AccountId: 011433970860
ContactId: b29bf100-89c3-4676-87a8-e15215d91b63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274130 ms
Total Talk Time (AGENT): 69712 ms
Total Talk Time (CUSTOMER): 147362 ms
Interruptions: 0
Overall Sentiment: AGENT=2.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/b29bf100-89c3-4676-87a8-e15215d91b63_20250523T16:00_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], calling on behalf of the dental office to check the eligibility and the benefits for the patient on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify benefits for you, and you said your name is [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes the member ID is 02621212.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and patient's name, date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing an effective date of [PII] of this year. Policy is showing active, and are you needing a general breakdown of benefits or I can send you a fax back.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I have a very specific question for this patient. I believe college students in a calendar year plan with standard coordination of benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And could you please, uh, like, uh, I believe there is nothing has been used and me from the plan maximum and deductible.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the plan maximum is $5500 and individual deductible is $50 and there is no family deductible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] And there is no auto benefit.
[AGENT][NEUTRAL] Correct, uh, the policy doesn't cover any major services.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Not, uh, not Android pay as well.
[AGENT][NEUTRAL] Endopperio oral surgery, all of center major which is not covered under the plan.
[CUSTOMER][MIXED] I can, there is a missing tooth cloth but no waiting period.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the composites are under 80%, it's not downgraded.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Fluoride and ceilings are not covered due to the age limit.
[AGENT][NEUTRAL] There is an age limit, correct.
[CUSTOMER][NEUTRAL] Mhm. And uh so periodic exam is under 100% to 12 months. By doing, it's under 100% once in 12 months, and pro fee is also 100% once in 6 months.
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] And FMX and Pao, they share frequency and it's under 80% and the frequency would be 1 in 5 calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the group name and the group number would be Oxford Global Resources, and the number is 70052.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the payer mailing address would be [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please help me with the history for this patient that might affect the frequency?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, they don't have any history that would affect the frequency.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect. And I believe 9223 and 9310, they are covered services under 80%.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what would be the frequency for 9310? Is there any frequency?
[AGENT][NEGATIVE] There's no frequency.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, I have only 4 codes. I want to know this. I believe these codes are not covered, so can I give all these 4 codes at once?
[AGENT][NEUTRAL] What are the codes?
[CUSTOMER][NEUTRAL] OK. 0367 04317953 and [PII].
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Correct, those codes are not covered under the plan.
[CUSTOMER][POSITIVE] Perfect. And just to be sure, there is no end of end period as well, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. No history. Could you please spell your name for me?
[AGENT][NEUTRAL] Sure, [PII], last initial [PII].
[CUSTOMER][POSITIVE] Thank you. Thank you so much for your help. I'm done with my question. Have a nice day.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. Thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] Thank you, bye.