AccountId: 011433970860
ContactId: c1c897f5-15b2-4482-983c-a1c48cff5267
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 544039 ms
Total Talk Time (AGENT): 139575 ms
Total Talk Time (CUSTOMER): 221434 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/c1c897f5-15b2-4482-983c-a1c48cff5267_20250106T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I'm calling from a dental office in [PII], and I've got a patient here, um, that I need to get a breakdown for.
[AGENT][NEUTRAL] I'm sure [PII] and I can fax over benefits to you. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] sorry the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, can I get the policy number, please?
[CUSTOMER][NEUTRAL] It is 301-401-481.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, I can look them up by the social.
[CUSTOMER][NEUTRAL] Oh, you know what?
[AGENT][NEUTRAL] Do you have that.
[CUSTOMER][NEUTRAL] That's probably what's wrong. They, there's a different number in here and I don't know where this one came from.
[CUSTOMER][NEUTRAL] Um, let me change in the system here.
[CUSTOMER][NEUTRAL] Try uh policy number 025.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 64774.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I found them in our system and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on the policy was [PII] and the policy is still active. And what's your fax number?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And is there a way I can get a verbal breakdown? He's already here in office and our, I don't trust our facts. Sometimes it takes a while, and his appointment is in about 6 minutes.
[AGENT][NEUTRAL] I'm sure. One moment, let me pull up his benefits.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also wanna make sure providers in that work.
[AGENT][NEUTRAL] OK, actually, we work with our providers. There's no network.
[CUSTOMER][NEUTRAL] OK, oh OK.
[CUSTOMER][POSITIVE] Good to know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this a um is this a calendar year or?
[AGENT][NEUTRAL] Yes ma'am, it's a, it's a calendar year policy and let's see we cover up to.
[CUSTOMER][NEUTRAL] Policy? OK.
[AGENT][NEUTRAL] We cover up to $500 per calendar year, um, and there is a $50 deductible that needs to be met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First.
[CUSTOMER][NEUTRAL] Has anything been used?
[AGENT][NEUTRAL] And it's
[AGENT][NEGATIVE] Um, so far, nothing's been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the deductible, of course, haven't been met yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there a missing tooth clause on this plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, there is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is it standard coordination of benefits?
[AGENT][NEUTRAL] Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see, the deductible apply to diagnostic and preventive, or?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and then in our diagnostic and preventive covered at 100%?
[CUSTOMER][POSITIVE] I like their
[AGENT][NEUTRAL] The preventative is covered at 100%.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And radiographs, the basics and basic restoratives, they're covered at 80% and no waiting period.
[CUSTOMER][NEUTRAL] OK, so a periodic exam, that's 80%?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then all X-rays, um, full mouth X-rays, bite wings, all those.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and then let's see, can you tell me the frequency for 0120?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] take it out
[CUSTOMER][NEUTRAL] Not surprise drive like.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][POSITIVE] Do you mind to run back to huddle to hear if there's anything we need so we can thank you.
[AGENT][NEUTRAL] OK, that's covered at 100% under preventative.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah go on.
[CUSTOMER][NEUTRAL] Alright and then the frequency?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Pull and medical insurances for this.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] One every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um full mouth X-rays 0210.
[AGENT][NEUTRAL] 1 every 5 years.
[CUSTOMER][NEUTRAL] OK, and I'm assuming patients eligible since it just became active in November. OK, and then, uh, by wings 0274 and that was at 80% correct?
[AGENT][POSITIVE] That's correct. Mhm.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Use it all X-rays, OK, um, for 0274.
[AGENT][NEUTRAL] By playing
[AGENT][NEUTRAL] One every year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then does pano share frequency with FMX?
[AGENT][POSITIVE] Yes, ma'am, it does.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] And you said deductible fine.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Is it once every 6 months for pro fee 111 10?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] Alright, and then it fluoride covered on this plan 1206?
[CUSTOMER][NEUTRAL] Yeah and another.
[AGENT][NEUTRAL] Yes, ma'am. That's covered on the preventative. Yes, it's covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how often?
[AGENT][NEUTRAL] One every 6 months.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Alright, and then you mentioned basic was covered at 80%, um, for is that for 23.93 posterior composite?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, ma'am, those are included.
[CUSTOMER][NEUTRAL] OK, and then you said no waiting periods, um, is that the, uh, composite, uh, downgraded or covered?
[AGENT][NEUTRAL] It's covered.
[CUSTOMER][NEUTRAL] And then is there any major coverage on the policy?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, ma'am. I'm not showing any.
[CUSTOMER][NEUTRAL] OK, any other procedures like oral surgery or anything that might count as basic and anything like that?
[AGENT][NEUTRAL] Um, no, ma'am. I'm only showing basic, restorative and preventative.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Awesome OK well thank you so much for your help I greatly appreciate it.
[AGENT][NEUTRAL] OK, and would you still like a fax? Yes.
[CUSTOMER][POSITIVE] And then yes I would love that thank you.
[AGENT][NEUTRAL] OK. And again, the fax number is [PII]. Attention [PII].
[CUSTOMER][NEUTRAL] That's correct, yes, and then I'm sorry, I didn't get your name at the beginning.
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that's it thank you so much I appreciate you.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Hm, thank you.