AccountId: 011433970860
ContactId: c82a04f3-f266-4cd6-a943-34e961ef0819
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282470 ms
Total Talk Time (AGENT): 93084 ms
Total Talk Time (CUSTOMER): 119830 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/c82a04f3-f266-4cd6-a943-34e961ef0819_20250410T20:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling um because I received the fax of benefits, but I had questions on here if you could please help me.
[AGENT][NEUTRAL] Uh yes, Ms. [PII], I can help you and you got a dental fax back and you have questions about it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, Ms. [PII], what is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is the insured's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, so it's [PII]. Uh, date of birth is [PII], and the ID is 06, I'm sorry, 02608929.
[AGENT][NEUTRAL] OK, let me pull her policy up real quick.
[CUSTOMER][NEUTRAL] Let me call you right back, OK?
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] OK, I've got her pulled up. Um, let me pull up her, the fax back that you received so I can be looking at what you're looking at, OK?
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] It's gonna be just a sec.
[CUSTOMER][POSITIVE] No worries.
[AGENT][POSITIVE] OK, I've got it pulled up. How can I help you with with your questions today?
[CUSTOMER][NEUTRAL] Yeah, so it looks like um from what I'm seeing there's a preventative and basic but it doesn't look like there's anything under um major listed under here so is that just not covered?
[AGENT][NEUTRAL] Right, this policy is the low policy and it only covers preventative and basic.
[CUSTOMER][NEUTRAL] Preventative and basic, OK.
[CUSTOMER][NEUTRAL] OK, so for the restorations, are there downgrades?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Frequency?
[AGENT][NEUTRAL] For restoration?
[AGENT][NEUTRAL] Uh, let me, let me see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It doesn't have a frequency. It just says basic restorative expenses is is 80% of allowable of the UCR.
[AGENT][NEUTRAL] And there's no waiting period.
[CUSTOMER][NEUTRAL] OK, um, and then is it safe to say that if it's not listed on the fax back then it's not a coverage service?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Only because you know, yeah, because some you know some insurances put um you know um or I mean not ortho um like oral surgery under basic and some consider it major and I don't see a code here for any extraction so that would be considered major then right? Or do you have a better view of what they consider major and maybe you can just list those for me?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, we don't, um, because nothing major is covered under this policy.
[CUSTOMER][NEUTRAL] OK, but, um, again something like simple extractions are considered.
[CUSTOMER][NEUTRAL] Major
[AGENT][NEUTRAL] Now I do see that um if you code the extraction as 7140, the CDT code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see it on there under base? Yeah, that's covered.
[CUSTOMER][NEUTRAL] That one's covered then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then I guess I have to go based on that. OK, now the only other thing on the on the fax back um it looks like there's a bunch of like, you know, uh, limitations so I HF but what was not included in the fax is like the key for those.
[AGENT][NEUTRAL] Yes, it's at the the the last page at the bottom of page 4.
[CUSTOMER][POSITIVE] OK, I have page 40, OK, OK, OK, I see them now. Thank you, [PII], you're the best. OK.
[AGENT][POSITIVE] Yes, ma'am. You're so welcome.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][POSITIVE] Have a good rest of your day. OK, bye.
[AGENT][POSITIVE] You too. Thank you, Ms. [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye.