AccountId: 011433970860
ContactId: a2ef08f8-8a2f-4db6-833e-88526efcc529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285450 ms
Total Talk Time (AGENT): 175447 ms
Total Talk Time (CUSTOMER): 100794 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/a2ef08f8-8a2f-4db6-833e-88526efcc529_20250610T17:48_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm calling for eligibility for one of our patients.
[AGENT][NEUTRAL] OK, [PII], you're calling for eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes, that is for dental.
[AGENT][POSITIVE] OK, and [PII], for our dental policies, we have fax facts of the member's benefits that I'll be happy to send to you. Uh, first off, what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And will you spell your first name for me to make sure I have it correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] So I don't know if I have the right number, but I have um 01663555.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I'm calling for [PII], is spelled [PII], and the date of birth is, one second.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, this policy number that you gave me is an old supplemental medical policy that's no longer active. This policy was active from [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And they do have another supplemental policy that is active under a different number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That policy number is 01896475.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[AGENT][NEUTRAL] Now, again, this is a supplemental policy to their primary health care insurance. It is not a dental policy.
[CUSTOMER][NEUTRAL] OK, so would.
[AGENT][NEUTRAL] Is this for routine dental? I mean, is this, uh, I'm gonna pull up the policy information too, because under their exclusion section.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a second.
[AGENT][NEUTRAL] On this policy, dental or vision services, including treatment, surgery, extractions, or X-rays are excluded unless it is resulting from an accident occur occurring while the covered person's coverage is in force and if performed within 12 months of the date of such accident or it's due to a congenital disease or anomaly of a covered newborn child.
[CUSTOMER][NEUTRAL] Mm, so no, this will not be this OK, yeah, yeah, I know, I know that, but I know some dental coverage or some medical coverage also have dental, dental on it also, um, so for instance this would not cover um a code 292392 for fillings.
[AGENT][NEGATIVE] No, this is not dental coverage.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, so.
[AGENT][NEGATIVE] If it's for, no, ma'am, it would not.
[CUSTOMER][NEUTRAL] OK, well then I don't need any further information from you then, um, because that was what it was gonna be for.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] Oh, yes, ma'am. So that is, you're very welcome. So is that's all then that I could help you with. Thank you again for calling APL and I hope that you have a wonderful afternoon.
[CUSTOMER][POSITIVE] All right I appreciate your help.
[CUSTOMER][NEUTRAL] But I just have a couple more questions. So I just have a couple more questions. I just wanna make sure because this person do come for routine cleanings and so forth. So will it cover routine cleaning or what you're telling me is not cover routine. It was accidental.
[AGENT][NEUTRAL] OK, sure. Mhm.
[AGENT][NEGATIVE] That's not covered.
[AGENT][NEUTRAL] Correct. It would only
[CUSTOMER][NEUTRAL] Um, it, it, it's an accident. Mhm.
[AGENT][NEUTRAL] Correct. It would only, dental and vision services are excluded from this policy except if it's resulting from an accident occurring while they've been
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the coverage has been enforced and performed in within 12 months of the date of such accident or a congenital anomaly. Anything else is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Excellent. Alright, thank you so much, [PII]. I appreciate your help and I hope you have a great day.
[AGENT][POSITIVE] Of course, I hope you have a great day, [PII]. So that is all I can help you with. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes bye bye.
[AGENT][POSITIVE] Thank you, bye bye.