AccountId: 011433970860
ContactId: c07ca22a-05be-4b92-baf6-3b7e5177ea54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449019 ms
Total Talk Time (AGENT): 164380 ms
Total Talk Time (CUSTOMER): 63206 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/c07ca22a-05be-4b92-baf6-3b7e5177ea54_20250502T18:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I was calling to confirm um eligibility and get a breakdown of benefits.
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits. And may I have your name?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, 021-73353.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh last name is um [PII] Birthday is [PII].
[AGENT][NEUTRAL] What's the first name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. You need this information given to you verbally or faxed over to you, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, can you do verbal and fax just because they're here now.
[AGENT][NEUTRAL] Um, yes, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] We have an effective date of [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you need a full breakdown of benefits?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, OK, so for this one we have a calendar year maximum of $1500 with the $50 deductible, $150 per family if you say you can. The deductible does not apply to preventatives.
[AGENT][NEUTRAL] Prevent that cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%.
[AGENT][NEUTRAL] Basic expense and basic restorative expenses cover 80%.
[AGENT][NEUTRAL] Major service including endoonics, periodontics, prostatic repair, and oral surgery, they're all 40% after the 12 month waiting period, which this one is already out of the waiting period.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then we have um frequencies. For the frequencies we have cleanings once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12.
[AGENT][NEUTRAL] By wings is one for 12 month period.
[AGENT][NEUTRAL] For my X-rays and panels are once every 5 years.
[AGENT][NEUTRAL] Crowns and bridges is once every 7 years per tooth. Partial and dentures are once every 5 years, and the policy does have a missing tooth cloth, orthodontics, and implants are not covered.
[CUSTOMER][NEUTRAL] OK perfect and did you say oral surgery was basic or major?
[AGENT][NEUTRAL] Major.
[AGENT][NEUTRAL] Which is 40%.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, and is there fluoride coverage?
[AGENT][NEUTRAL] It does have an age limitation on the fluoride. So we have um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so maximum of 1 procedure for 12 months, it is going to be limited to dependent children under the age of [PII].
[CUSTOMER][POSITIVE] OK perfect and then can I just get your name one more time?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK perfect I think that was you said waiting period they've already met.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, it's already been on the waiting period. Um, do you need the fax to be sent out to you, Miss [PII]?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK. May I have the fax number?
[CUSTOMER][NEUTRAL] 254-870.
[CUSTOMER][NEUTRAL] 9886.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. OK, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.