AccountId: 011433970860
ContactId: bc9f1e1b-e83a-42cd-87ab-737311cc3b66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299720 ms
Total Talk Time (AGENT): 93183 ms
Total Talk Time (CUSTOMER): 77680 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/bc9f1e1b-e83a-42cd-87ab-737311cc3b66_20250415T13:55_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey this is [PII]. I just wanted to um.
[CUSTOMER][NEUTRAL] Check on some eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, so I have 023-39005.
[AGENT][NEUTRAL] OK, thank you. And patient name and date of birth?
[CUSTOMER][NEUTRAL] So, um, the patient's name is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] All right
[AGENT][NEUTRAL] OK, and you're needing eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Looks like he's effective [PII].
[AGENT][NEUTRAL] Uh, policy is current.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Um, for the benefits, I can send a fax back, um, or we can, you can get information on the phone or both.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Yeah, if I could just ask you a few questions I'm able to maybe be able to get the benefits over the phone, um, what's his his deductible?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so let's see, he's got.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy. Um, so the calendar year maximum is 1500, um, deductible is applicable to, um,
[AGENT][NEUTRAL] Radiographs.
[AGENT][NEUTRAL] Well, actually, let's see this is.
[AGENT][NEUTRAL] Yeah, looks like radiographs, which includes FMX, basic, basic restorative.
[AGENT][NEUTRAL] Uh, major and that deductible is $50.
[AGENT][NEUTRAL] Calendar year
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if you could just give me the basic um percentages on for diagnostic major basic.
[AGENT][NEUTRAL] Uh, preventative services pay 100%, no deductible.
[AGENT][NEUTRAL] Um, radiographs, FMX, basic, basic restorative.
[AGENT][NEUTRAL] And that pays 80% after that $50 deductible.
[AGENT][NEUTRAL] And then major services which include Edo Perio, Prosthodontic, that pays 40%, same deductible. There is a 12-month waiting period for major services.
[CUSTOMER][NEUTRAL] OK, but that's been that correct?
[AGENT][NEUTRAL] It has, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] Does he have any history on code D0210?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] What's the
[AGENT][NEUTRAL] I don't show any history.
[CUSTOMER][NEUTRAL] OK, what about D0330?
[AGENT][NEUTRAL] Uh, I don't show any history on that either.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] I think that and he hasn't used any of his um benefits for the year.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] No, he's not.
[CUSTOMER][POSITIVE] All right, thank you so much for all your help.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.