AccountId: 011433970860
ContactId: 9efac580-a856-4919-a31d-c3f1942b3f9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375549 ms
Total Talk Time (AGENT): 131581 ms
Total Talk Time (CUSTOMER): 142099 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/9efac580-a856-4919-a31d-c3f1942b3f9b_20250110T21:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling on behalf of the dental office to check the eligibility and benefit for a member on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] And the UV date on this thing.
[CUSTOMER][NEUTRAL] Um, policy number is 02554265.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised a verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for, um, I'm sorry, were you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It would be great if you help me with the benefit of the call and just to make sure what kind of plan it is for the member.
[AGENT][NEUTRAL] Um, this is a dental plan?
[AGENT][NEUTRAL] I don't, I, I don't think I understand the question. I'm sorry.
[CUSTOMER][NEUTRAL] Potential plan, but
[CUSTOMER][NEUTRAL] Under dental plan there are various uh type of plan right like PPO, Medicare, Medicaid, HMO. So what kind of plan it is.
[AGENT][NEUTRAL] Um, it's commercial, it's a commercial dental plan. It's not affiliated with um.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, and, and what about the network status for the provider? Will the provider be in network out of network?
[AGENT][NEUTRAL] Um, there is no network so the patient can see any provider they choose.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and is the member the subscriber?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] What about the group name?
[AGENT][NEUTRAL] Group name is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Lark
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Knock
[AGENT][NEUTRAL] L A R K Lark L L C.
[CUSTOMER][NEUTRAL] OK, and the group number?
[AGENT][NEUTRAL] Group is 70083.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 70083. And is it a family plan or a single coverage?
[AGENT][POSITIVE] This is simple.
[CUSTOMER][NEUTRAL] Singular, right?
[CUSTOMER][NEUTRAL] OK. What about the claim mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] And that's in [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. But
[CUSTOMER][POSITIVE] Amazing. What about the deductible and the max on this plan?
[AGENT][NEUTRAL] Maximum is $500 per calendar year, deductible is $50.
[CUSTOMER][NEGATIVE] Deductive applies to with services.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Deductible only apply, well, there are no major services and the deductible only applies to the basic.
[CUSTOMER][NEUTRAL] No major services you're saying? OK. And is orthodontic service covered?
[AGENT][NEUTRAL] major services.
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Is orthodontic service covered?
[AGENT][NEUTRAL] No, I'm sorry, no major services.
[CUSTOMER][NEUTRAL] Orthodontic.
[AGENT][NEUTRAL] Ortho is considered major, so no, it's not covered. I'm sorry.
[CUSTOMER][NEUTRAL] OK. What about preventative and basic?
[AGENT][NEUTRAL] Yes, preventative is covered at 100%. Basic is covered at 80%.
[CUSTOMER][NEUTRAL] The coverage?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What about endontic, periodontic, and oral surgery?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[AGENT][NEGATIVE] That's considered major, it would not be covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Any waiting period or missing tooth loss?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Um, there is no waiting period and there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK, just to make it sure, endo PO all all three and the major right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what.
[AGENT][NEUTRAL] Simple extraction is covered.
[AGENT][NEUTRAL] Um, and what was the other one you asked?
[AGENT][NEUTRAL] Um, that I would have to fax over the coding, um, but I believe that is not covered, but I'd have to fax over the coding for you.
[AGENT][NEUTRAL] But Pero is considered major.
[AGENT][NEUTRAL] Coding is not given verbally. We have to fax that over to you.
[AGENT][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] You should receive that fax in the next 10 minutes.
[AGENT][NEUTRAL] Um, frequency for preventative.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] That will be once every 6 months.
[AGENT][NEUTRAL] I'm sorry?