic, basic restorative FMX panoramic is 80, and for major services which would include endo perio and oral surgery, pays at 40%.
[CUSTOMER][NEUTRAL] Thank you very much, ma'am. And yeah, uh, could you please verify me percentage and the frequency for two codes?
[AGENT][NEUTRAL] I'm sorry, say it again.
[CUSTOMER][NEUTRAL] Uh, could you please verify me the insurance percentage and frequency for codes?
[AGENT][NEUTRAL] How many codes are you needing to verify?
[CUSTOMER][NEUTRAL] Uh, I just need two codes.
[AGENT][NEUTRAL] OK, what are the codes?
[CUSTOMER][NEUTRAL] Yeah, uh, the first code is 4341 and the last code is 4999.
[AGENT][NEUTRAL] What is the 4999 code for?
[CUSTOMER][NEUTRAL] Uh, that's a dental code.
[AGENT][NEUTRAL] Uh, and see if it's covered. One moment.
[AGENT][NEUTRAL] Uh, the 4999 is not covered under the policy. The 4341 major is once every 24 months.
[CUSTOMER][POSITIVE] OK, thank you very much. And can we perform all 4 drinks on the same day for treatment?
[AGENT][NEUTRAL] I'm sorry, can you do what?
[CUSTOMER][NEUTRAL] Can you perform all quadrants on the same day for treatment?
[AGENT][NEUTRAL] All 4 can be done on the same day.
[CUSTOMER][NEUTRAL] Yeah, and what is the replacement cost for the crown?
[AGENT][NEUTRAL] Uh, crowns are once every 7 years.
[CUSTOMER][NEUTRAL] OK, thank you very much, ma'am. And yeah, could you please fax back the benefit details of this patient to me?
[AGENT][NEUTRAL] Sure. What is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, that's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah. Yes.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, yeah, uh, last but not least, could you please tell me your name and your card reference number for this patient?
[AGENT][NEUTRAL] Uh, you may use my name in today's date. It's call reference. Name is spelled [PII], last initial [PII]
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you very much for providing information and you have a great day. Bye for now, stay for the day.
[AGENT][POSITIVE] You too. Thanks for calling APL. Bye.