AccountId: 011433970860
ContactId: c3463d28-3cc9-4cb6-8366-8d0321cb7454
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245759 ms
Total Talk Time (AGENT): 110088 ms
Total Talk Time (CUSTOMER): 105468 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/c3463d28-3cc9-4cb6-8366-8d0321cb7454_20250411T19:33_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, yes, honey, um, my name is [PII]. I'm calling from Camp Care Health Corporation. I am trying to get verification on, uh, a patient's insurance, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with the eligibility, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is gonna be 02566046.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The date of birth is going to be [PII].
[CUSTOMER][NEUTRAL] And the name is [PII].
[AGENT][NEUTRAL] You must.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And this is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. OK. We have an effective date of [PII]. It is active at the moment. Do you need any benefit information faxed over to you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yes, um, I was also wondering besides faxing over, can we just get that so this way I would know diagnostic and preventative basic major, any co-pays or deductibles.
[AGENT][NEUTRAL] OK, bear with me just a second, let me pull the benefits on the policy.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. There's no history for [PII]. Um, we have a calendar year maximum of $1500 per cover insured with a $50 deductible, $150 if it's a family plan, and deductible does not apply to preventative expense.
[AGENT][NEUTRAL] Preventative is cover 100%.
[AGENT][NEUTRAL] Radiograph FMXs cover 80%, basic expense and basic restorative expenses cover 80%. There is a 12 month waiting period for any major service, including endodonics, periodonics, postodonic repair, and oral surgery.
[CUSTOMER][NEUTRAL] OK, and can you let me know if we are in contract?
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] There's no network on this one. There's no network. We pay on the usual and customary rates UCR.
[CUSTOMER][NEUTRAL] Or in network.
[CUSTOMER][NEUTRAL] They pay according to the fee schedule, OK, so.
[CUSTOMER][NEUTRAL] I I got my sofa.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, so it's according to the fee schedule?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then you said no, no deductible, um, no copay?
[AGENT][NEUTRAL] Correct. Uh, there is no co-payments. Um, there is a deductible of $50 per insured or $150 per family. No, the deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK, is there a dentist that he can go to that he doesn't have to pay all this? Is there a dentist that he wouldn't have to pay where he would, uh, it would be covered or assigned to?
[AGENT][NEUTRAL] Mm, what do you mean you don't have to pay?
[CUSTOMER][NEUTRAL] OK, so if he has this coverage, does he have a special dentist that he can go to that goes according to the breakdown coverage in network?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, no, he can go, he can go to any dentist. We pay the same thing to any dentist. We don't have a network.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] No. Alright, OK, thank you so much. No.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today for you?
[CUSTOMER][NEUTRAL] Nope, that's all.
[AGENT][POSITIVE] OK, thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] OK.