AccountId: 011433970860
ContactId: cb88f25e-7694-4996-a2ba-522d6197729f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258420 ms
Total Talk Time (AGENT): 74363 ms
Total Talk Time (CUSTOMER): 100825 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/cb88f25e-7694-4996-a2ba-522d6197729f_20250305T20:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, this is [PII] calling from I Smile Dental Clinic. I'm just calling again to double check one of our patients benefits for fillings. Can you help me with that?
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Sure, this is direct. That would be [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure. That would be 2259801.
[CUSTOMER][NEUTRAL] Patient's name that would be for [PII], [PII].
[AGENT][NEUTRAL] And you were calling in for benefits or verification of what you were previously told?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, this is for fillings for code D 2392. The previous rep told me that it's basic 80% once per 5 years per tooth. No history and no downgrades, but I just check here on the fax back of benefits. It's showing here 1 tooth per 24 months. So yeah, what's the correct benefit for fillings?
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] I'm sure, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And that's 2392.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] In regards to that verification of coverage does not guarantee the payment of the claim. It is showing that the member has replacements of existing only if in phase in place for 24 months and then.
[AGENT][NEUTRAL] There's also showing maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] Thank you for that. So what should be the frequency for the 23921 tooth per 24 months?
[AGENT][NEUTRAL] Maximum of 1 each tooth per 24 months.
[CUSTOMER][POSITIVE] Thank you for that. So I'm, I
[AGENT][NEUTRAL] If they need a replacement, if it's existing in place for 24 months.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] So I should disregard the 1 for 5 years per tooth, right?
[AGENT][NEUTRAL] It's what the fax back is stating if you see that there was a difference that was that you were informed for the fax back, that is what it's stating.
[CUSTOMER][NEUTRAL] Because on the fax back this is what's showing as well the replacement of existing only if in place for 24 months and maximum of 1 each per 24 months. So I should, we should follow this one, right? Not the one per 5 years.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. So I just want to confirm as well no history and no downgrades for failings, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you for that. So yeah, that's it for me today. Thank you so much. If you can just spell your name for me and a reference number please.
[AGENT][NEUTRAL] The reference number would be my first name, [PII], spelled [PII], last initial of [PII] in today's date.
[CUSTOMER][POSITIVE] Thank you for that, [PII]. That's it for me today. Have a great day and bye for now.
[AGENT][POSITIVE] And thank you so much for calling American Public Life, JD. You have a great day as well.