AccountId: 011433970860
ContactId: c41df6d1-f10a-4eb2-bf94-9fbeb3f8f803
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440619 ms
Total Talk Time (AGENT): 219358 ms
Total Talk Time (CUSTOMER): 119534 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/c41df6d1-f10a-4eb2-bf94-9fbeb3f8f803_20250610T14:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I need to verify dental benefits for a patient, please.
[AGENT][POSITIVE] Sure, I could check those benefits for you. uh, what was your name please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He, so the patient's here right now and he does not have a card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, do you have the members social? I could search for them that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK and then what was the name for the member?
[CUSTOMER][NEUTRAL] All right. It's [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, there we are and then uh do you have the member's date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. So I did find their policy um it is currently active, uh, did you want me to go ahead and give you that policy number?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] Sure, that is 0262.
[AGENT][NEUTRAL] 4252.
[CUSTOMER][NEUTRAL] OK. Um, is there a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A group number?
[AGENT][POSITIVE] Yes, let me go ahead and get that for you.
[CUSTOMER][NEUTRAL] And then a group name also if you have that.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Of course, OK, so that group number is 70095.
[AGENT][NEUTRAL] And then that group name is uh it's one word Testaff, so T E M P S T A F F.
[AGENT][NEUTRAL] And then ink
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty and then if you would like I can send you a fax back that shows all of the covered procedures and benefit information um I do understand that while the patient is there I can still answer questions for you over the phone um but I don't mind sending this fax back for you as well if you'd like.
[CUSTOMER][POSITIVE] Oh yes, that would be, that would be great. Thank you.
[AGENT][NEUTRAL] OK, sure, one moment.
[AGENT][NEUTRAL] OK, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, I will go ahead and get that sent now. I should get it within about 10 minutes or so. Um, what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] Um, well, I do, I do wanna make sure that the claims mailing address I have on file is correct. I have [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No ma'am, that is our uh old address whenever you're ready I can go ahead and give you our correct one.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What about the payer ID?
[AGENT][NEUTRAL] Yeah, that is uh 60801.
[CUSTOMER][NEUTRAL] OK, that is what I have good, um, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For, let's, uh, let's, I guess a full mouth set of X-rays. Do you need the dental code?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I was just wondering if
[CUSTOMER][NEUTRAL] Yeah, if the deductible applies to that and.
[AGENT][NEUTRAL] Full mouth X-rays and panoramics. It does, yes, OK, so, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so this policy does um act on a calendar year, so the total benefit amount is $750 per calendar year. There is a $50 deductible and it does not apply to preventative services. It does apply to X-rays, basic, anything else besides preventative.
[CUSTOMER][NEUTRAL] OK and what are basic services paid out?
[AGENT][NEUTRAL] 80% um the same is going to be for radiographs and FMX.
[CUSTOMER][NEUTRAL] 80% OK, um.
[CUSTOMER][NEUTRAL] Does he have a waiting period for any services?
[AGENT][NEUTRAL] No, so in short, this policy does not offer any sort of major expenses, so no oral surgery, no periodontic endedontic. Those would be the only things with a waiting period. This policy has none of those offered, so there is no waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that means, you said no oral surgery, no perio, no endo?
[AGENT][NEUTRAL] Right, uh, nothing considered major, it's just going to be preventative, um, SMX and the basics.
[CUSTOMER][NEUTRAL] OK. So fillings.
[CUSTOMER][NEUTRAL] And X-rays, and cleaning.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Right, yeah, there's a few and if you have specific codes I can look for those if you're looking for anything in particular.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, uh, uh, posterior resin, composite resins, do they downgrade to amalgam? That would be D 2391.
[AGENT][NEUTRAL] 91.
[AGENT][NEUTRAL] Is covered under basic. Give me just a moment.
[AGENT][NEUTRAL] OK, no, there's no downgrades.
[CUSTOMER][NEUTRAL] No downgrade, OK.
[CUSTOMER][NEUTRAL] Alright, that's, that's pretty much all I need to know.
[AGENT][NEUTRAL] OK, yeah, so I did send that fax back um if you were looking for a specific procedure and you don't see it listed, that simply means it's not a covered procedure under this policy.
[CUSTOMER][POSITIVE] Perfect. Sounds easy. Thank you so much.
[AGENT][NEUTRAL] All right. Of course. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.