AccountId: 011433970860
ContactId: a018d5d0-59f8-460a-b915-78c8c47df06e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436470 ms
Total Talk Time (AGENT): 157083 ms
Total Talk Time (CUSTOMER): 113982 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/a018d5d0-59f8-460a-b915-78c8c47df06e_20250625T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello, good afternoon. I'm calling from a dental provider office, and I was already, we, we had already requested a fax, but we still haven't received for benefits for a patient that's here in office.
[AGENT][NEUTRAL] Oh, OK, alright, can I get your name and the name of the provider's office you're calling from and the phone number?
[CUSTOMER][NEUTRAL] Yes, no problem, and my name is [PII].
[CUSTOMER][NEUTRAL] And the provider's name is [PII].
[CUSTOMER][NEUTRAL] And the phone number to our office is [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It would be the policy number 026257.
[CUSTOMER][NEUTRAL] 68 and the date of birth would be [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, and it's for [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I just sent that um to let me see who I sent it to.
[AGENT][NEUTRAL] Give me just a minute um.
[AGENT][NEUTRAL] It is, I sent it to [PII].
[CUSTOMER][POSITIVE] Yes ma'am no we still have it.
[AGENT][NEUTRAL] I still haven't got it. OK, let me send it again while we're on the phone together.
[CUSTOMER][NEUTRAL] Is there a possibility that I can get a benefit breakdown over the phone?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me look and see what their benefit is for the calendar.
[AGENT][POSITIVE] Yeah and I can give that to you.
[AGENT][NEUTRAL] OK, and this is just to verify his benefits. It's not a guarantee of payment. He has a calendar year maximum of $750 with a $50 co-pay and the copay is still left to pay and the benefit amount is still full. It's still $750.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I understand ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any waiting period?
[AGENT][NEUTRAL] Uh, no, ma'am. He does not have a waiting period. This is just a preventative and basic policy.
[CUSTOMER][NEUTRAL] I understand no major coverage correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, for the extractions, would those fall under basic or major?
[AGENT][NEUTRAL] What is the um code?
[CUSTOMER][NEUTRAL] It would be 37,140 and the 7210.
[AGENT][NEUTRAL] 7140.
[AGENT][NEUTRAL] It's considered basic.
[CUSTOMER][NEUTRAL] Also 7111 ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we have [PII].
[AGENT][NEUTRAL] Uh, that's considered basic. Uh, [PII] is also considered basic.
[AGENT][NEUTRAL] And of course you know this is to verify the benefits it's not a guarantee of payment, um, and then you said there was one other code you gave me.
[CUSTOMER][NEUTRAL] yeah, OK.
[CUSTOMER][NEUTRAL] pocket
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] 7210. Let me look and see if I can find that one.
[CUSTOMER][NEUTRAL] Um, well, when he.
[AGENT][NEGATIVE] I do not have a 7210 on the fax back, so therefore, it's not covered.
[CUSTOMER][NEUTRAL] I understand ma'am no coverage and for the sea lens 1351.
[AGENT][NEUTRAL] May.
[AGENT][NEUTRAL] It's considered preventative.
[CUSTOMER][NEUTRAL] Mm, is there any limitations on the age or the teeth covered?
[AGENT][NEUTRAL] Yes, um, it's a maximum of 1 procedure per 36 months, limited dependent children under the age of [PII].
[AGENT][NEUTRAL] And there's one more, let me look at it.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] Understood ma'am and.
[CUSTOMER][NEUTRAL] At least that was just my question and then for the just to confirm the endo.
[CUSTOMER][NEUTRAL] Would fall under major as well correct?
[AGENT][NEUTRAL] Uh, what is the code?
[CUSTOMER][NEUTRAL] 3310.
[AGENT][NEUTRAL] Let me see if it's on here.
[AGENT][NEUTRAL] Uh, that is a non-covered procedure on this policy.
[CUSTOMER][POSITIVE] Understood ma'am those would just be my questions for this patient. Thank you so much for your help and just a reference number please.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, you can use my name [PII] Y.
[AGENT][NEUTRAL] In today's state.
[CUSTOMER][POSITIVE] Understood Mr. [PII], thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day. Is that everything I can help you with?
[CUSTOMER][POSITIVE] Yes, so that would be everything thank you so much, ma'am.
[AGENT][POSITIVE] OK, you take care. Thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you you too miss bye bye.