AccountId: 011433970860
ContactId: a75434ee-352e-4ce7-9f76-9f76d675df94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 915359 ms
Total Talk Time (AGENT): 303135 ms
Total Talk Time (CUSTOMER): 282409 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/a75434ee-352e-4ce7-9f76-9f76d675df94_20250507T19:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. I'm [PII] calling from provider's office to check on dental eligibility and the benefits, ma'am. Yes, ma'am, and for your information, this call may be monitored for quality and training assistance, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], so you're needing dental eligibility and benefit information, is that correct?
[CUSTOMER][POSITIVE] Yes, ma'am. That's right.
[AGENT][NEUTRAL] Yes, ma'am, and on our dental policies, [PII], we have fax backs of the member's benefits that I will send to you. But first off, what is a good callback number for you please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, ma'am. It's [PII] and it's without extension.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Sure, ma'am. It is 02371145.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure, ma'am.
[AGENT][NEUTRAL] And any information, [PII] that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, I have one on file. It is uh [PII] and the date of birth is [PII], sorry, [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so she had been a dependent on this policy, but this policy is no longer active, [PII]. The policy had an effective date of [PII], and this policy turned on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK, one moment, ma'am.
[AGENT][NEUTRAL] And there is no other policy?
[CUSTOMER][NEUTRAL] So, could you please confirm me the patient?
[CUSTOMER][NEUTRAL] OK. So could you please confirm me the patient was effective on uh uh [PII]. Is that right, ma'am?
[AGENT][NEUTRAL] The policy would have still been active at that time.
[CUSTOMER][NEUTRAL] OK. Got it, ma'am. Thank you. And I'm here to verify the benefits for that particular date only for [PII]. Please help me out for that, ma'am.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] OK, so I'll be happy to send you a fax back of the member's benefits. One moment, please.
[CUSTOMER][NEUTRAL] Yes, sure, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] It takes a moment to load this information, so bear with me just a moment please.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEGATIVE] OK, so I tell you what, because it's going to it's not going to allow me.
[AGENT][NEUTRAL] To send the sheet, I mean to change the coverage status to put the termination date in there, what type of benefit information do you need?
[AGENT][NEUTRAL] Because the facts back is gonna show that the policy is active, normally we would not send benefits for a policy that's not active.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] For a year, because that was over a year ago for that data service.
[CUSTOMER][NEUTRAL] Oh, OK. Understood, ma'am.
[CUSTOMER][NEUTRAL] OK. So, I'll just uh get the information which you are required over here. So, could you please confirm me, ma'am, what is the claim mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And then could you please confirm me like the group name and the group number?
[AGENT][NEUTRAL] The group number had been 70056.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name was Management.
[AGENT][NEUTRAL] Analysis and utilization.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, ma'am.
[CUSTOMER][NEUTRAL] Management analysis.
[CUSTOMER][NEUTRAL] Utilization. Yeah.
[AGENT][NEUTRAL] And utilize management analysis and utilization.
[CUSTOMER][NEUTRAL] OK. And could you please confirm me like uh the uh the subscriber in the plan is [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the date of birth for the Xena will be [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any middle initial or middle name for [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And then for which the middle initial, ma'am?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK. And then, uh, the benefit period runs in a calendar year or the policy year?
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] OK, and then coordination of benefits for that standard or non-duplicate?
[AGENT][NEUTRAL] Standard.
[CUSTOMER][NEUTRAL] OK. And does the patient has a missing too plus and waiting period?
[AGENT][NEUTRAL] I'm sorry, what was the, what was your question? I didn't understand you.
[CUSTOMER][NEUTRAL] Missing tooth loss and waiting period.
[AGENT][NEUTRAL] There is a missing tooth cloth, no waiting period.
[CUSTOMER][NEUTRAL] OK, got it, ma'am. And kindly please confirm me, ma'am, uh what is the plan maximum, demanding maximum with deductibles for individual and then for family.
[AGENT][NEUTRAL] The calendar year maximum benefit was $500 per covered insured with a $50 per calendar year per insured deductible up to $150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy only cover had benefits for preventative and basic expenses. No major services or endoapario covered.
[CUSTOMER][NEGATIVE] Uh nothing.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, got it, ma'am. And also, please confirm me if the patient has any accumulations when the patient was active.
[AGENT][NEUTRAL] No history on file?
[CUSTOMER][NEUTRAL] OK. And does the patient has also coverage?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] As I just explained, only preventative and basic, no major and though none of that is covered. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] OK. And uh yes, ma'am.
[AGENT][NEUTRAL] Or not also.
[CUSTOMER][NEUTRAL] Oh, OK. And could you please confirm me like, uh, exam, the frequency for exams, ma'am?
[AGENT][NEUTRAL] A proceed once every 6 months, oral evaluation 2 for 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For bite wings?
[AGENT][NEUTRAL] Once for 12 months.
[CUSTOMER][NEUTRAL] Uh, prophylaxis?
[AGENT][NEUTRAL] Once every 6 months?
[CUSTOMER][NEUTRAL] OK. So exams, bye wings, and pro it covered under the preventative.
[AGENT][NEUTRAL] You would have to give me the code for me to check.
[CUSTOMER][NEUTRAL] Oh, OK. 0120.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's under, that's under preventative.
[CUSTOMER][NEUTRAL] OK. 0210.
[AGENT][NEGATIVE] It falls under basic.
[CUSTOMER][NEUTRAL] Uh, what is the percentage for basic, ma'am?
[CUSTOMER][NEUTRAL] With the frequency.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's at 80% of the allowable, subject to the $50 calendar year deductible.
[AGENT][NEUTRAL] And that again, I've already given you the, yes ma'am and I have given you the frequency. One X-ray procedure for 5 year, on this one for FMX it's limited to one X-ray procedure for 5-year period.
[CUSTOMER][NEUTRAL] for now.
[CUSTOMER][NEUTRAL] OK. So for 0330 panoramics also 80% once in five years.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, ma'am. And then 0274, is it 100%?
[AGENT][NEUTRAL] That does fall under preventative and the limitation on this one.
[AGENT][NEUTRAL] It's limited to one bite wing X-ray procedure, that's 0270, 0272, or 0274 per twelve-month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 1110, we discussed the frequency, ma'am, just if it is covered at basic or uh preventative.
[AGENT][NEUTRAL] Preventative. That's preventative.
[CUSTOMER][NEUTRAL] OK. Fluoride 1206.
[AGENT][NEGATIVE] I don't like, I don't think that's covered. One moment.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEGATIVE] Not covered. It's uh 1208 against you right, not covered.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Se length
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] Oh, OK. 1351.
[AGENT][NEUTRAL] That falls under preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's maximum 1 procedure for [PII], age limited to dependent children under the age of [PII] and applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] Age limit
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Got it, ma'am. [PII].
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Basic restorative.
[CUSTOMER][NEUTRAL] Is there any downgrades?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK. Uh 4910.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh,
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] Basic.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Falls under basic.
[CUSTOMER][NEUTRAL] No frequency?
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] There is no limitation listed on that?
[CUSTOMER][NEUTRAL] OK. 9223?
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] And the last will be like 9944.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, one more code, ma'am. 7240, oral surgery.
[CUSTOMER][POSITIVE] Sorry for that.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] OK. Thank you, ma'am. And could you please confirm me, is there any claim on file for the those?
[AGENT][NEGATIVE] As I explained, there's no history on file. As I explained, there's no history on file.
[CUSTOMER][NEUTRAL] Uh, [PII] of
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Got it, ma'am. Thank you very much. I, uh, could you please spell me your name for the documentary purpose?
[AGENT][NEUTRAL] [PII] I you will use my name as as well for your call reference number and if you do file this claim with APL once the claim has been processed, we do have a portal for you to check claim status in and the website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Got it, ma'am. Thank you very much, ma'am. And also one last thing, ma'am. The termination date is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you, ma'am.
[AGENT][POSITIVE] You're welcome and.
[CUSTOMER][POSITIVE] Thank you very much for your assistance, ma'am, and have a wonderful night.
[AGENT][POSITIVE] You're welcome, [PII]. So if that is all I can help you with, thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Bye-bye, ma'am. Have a great day.
[AGENT][POSITIVE] You too. Thank