AccountId: 011433970860
ContactId: c2a1471c-4d14-4c7f-bbec-0a59c125429a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306109 ms
Total Talk Time (AGENT): 182390 ms
Total Talk Time (CUSTOMER): 112022 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c2a1471c-4d14-4c7f-bbec-0a59c125429a_20250305T20:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I need to verify dental eligibility and benefits.
[AGENT][POSITIVE] Alrighty, [PII], I'll be glad to help you. Go ahead and give me a good policy number, please.
[CUSTOMER][NEUTRAL] I have 02564202.
[AGENT][NEUTRAL] 202. OK, [PII], thank you for that information. Now, while I'm pulling this up, go ahead and give me a good return telephone card number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thanks so much for all that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] Patient's name is gonna be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for that, [PII]. It looks like [PII] is the insured on this dental plan. I do show the original effective date as [PII]. Patient is active and current, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want the backup benefit. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, well, I need to, uh, I need a breakdown, then I'll break down.
[AGENT][POSITIVE] OK, we do a backpack of benefits.
[CUSTOMER][NEUTRAL] OK, so you don't over the over the phone.
[AGENT][POSITIVE] I can give you verbal, um, just the, the, the general benefits I can give you verbal, but the fact like of benefit is gonna tell you every code covered, how it is covered, you should have it in just a couple of minutes as well, so we can do both.
[CUSTOMER][NEUTRAL] history that history for cleaning and then these just eligibility like remaining and just put it here yeah just put it in.
[AGENT][NEUTRAL] What's your good fax number, [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, let me get that pulled up right quick. Let's see.
[AGENT][NEUTRAL] All right, [PII], like I said, I'm gonna get your back started and then, oh, [PII], I'm so sorry, [PII], I'm sitting here calling you [PII]. OK, [PII], let me get that corrected. Thank you for that. All right, let's see.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Mhm. No worries.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Alright, while your fax is on the way, I'll go ahead and give you the general benefits. Uh, this policy has a $500 max benefit payable per calendar year.
[AGENT][NEUTRAL] Now what that includes 500, mhm.
[CUSTOMER][NEUTRAL] $500? Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what that includes is your preventative.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Paid at 100%.
[AGENT][NEGATIVE] No deductible.
[CUSTOMER][NEUTRAL] But I
[AGENT][NEUTRAL] And then your basic benefit has a $50 deductible, then payable at 80% up to the $500 max benefit payable per calendar year. They do not have any major coverage here at all, and they are in a PPO network, which will be the only thing that will not be on that fax back.
[AGENT][NEUTRAL] And they are in the Carrington PPO network, [PII].
[CUSTOMER][NEUTRAL] OK, so no major coverage, OK.
[AGENT][NEGATIVE] No major coverage that is correct and every procedure code that is covered will be on that fax back of benefit and if the procedure code is not on this fax, it is not covered here at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's not in the fax it's not covered, OK, and they'll tell me the frequencies and everything in the fax, OK, and um.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] I don't know if that will be there um are product sections covered?
[AGENT][NEUTRAL] Oh, what cupboard?
[CUSTOMER][NEUTRAL] Prior extractions.
[AGENT][NEUTRAL] Uh, every code that is covered is on that back to back.
[CUSTOMER][NEUTRAL] Oh, OK. Does oral surgery, do we bill it under the dental or medical?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It's not gonna be covered here at all.
[CUSTOMER][NEUTRAL] Oh, not covered, OK.
[AGENT][NEGATIVE] No, ma'am, they have no major coverage. Yeah.
[CUSTOMER][POSITIVE] OK, OK, so that's government. OK, perfect. OK, OK, so then, um, and I did give you the fax number, right? The [PII]. OK, perfect. OK, OK, thank you so much.
[AGENT][NEUTRAL] All right. Yes, ma'am. Was that all I can help you with?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, it's on the way as well.
[AGENT][POSITIVE] OK, well, you're so welcome. Is that all I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Yes, thank you so much.
[AGENT][POSITIVE] All right. Yes, ma'am, and thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, you too, thank you.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.