AccountId: 011433970860
ContactId: af98c099-7551-46b7-85a1-1873ec72cddc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409679 ms
Total Talk Time (AGENT): 215779 ms
Total Talk Time (CUSTOMER): 160787 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/af98c099-7551-46b7-85a1-1873ec72cddc_20250602T16:51_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII] with Doctor [PII]. We're a dental office. I have a patient that, uh, if you would check and I'm not familiar with your insurance, so if you could let me know how we can go about making this work.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so you're needing to get eligibility and benefit information for a member, is that correct, [PII]? OK, yes, ma'am. I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][POSITIVE] Yes, please, very much so.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] The policy number is 2558135.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please, [PII] to get the member's information pulled up, so just one moment please.
[CUSTOMER][NEUTRAL] You bet
[CUSTOMER][NEUTRAL] And you can just go with the.
[AGENT][NEUTRAL] OK. One second, [PII].
[CUSTOMER][POSITIVE] Oh, that's fine I appreciate you looking.
[AGENT][POSITIVE] Yeah, sure, thank you.
[CUSTOMER][NEUTRAL] I have a social if that would help.
[AGENT][NEUTRAL] No, that's OK. I'm gonna be able to locate it with this. It's just taking a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's fine, it's Monday.
[AGENT][POSITIVE] Yes, ma'am. It sure is.
[CUSTOMER][NEUTRAL] It sure is. I know. I don't know about you, but the weekend went by way too fast.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Oh, it seems like I've, I, and it's only 12, right at 120, and I feel like I've already worked 5 days this week.
[CUSTOMER][NEUTRAL] I know, I know.
[CUSTOMER][NEUTRAL] Isn't that something?
[AGENT][NEUTRAL] So that means it's gonna be some kind of week, right?
[CUSTOMER][NEUTRAL] We're only 11 and I feel that way.
[AGENT][NEUTRAL] Oh, OK. So, and too, [PII], while this is loading on our, um, dental policies, we have facts backs of the members' benefits that I can send over to you that will give you.
[CUSTOMER][NEUTRAL] We don't have a fax, so if you would just let me know if he's eligible and I know we're not in network how we can, you know, an address I can send you a claim and that type of thing.
[AGENT][NEUTRAL] Sure, and then just.
[AGENT][NEUTRAL] Uh, OK, so any information that is provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this dental policy and this policy is active, Cathy, with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do not.
[AGENT][NEUTRAL] Have any history on file for him.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] This is not a network plan, so he may choose any provider.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Our mailing address for the claims is going to be [PII].
[AGENT][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Now, on his plan it.
[CUSTOMER][NEUTRAL] Does he have a maximum a deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, on this plan, the calendar year maximum benefit for covered services is $1500.
[CUSTOMER][NEUTRAL] OK OK.
[AGENT][NEUTRAL] And there is a $50 deductible.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And like for for preventive services, is it paid at 50%, 100%, 80%?
[AGENT][NEUTRAL] Preventative is 100% of the UCR of the service region.
[CUSTOMER][NEUTRAL] Now if we were to do a root canal or a crown, is there a waiting period, or can we go ahead and do that?
[AGENT][NEUTRAL] For majors, for major services, there is a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But he's had the insurance for 12 months, right?
[AGENT][NEUTRAL] This policy, no, ma'am, this policy went into effect [PII]. Mhm.
[CUSTOMER][NEUTRAL] Oh, in December, that's right, 24, so we have to wait till December. OK, so major and when, when he is covered, is it at.
[CUSTOMER][NEUTRAL] 50% for a crown.
[AGENT][NEUTRAL] Uh, major services are 40% of the UCR subject to the calendar year, uh, deductible, mhm, and then that.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, OK, and like an extraction, it, it's covered before that's not really I mean it's major, but it's not under that wait period, is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the code? I would have to check the code.
[CUSTOMER][NEUTRAL] Uh let me look here. I don't know right off the top of my head, but I got it right here. Let's see. I like your accent, by the way.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, thank you. It's very Southern.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I, it is, and I love it. I, I like that kind of stuff. D 7140.
[AGENT][NEUTRAL] OK, thank you. Give me just a moment.
[AGENT][NEUTRAL] OK, so that's gonna fall under basic 7140, correct?
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And so that for basic, that is at 80% of UCR subject to the $50 calendar year deductible with no waiting period.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][POSITIVE] OK, perfect. OK, you, you, you've helped me a lot. I appreciate it.
[AGENT][POSITIVE] Well, you are certainly very welcome. And then [PII], I'm gonna go ahead and give you our website for our portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We have a portal that you should be able to check claim status and once the claim has been processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And the website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh. Yes, ma'am.
[CUSTOMER][POSITIVE] Secured OK perfect thank you I appreciate your help. Have a good day.
[AGENT][NEUTRAL] Yes, I am.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. I hope you have a great day too, and if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you mhm bye bye.
[AGENT][NEUTRAL] Bye bye.