AccountId: 011433970860
ContactId: 9bc0e0c8-3fed-4cb6-b77f-996dc09d1033
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 816479 ms
Total Talk Time (AGENT): 202896 ms
Total Talk Time (CUSTOMER): 170483 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/9bc0e0c8-3fed-4cb6-b77f-996dc09d1033_20250114T20:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, good morning. Uh, good afternoon. This is [PII] speaking and I'm calling for checking some dental information for the patient, please.
[AGENT][NEUTRAL] What information are you needing today, Mr. [PII]?
[CUSTOMER][NEUTRAL] So I'm calling for checking the liability and benefits and dental benefits for the patient. Mhm.
[AGENT][NEUTRAL] What is your name?
[AGENT][POSITIVE] OK, sure, I can assist you with eligibility and benefits for dental. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It's gonna be.
[CUSTOMER][NEUTRAL] I have the Social Security number. That's fine?
[AGENT][NEUTRAL] Um, bear with me. I'll have to use another system, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead with the social.
[AGENT][NEUTRAL] Mr. [PII], go ahead with the social.
[CUSTOMER][NEUTRAL] Yeah, sure. It's gonna be [PII].
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] It's gonna be [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. All right, and you need the information, um, the benefit information given to you verbally or faxed over to you or you have a specific questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So first of all, I have some specific question.
[AGENT][NEUTRAL] OK, go ahead with your questions.
[CUSTOMER][NEUTRAL] It's gonna be regarding today. It's gonna be for dental. First of all, I wanna know what is the effective today for this policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, effective date is [PII] and it is active at the moment.
[CUSTOMER][POSITIVE] Pa is happy, right?
[AGENT][POSITIVE] Um, correct.
[CUSTOMER][NEUTRAL] OK. Can you provide me what is the annual maximum for the dental side? The annual maximum?
[AGENT][NEUTRAL] OK, let me see how much is this 11 moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, the calendar year maximum is $500 with a $50 deductible, and this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] OK. You say 500, right?
[AGENT][POSITIVE] 500, yes, correct.
[CUSTOMER][NEUTRAL] 500. Nothing has been met.
[AGENT][NEUTRAL] Not as of today it started all over again on [PII] of this year.
[CUSTOMER][NEUTRAL] I'm so sorry. I can't, I can't hear you. Say that again.
[AGENT][NEUTRAL] And the benefits started all over again in [PII], on [PII], so they have not used their benefits as of today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, can you repeat what is the individual deductible for this policy?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] 50.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, is there any history on file for this patient or no history at all?
[AGENT][NEUTRAL] Let me check and see if there's any. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no history at all.
[CUSTOMER][NEUTRAL] OK, sir. So regarding to flu right 1208, is there any age limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me check. And you said it was fluoride?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] put the breakdown of benefits one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like it's gonna be limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] [PII], so it's main patient is not, is not eligible for that one.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So no history at all. OK. So regarding to the car insurance, regarding to the car insurance, can you provide me what is the car insurance for preventative by services?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, this one for preventative we cover 100%.
[AGENT][NEUTRAL] Radiograph FMX Discover at 80.
[AGENT][NEUTRAL] Basic expense and basic restorative expense is 80%.
[AGENT][NEUTRAL] So the member is responsible for 20% of radiograph FMX basic expense and basic restorative. Um, with this policy, there's no major service. So endodontics, periodontics, prosthodontic repair and neurosurgery are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any waiting period?
[AGENT][NEGATIVE] Not with this one.
[CUSTOMER][NEUTRAL] And do you set assignment of benefits, right?
[AGENT][NEUTRAL] We do.
[CUSTOMER][NEUTRAL] OK. May I know what is the group number and the, and the group name for this policy?
[AGENT][NEUTRAL] OK, let me get that for you.
[AGENT][NEUTRAL] Group number is 70056. Again, that's 70056. The group name is MAU.
[CUSTOMER][NEUTRAL] You say M as in Mary, A as in Alpha, U as in umbrella, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] 49.
[CUSTOMER][NEUTRAL] No, may your services. OK. So now I would like to know if you can send me a fax for creating the new breakdown. That's fine.
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] The fax number is gonna be 972-871.
[CUSTOMER][NEUTRAL] 9802.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To your attention.
[AGENT][NEUTRAL] Is it gonna be to your attention, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes. So about, can you repeat your name again, please?
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII], last initial [PII], and Mr. [PII], can you hold for me while I send this fax over to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Good, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you should be there in a few minutes. Is there anything else I'm gonna help you with today, Mr. [PII]?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Well, yes, so I, yeah, I'm here. So the last question is gonna be regarding to, to calls. It's gonna be for SRP and maintenance.
[CUSTOMER][NEUTRAL] Are those costs covered under this policy? 43, 41, and 4019?
[AGENT][NEGATIVE] Pero is not covered. No, they're not covered. No. Mm mm.
[CUSTOMER][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 4, 49 is not covered as well, right?
[AGENT][NEUTRAL] Correct, it's not covered.
[CUSTOMER][NEUTRAL] OK. Preventative service all are covered under this policy, right?
[AGENT][NEUTRAL] Preventative, yeah, but regular preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No periods.
[CUSTOMER][NEUTRAL] OK. So now the last question is gonna be regarding to the reference number for the call.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK. That's all right now. Thank you so much for providing me that information. Have a good day in the car. Bye-bye.
[AGENT][POSITIVE] Yes ma'am. Thank you for calling APR. Have a good day. Bye-bye, Mr. [PII].
[CUSTOMER][POSITIVE] OK thank you bye bye thank you bye.
[AGENT][NEUTRAL] Mm