AccountId: 011433970860
ContactId: b45a7fc1-5498-4efd-9b4c-20c85d8fe06d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671099 ms
Total Talk Time (AGENT): 220230 ms
Total Talk Time (CUSTOMER): 157980 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/b45a7fc1-5498-4efd-9b4c-20c85d8fe06d_20250521T20:12_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] Yeah, hi, this is [PII] calling from Market Dental, and I'm here to verify eligibility of the patient. So could you please help me with this?
[AGENT][NEUTRAL] I'm, I'm very sorry. I'm very sorry, your voice is fading in and out. I wasn't able to understand what you were saying.
[CUSTOMER][NEUTRAL] I'm [PII] calling from Markiy Dental. I'm here to verify eligibility benefits of the patient. So could you please help me with this?
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits on a dental policy, is that correct?
[CUSTOMER][NEUTRAL] This a
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And [PII], for our dental policies, we have facts backs of the benefits that I will send to you.
[AGENT][NEUTRAL] But first off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That is [PII]. No extension is the direct line.
[AGENT][NEUTRAL] OK, the phone number again is [PII], and then what is the rest of it?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, I'm going to repeat that. I think [PII].
[AGENT][NEUTRAL] Thank you and the patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] It is 614903.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], and date of birth is [PII] is the date of birth.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this policy and yes ma'am, it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] [PII]. OK, just reconfirming if it is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] OK, and [PII], what is a good fax number that I can send his benefit information to?
[CUSTOMER][NEUTRAL] Yeah, if I need, uh, are you able to go with the verbal because I, if I need it, uh, I don't need all details. I need it, I'll go with the fax. Please go with the direct an annual max of this call.
[CUSTOMER][NEUTRAL] This patient
[AGENT][NEUTRAL] You're only needing the annual maximum and deductible, is that correct?
[CUSTOMER][NEUTRAL] No, I need uh com uh minimum details, not a complete breakdown.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so the calendar year maximum is $11,000 for covered services for covered person.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] With a $50 calendar year deductible per cover person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about the question of preventative basic and major?
[AGENT][NEUTRAL] This plan pays specific dollar amounts for certain services.
[AGENT][NEUTRAL] And the benefit amount?
[CUSTOMER][NEUTRAL] the co-pay plan?
[AGENT][NEGATIVE] No, ma'am, it is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Uh, what information do you need? Again, it provides specific benefit amounts for covered services.
[CUSTOMER][NEUTRAL] I need
[CUSTOMER][NEUTRAL] I need questions of preventative basic and major.
[AGENT][NEUTRAL] Preventative
[AGENT][NEUTRAL] There's no coinsurance.
[CUSTOMER][NEUTRAL] OK. Are are covered in 100%?
[AGENT][NEUTRAL] Again, this plan, this plan pays specific dollar amounts for certain covered codes.
[CUSTOMER][NEUTRAL] OK. What about the group number?
[AGENT][NEUTRAL] The group number, there is no group number for this policy.
[CUSTOMER][NEUTRAL] OK. And the patient is subscriber dependent for this plan.
[AGENT][NEUTRAL] He is the subscriber.
[CUSTOMER][NEUTRAL] And orthodontic scar for this patient?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Orthodontics cover for this patient?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're saying for this plan or this patient only?
[AGENT][NEGATIVE] This plan that this member has does not have benefits for Orthod.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I go with the, uh, can I go with the course? I need the history which one affect the frequency limitations.
[AGENT][NEUTRAL] How many codes do you have for this number [PII]?
[CUSTOMER][NEUTRAL] I, I have some uh particular quotes and I need the history which is the frequency limitation.
[AGENT][NEUTRAL] Yes, ma'am. How many?
[CUSTOMER][NEUTRAL] Nearly 10 cos.
[AGENT][NEUTRAL] How many?
[AGENT][NEUTRAL] What is your first code?
[CUSTOMER][NEUTRAL] 0120
[AGENT][NEUTRAL] Data service
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I need percentage also. Give me the percentage also for the sports.
[AGENT][NEUTRAL] I'm sorry, give you what?
[CUSTOMER][NEUTRAL] Percentage is a 100% or not confirming that one.
[AGENT][NEUTRAL] That would fall under preventative and the benefit amount on this policy, it again, it's not percentages, it has specific benefit amounts for specific codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2160
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2160.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] I'm sorry, what was that code again?
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] 8:30 of 23.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] Did you say 2950?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 8:30, 23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEUTRAL] No history?
[CUSTOMER][NEUTRAL] 112
[AGENT][NEUTRAL] I'm sorry, your voice cut out. What was the last code?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] That one is 1110, a prophylaxis.
[AGENT][NEUTRAL] 5 22 24.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] 5 22 2024.
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] No history?
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] Did you say 4910?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] No history?
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 1206.
[AGENT][NEUTRAL] 52224.
[CUSTOMER][NEUTRAL] OK. 2391.
[AGENT][NEUTRAL] 1213 2018.
[CUSTOMER][POSITIVE] Thank you so much. That's it from my end. Give me the reference number for this call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you would use my name that I gave you along with today's date and [PII], if you all end up filing a claim for this member with APO once the claim has been processed, we do have a portal in which you can check claim status and the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And please spell your name for me.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much and have a great day bye bye.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL if that is all I can help you with. I hope you have a nice day as well.
[CUSTOMER][POSITIVE] Thank you.