AccountId: 011433970860
ContactId: ca6efc85-b7b6-496a-8a3c-4dfe495d1e62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386149 ms
Total Talk Time (AGENT): 136225 ms
Total Talk Time (CUSTOMER): 150349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/ca6efc85-b7b6-496a-8a3c-4dfe495d1e62_20250317T22:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[AGENT][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Mary Dental. How are you doing today?
[AGENT][NEUTRAL] I am fine, Ms. [PII] and yourself?
[CUSTOMER][NEUTRAL] I'm calling for rental eligibility and benefits. Could you please help me with the benefits?
[AGENT][NEUTRAL] Sure, I can verify benefits for you. And you say your name is [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Uh spell that for me, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And what is that policy number?
[CUSTOMER][NEUTRAL] Uh, just a second. Policy number is going to start with 02587326.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Callback number is [PII]. This is direct callback number, no extension.
[AGENT][NEUTRAL] OK, thank you. And um may I verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, just a second, I'm going to verify for you.
[CUSTOMER][NEUTRAL] One moment, bear with me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, yes. Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling to verify eligibility and benefits, correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, I'm showing an effective date of [PII]. Policy is active, and now you just need a general breakdown of benefits or I can send a fax back?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, any general benefits on the call?
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment, just a verification of coverage. Patient has
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have some questions. Uh-huh. Just a second, just a second. Bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] as you
[CUSTOMER][NEUTRAL] How is your day going on?
[AGENT][NEUTRAL] Fine.
[CUSTOMER][POSITIVE] That's good to hear that, yes.
[CUSTOMER][NEUTRAL] What was your, how was your weekend?
[AGENT][NEUTRAL] It was fine, and yours?
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK just a second.
[AGENT][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] Uh, what was the effective date? Can you just repeat once more effective date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what would be the group number?
[AGENT][NEUTRAL] One moment. Group number 70069.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this a Data PPO policy or is it any HMO or
[CUSTOMER][NEUTRAL] Any other policy?
[AGENT][NEUTRAL] We don't have any, we don't have any preferred providers. This is just a limited group dental policy.
[CUSTOMER][NEUTRAL] OK. May I know the preventive basic major percentages?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] May I know the preventive basic major percentages?
[AGENT][NEUTRAL] Sure. Uh, preventive pays 100% of UCR, basic, basic restorative FMX panoramic pays at 80%, and major services are not covered, and that would include endo perio and oral surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. And 2740 is not a covered benefit, right?
[AGENT][NEGATIVE] If it's major, it's not covered.
[CUSTOMER][NEUTRAL] OK. And may I know the individual deductible, family deductible, and the annual max?
[AGENT][NEUTRAL] Not a guarantee of payment, just a verification of coverage. The patient has a benefit max of $500 per calendar year, and they have a $50 deductible that is applied to everything but preventative services. And there's not a family deductible since she's the only one on the policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 195
[CUSTOMER][NEUTRAL] OK. What will be the group name?
[AGENT][NEUTRAL] Uh, the group name is ATC Healthcare Services.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] Mm, just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What will be the free schedule?
[AGENT][NEUTRAL] Policy does not pay by fee schedule or pays by UCR.
[CUSTOMER][NEUTRAL] no longer
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Is it out of network benefits?
[AGENT][NEUTRAL] We don't have a network.
[CUSTOMER][NEUTRAL] You don't have in-network benefits?
[AGENT][NEUTRAL] We don't have a network.
[AGENT][NEUTRAL] The policy pays by UCR.
[CUSTOMER][NEUTRAL] Uh, uh, just confirming, is this, uh, in-network or out of network benefits?
[AGENT][NEUTRAL] We do not have a network.
[CUSTOMER][NEUTRAL] We do not have any network, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But I need in-network benefits. Could you please help me with the e-network benefits?
[AGENT][NEUTRAL] Well, we don't have a network. We don't have a network, so the benefits I gave you is the benefits on the policy. We don't have a network.
[AGENT][NEUTRAL] The policy is open.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Uh, just a second, just confirming, OK? Just bear with me.
[AGENT][NEUTRAL] Mhm.