AccountId: 011433970860
ContactId: a19de3b7-830b-4103-9cdb-7818d1ab33f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228240 ms
Total Talk Time (AGENT): 78716 ms
Total Talk Time (CUSTOMER): 92419 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/a19de3b7-830b-4103-9cdb-7818d1ab33f4_20250212T19:41_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] I was trying to get a breakdown of benefits for my patients.
[AGENT][POSITIVE] I'd be happy to assist with benefits. May I have your first name please?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] And [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] [PII] I'm sorry [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Mm, is that on the policy number is 02584555.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active.
[AGENT][NEUTRAL] Effective date is [PII] and were you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Can I get both, uh, verbal and fax?
[AGENT][NEUTRAL] Now, verbally, we don't do the coding and frequencies, but everything else can be faxed over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, everything else can be done verbally.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Don't take a fax.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] What's that fax number?
[CUSTOMER][NEUTRAL] Can you tell me the fee schedule? Oh sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, it's UCR.
[CUSTOMER][NEUTRAL] UCR OK.
[AGENT][NEUTRAL] You should receive that fax in the next 5 to 7 minutes.
[CUSTOMER][NEUTRAL] OK, do you show that we're in network?
[AGENT][NEUTRAL] We don't have a network patient can see any provider they choose.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can I just ask you a few questions that usually aren't on the paper, and you can tell me if it's on the paper? Is there a waiting period or missing two calls?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] For this policy, there is no waiting period and yes there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK, post your composites are those downgraded to the amalgams.
[AGENT][NEUTRAL] We don't do downgrades.
[CUSTOMER][NEUTRAL] No, OK, same thing for crowns.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, is it 18,050?
[AGENT][NEUTRAL] Oh, let me back up. This policy doesn't cover for crown. It doesn't cover for any major services.
[CUSTOMER][NEUTRAL] Oh, no major, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So is it 180 then 100 for 100 preventative and 80 for basic.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] How about endoperio oral surgery?
[AGENT][NEGATIVE] That's considered major, it's not covered.
[CUSTOMER][NEUTRAL] OK, is this a calendar year then?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, does the profiR frequency with apparent maintenance?
[CUSTOMER][NEUTRAL] Parent maintenances and covers that considered.
[AGENT][NEGATIVE] That's not covered.
[AGENT][NEGATIVE] Yeah, that's not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I'm assuming only fillings are covered covered under this plan.
[AGENT][NEUTRAL] Yes, only preventative and basic services.
[CUSTOMER][POSITIVE] OK, alright, and uh I guess I'll read everything else if I need any more help I'll call you back.
[AGENT][NEUTRAL] OK, now if you don't see a code on the fax that means it's not covered.
[CUSTOMER][NEUTRAL] OK, no code on fax.
[CUSTOMER][NEUTRAL] Not covered all right, thank you so much.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] No ma'am, that's it.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you too.
[AGENT][NEUTRAL] Bye-bye.