AccountId: 011433970860
ContactId: c41720f6-b17d-4d7b-befb-1cebe0311510
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240800 ms
Total Talk Time (AGENT): 150233 ms
Total Talk Time (CUSTOMER): 59356 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/c41720f6-b17d-4d7b-befb-1cebe0311510_20250213T13:10_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], I need to get a um breakdown of dental benefits, please.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have your name and a callback number and that policy number?
[CUSTOMER][NEUTRAL] Uh, name is [PII]. Call back is [PII] and ID number is 60801.
[AGENT][NEUTRAL] Mm mm that sounds like the group number it should be listed on the card, should say policy or certain number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] Can you look it up by.
[AGENT][NEUTRAL] Do you have their social? Mhm.
[CUSTOMER][NEUTRAL] Social?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] What is this member's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 242-478-0. It's 242-4780.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active. Calling to verify benefits eligibility, she has a maximum benefit amount of $1500 per calendar year with a $50 deductible. [PII] that does not apply to preventative services, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[AGENT][NEUTRAL] She has no history on file, nor has she utilized any of her benefits for [PII] or metal deductible. And I can send you a dental schedule of her breakdown by fax if you would like.
[CUSTOMER][NEUTRAL] Yeah, that would be great. um, is this a PPO plan?
[AGENT][NEUTRAL] This policy is not a PPO or HMO it's just an open policy insurance. It's an open insurance policy due to [PII] being a truck driver, meaning she can go wherever she desires to go.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the assignment of benefits, as long as the assignment of benefits are signed, then the payment would definitely go to the provider.
[CUSTOMER][NEUTRAL] OK, so no fee scheduled then because you're not.
[AGENT][NEUTRAL] No, it's based on a user and customary like preventative at 100, basic 80, major 40.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 180. OK, um, are you ready for the fax?
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So I have [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So let me give you a description of the schedule, so it's gonna have the patient's information, policy number, effective date, calendar year max deductible, the category of expenses, the covered expense by um the percentage, the waiting period, 12 month waiting period exhausted.
[AGENT][NEUTRAL] So everything is available for her all services um it's gonna have the frequencies, it's gonna have information to submit a claim.
[AGENT][NEUTRAL] Oh, it's gonna have a procedure codes, the description of the procedure codes, and then it's gonna have the limitation column. There's gonna be alphabets in parentheses, and on the very last page, there's a box with those letters in parentheses showing the meaning of each limitation. I just like to break down the schedule cause a lot of not, I don't want nobody to be confused when they leave off the phone with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK, uh thank you.
[AGENT][NEUTRAL] When they get the schedule.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, have a good [PII].
[AGENT][POSITIVE] Thank you, same to you as well and thanks for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] Sure you too bye.
[AGENT][POSITIVE] Thank