AccountId: 011433970860
ContactId: beb1ddf5-83f3-439e-a959-a52148f4f6ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384140 ms
Total Talk Time (AGENT): 150320 ms
Total Talk Time (CUSTOMER): 128378 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/beb1ddf5-83f3-439e-a959-a52148f4f6ad_20250516T16:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, yes, my name is [PII]. I'm calling to verify a patient's dental eligibility and benefits.
[AGENT][NEUTRAL] All right, [PII]. Happy to verify benefits. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Um, let me see here.
[CUSTOMER][NEUTRAL] Sorry, I thought I had it in front of me, but um.
[AGENT][POSITIVE] No, no worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I don't think this is right they have his ID number as 88.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Or maybe 887 5 um.
[AGENT][NEUTRAL] Mm, it seems like a group number.
[CUSTOMER][NEUTRAL] Sorry, I didn't realize how it looked until now.
[AGENT][NEUTRAL] That's OK. That seems like a group number maybe or.
[CUSTOMER][NEUTRAL] That's what I was thinking too.
[AGENT][NEUTRAL] Hm, do you have their name or social? We can check with that.
[CUSTOMER][NEUTRAL] Um, I do have his name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII] and um I have his date of birth as well if you need that.
[AGENT][NEUTRAL] OK. And last name is [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] It's the first name [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And then [PII], what do you have for the date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] All right. Patient does have an active plan. Do you want this policy number?
[CUSTOMER][POSITIVE] Yes, that would be great, thank you.
[AGENT][NEUTRAL] Yeah, not a problem. Uh, policy number is gonna be 9, excuse me, 994864.
[AGENT][NEUTRAL] And the effective date on here is um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then I'm happy to give you uh verbally a breakdown of whatever you need. We can also send a fax back, whatever works best for you.
[CUSTOMER][NEUTRAL] Sure, yeah, um, I'll just do a verbal breakdown, um, if that's OK.
[AGENT][NEUTRAL] Yeah, absolutely. So it looks like the calendar year max for the patient is gonna be $1500. They do have a calendar year deductible of $50 and it looks like it's up to $150 for the family.
[AGENT][NEUTRAL] Let me see what they use.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh sorry, uh, can you tell me if he's used or met any of his max or deductible?
[AGENT][NEUTRAL] Uh, looks like the patient has the deductible in the full amount remaining for the year.
[CUSTOMER][POSITIVE] OK, sounds good thank you.
[AGENT][NEUTRAL] Not a problem. And then did you just need um percentages and waiting periods?
[CUSTOMER][NEUTRAL] Uh yes, if you don't mind.
[AGENT][NEUTRAL] OK, so it looks like preventative is covered at 100% of UCR.
[AGENT][NEUTRAL] Uh, looks like they have basic FMX.
[AGENT][NEUTRAL] And basic restorative is covered at 80%.
[CUSTOMER][NEUTRAL] OK, you said FMX does fall under basic also?
[AGENT][NEUTRAL] Mhm. At 80%, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it looks like major expenses are covered at 40. This will include endo perio oral surgery expenses as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's a 12 month waiting period for any major.
[CUSTOMER][NEUTRAL] And is there any waiting periods for basic or just for major?
[AGENT][NEUTRAL] Just for major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, can you tell me what, um, his group number and group name is if there is one?
[AGENT][POSITIVE] Yeah, absolutely, let's take a look.
[AGENT][NEUTRAL] All right, so the group name is Universal Trucking.
[AGENT][NEUTRAL] And then the group number is 15844.
[CUSTOMER][NEUTRAL] OK, let me just double check and make sure we don't have this plan here already.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] OK, oh, actually no, we don't have this exact plan. It doesn't look like, um, so see if there's anything else I'm missing here.
[CUSTOMER][NEUTRAL] And did you say if implants are covered service on this plan?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEGATIVE] It looks like they are not covered. Orthodontic treatment's not covered either.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, so implants and no ortho either.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, um, let's see here and um.
[CUSTOMER][NEUTRAL] Is this um a calendar year plan or is this a policy your plan?
[AGENT][NEUTRAL] It looks like it's a calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, um, I think that is actually all that I need for her, uh, for her, sorry, for him, um, but I appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Not a problem. Have a good rest of your day, [PII].
[CUSTOMER][POSITIVE] Alrighty thank you you too.
[AGENT][NEUTRAL] Bye-bye.