AccountId: 011433970860
ContactId: aca76e42-3a4c-45ee-9ac3-ebc7f04838c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198740 ms
Total Talk Time (AGENT): 92019 ms
Total Talk Time (CUSTOMER): 51919 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/aca76e42-3a4c-45ee-9ac3-ebc7f04838c2_20250106T14:58_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling from provider's office just trying to make sure a patient is still active for dental benefits.
[AGENT][POSITIVE] OK, yeah, I can definitely help you with some eligibility today, my friend, and give me just one moment.
[AGENT][NEUTRAL] And may I have your name and a good callback number, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Perfect. Thank you so much, Ms. [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. And what's that member's policy number?
[CUSTOMER][NEUTRAL] It's 603-011.
[AGENT][NEUTRAL] And your insured's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Yes, uh, [PII] is current and active on this plan with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, and she still has $1000 deductible?
[AGENT][POSITIVE] Um, that is an excellent question. Give me one moment to pull that up for you.
[AGENT][NEUTRAL] She has, it looks like her benefits are $1000 and her deductible is $50.
[CUSTOMER][NEUTRAL] OK, and um do y'all accept assignment of benefits even though we're out of network?
[AGENT][NEUTRAL] Uh, this policy doesn't have a network, so we will accept, we'll send benefits, and I do wanna let you know like any benefit information we give you over the phone is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I just have um 3 questions. Implants, are they covered?
[AGENT][NEUTRAL] Um, I, unfortunately don't know, uh, that procedure code. I don't know any of them off the top of my head. Would you mind giving me a procedure code and I can look at it for you?
[CUSTOMER][NEUTRAL] Yeah, it's 6 to 10.
[AGENT][NEUTRAL] 6010. I don't see that as a covered code on this, um, policy. I'm sorry.
[CUSTOMER][NEUTRAL] OK, and what about 9944?
[AGENT][NEUTRAL] 9944.
[AGENT][NEUTRAL] No, I'm sorry, I don't see that one either. Um, but 9944 is also the same as 9940, right? The acousal card.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Yeah, but we bill out 9944 so if it's not covered.
[AGENT][NEUTRAL] OK, if you, OK, no, it's not, but the 9940 is, so.
[CUSTOMER][NEUTRAL] OK, let me just make a note 0.
[CUSTOMER][NEUTRAL] Um, and do y'all pay crowns on seat date or prep date?
[AGENT][NEUTRAL] Um, either or, we don't have a, we don't have anything.
[CUSTOMER][NEUTRAL] OK, and no waiting periods?
[AGENT][NEUTRAL] No, they've hit over 12 months and over 3 years they've had our policy for 20 years. They're
[CUSTOMER][POSITIVE] OK, alright, that's what I needed to know, thank you so much.
[AGENT][POSITIVE] Totally good.
[AGENT][POSITIVE] My pleasure. Thank you.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][NEUTRAL] You too bye bye.