AccountId: 011433970860
ContactId: c4ad61df-006c-4099-8770-96495e845531
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377329 ms
Total Talk Time (AGENT): 144403 ms
Total Talk Time (CUSTOMER): 176764 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/c4ad61df-006c-4099-8770-96495e845531_20250108T21:20_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Did
[CUSTOMER][NEUTRAL] Hey, this is [PII] looking for patient dental benefit.
[AGENT][NEUTRAL] Sure, [PII]. I can assist you with that. Can I have your callback number and the, the policy number of the member?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 615898.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility, correct?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has a maximum benefit amount of $1000 per calendar year.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] With a $50 deductible up to $150 per family, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, can I check the provider participation is the in network or out of network?
[AGENT][NEUTRAL] This policy is a PPL. The member does not have a network.
[CUSTOMER][NEUTRAL] OK. So only people benefit, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I have the group name and the group number?
[AGENT][NEUTRAL] Um, 9283 is the group number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ryan Supply Company is the group name.
[CUSTOMER][POSITIVE] Perfect. Can I have the claim mailing address and the payer ID?
[AGENT][NEUTRAL] The payer ID, the payer ID to submit a claim is 60801.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the mailing address will be addressed to APL claims department.
[CUSTOMER][NEUTRAL] And the claim.
[AGENT][NEUTRAL] [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. Any waiting period or missing tooth loss?
[AGENT][NEUTRAL] There's a 12 month waiting period on all major services, however, that period exhausted in [PII]. The policy has been active since [PII].
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And missing to close.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] There is a missing tooth clause.
[CUSTOMER][POSITIVE] Perfect. Can you help me with the coverage percentage for diagnostic period basic and nature?
[AGENT][NEUTRAL] So it's not a percentage. It's based on a fee schedule. Would you like for me to send you a dental schedule?
[CUSTOMER][NEUTRAL] No, that will be fine.
[CUSTOMER][NEUTRAL] Any orthodontics coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No orthodontic coverage. Perfect. And can you help me with the patient history?
[AGENT][NEUTRAL] What is your first procedure code that you would like to check the history of?
[CUSTOMER][NEUTRAL] Uh, it's 0120.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]. What's your next code?
[CUSTOMER][NEUTRAL] 2021.
[CUSTOMER][NEUTRAL] 040.
[AGENT][NEUTRAL] [PII]. What's your next code?
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] It was [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 9. OK. 050.
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0330.
[CUSTOMER][NEUTRAL] 2798.
[AGENT][NEUTRAL] 230 or 220?
[CUSTOMER][NEUTRAL] 330.
[AGENT][NEUTRAL] Repeat that.
[CUSTOMER][NEUTRAL] 0330 panoramic X-ray.
[AGENT][NEUTRAL] No history on file. What's your next code?
[CUSTOMER][NEUTRAL] 0367.
[AGENT][NEUTRAL] Repeat that.
[CUSTOMER][NEUTRAL] 0367.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] And 1110 prophylaxis.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 1208 fluoride.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] 13513 land.
[AGENT][NEUTRAL] Repeat that.
[CUSTOMER][NEUTRAL] 1351 Sillands.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] 4341 and 4342 SRP.
[AGENT][NEUTRAL] I can only look at one code at a time, so which one do you want me to look at first?
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] 4342.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] And the last one is 4910.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][POSITIVE] Perfect. Can I have your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And today's date is a reference because unfortunately we don't provide reference numbers. Can I have your name again please?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][POSITIVE] Thank you [PII]. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] I'm done for this patient. Thank you so much, [PII], for helping me out. Have a great day ahead.
[AGENT][POSITIVE] You're welcome. Thanks for calling API. You have a great day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah