AccountId: 011433970860
ContactId: c0b53ada-6e04-4932-9f91-1d1eae8b1990
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326589 ms
Total Talk Time (AGENT): 92147 ms
Total Talk Time (CUSTOMER): 119405 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c0b53ada-6e04-4932-9f91-1d1eae8b1990_20250211T18:38_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yes ma'am, um, I was calling from the dental office. I'm trying to get a a benefit breakdown for a patient.
[AGENT][POSITIVE] I'll be happy to assist with benefits today. May I have your first name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And let you see if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02569305
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], I don't know Townsend 092292.
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guaranteed payment. I do show the policy is currently active. Effective date is [PII], excuse me, [PII], and would be needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Um, I can get that too, and I'm sorry, can I get your first name and reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And can you confirm if we're in network?
[AGENT][NEUTRAL] OK, with this policy there is no network patient can see any provider they choose.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] What is the fee schedule you follow?
[AGENT][NEUTRAL] UCR.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] User and customary UCR.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] ECR OK.
[CUSTOMER][NEUTRAL] And what is the plan maximums and deductibles?
[AGENT][NEUTRAL] Tell me your max is $1500 deductible is $50.
[CUSTOMER][NEUTRAL] Has anything been met?
[AGENT][NEUTRAL] He hasn't used anything so far this year.
[CUSTOMER][POSITIVE] OK, perfect. Is there Orthoax?
[AGENT][NEGATIVE] No, there's no or coverage at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Missing tooth cloth.
[AGENT][NEUTRAL] Yes, there is a missing two clause.
[CUSTOMER][NEUTRAL] OK, is diagnostic and preventative covered at 100% and does the deductible apply?
[AGENT][NEUTRAL] Um, yes, it's covered at 100 and it does not apply to the deductible.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Uh, basic restorative like fillings, what is that covered at?
[AGENT][NEUTRAL] Um, basic is covered at 80.
[CUSTOMER][NEUTRAL] OK, waiting periods?
[AGENT][NEUTRAL] There's only a waiting period on major.
[CUSTOMER][NEUTRAL] OK, what is that, uh, waiting period?
[AGENT][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On major like 2740, what is the coverage?
[AGENT][NEUTRAL] 40% it's covered at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it paid on prep or seat date?
[AGENT][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Prios required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, in the.
[CUSTOMER][NEUTRAL] Like 3310.
[AGENT][NEUTRAL] Um, and all expenses are covered at 40% and it's subject to the waiting period.
[CUSTOMER][NEUTRAL] OK, Pero.
[AGENT][NEUTRAL] Same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm assuming dentures like removable prosthodontics thing.
[AGENT][NEUTRAL] That's the same, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Implant coverage.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about bridge?
[AGENT][NEUTRAL] It's covered but it's under major.
[CUSTOMER][NEUTRAL] Waiting, OK, what about 7 to 10?
[AGENT][NEUTRAL] Coding is has to be faxed over we don't do that on the phone.
[CUSTOMER][NEUTRAL] OK, so oral surgery or extractions?
[AGENT][NEUTRAL] That's considered major and it's covered at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Twing period or so.
[CUSTOMER][NEUTRAL] OK, uh, that is all I need. If you can go ahead and fax that I'd appreciate it. Do you need the fax number?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, you should receive that fax within the next 10 minutes. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it. Thank you so much.
[AGENT][POSITIVE] Thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.