AccountId: 011433970860
ContactId: cbab8df9-0653-42c9-94b2-30dd9cad8011
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319799 ms
Total Talk Time (AGENT): 155753 ms
Total Talk Time (CUSTOMER): 97551 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/cbab8df9-0653-42c9-94b2-30dd9cad8011_20250620T22:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was wondering if you could give me a breakdown of benefits for this patient, please.
[AGENT][POSITIVE] Sure, I can check benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Thank you and do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, um, I don't have, I only have a social is that OK?
[AGENT][POSITIVE] Oh yeah, I can search that way.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the name for the member?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] OK, thank you for verifying that. And was this for medical or dental?
[CUSTOMER][NEUTRAL] For dental.
[AGENT][NEUTRAL] Dental. OK, give me just a moment, let me get that policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. Uh, so I do have the.
[AGENT][NEUTRAL] That policy number whenever you're ready I can give that to you.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that is 02.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 49
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7272.
[CUSTOMER][NEUTRAL] OK, thank you. Can I also get the group number?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes, let me go ahead and get that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is 7.
[AGENT][NEUTRAL] 0052.
[CUSTOMER][NEUTRAL] You said 70052?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] OK alrighty thank you.
[AGENT][NEUTRAL] Alrighty, yes, and so, uh, of course this policy is currently active. That effective date was [PII], and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, please. By any chance, oh I have a question. Is this a PPO?
[AGENT][NEUTRAL] Um, so this, uh, policy, it participates in the caring and PPO network.
[CUSTOMER][NEUTRAL] PPO network OK um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it OK to for you to give me like just the annual max and the remaining and the percentages and deductible while I wait for that fax?
[AGENT][NEUTRAL] Oh sure, no, I could still answer questions over the phone, absolutely, um, I'll go ahead and send that fax first though if you don't mind just so it because it can take about 10 minutes or so, um, yeah, what was that fax number for you?
[CUSTOMER][POSITIVE] Yeah thank you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alrighty I will go ahead and send that now um and what.
[AGENT][NEUTRAL] You, uh, just needed the annual max and such?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Let me get that information for you. Give me just a moment.
[CUSTOMER][POSITIVE] Mhm thank you very much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so counter your maximum benefit amount for each member is $500 and there is a $50 deductible that does not apply to preventative services up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then remaining is 500 correct?
[AGENT][NEUTRAL] Yes, none has been used before this.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Here, uh, none of the deductibles have been met and I will say as well when you get this fax back if you're looking for a specific procedure and you don't see it listed that means it's not going to be covered uh this policy doesn't have any sort of major coverage it's just going to be uh preventative FMX and basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] Mm, I see.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um, and what was the percentage for preventative and, uh, basic?
[AGENT][NEUTRAL] Uh, prevent
[AGENT][NEUTRAL] It is at 100% SMX and basics are at 80.
[CUSTOMER][POSITIVE] 180. OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And then another question, no, actually that's it. I'll just wait on the fax on the fax for him.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, sounds good. I did just send that to you you should be getting that shortly. There wasn't anything else I could help you with?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Um, no, that'll be it. Thank you so much for your help.
[AGENT][POSITIVE] Alright, yeah thanks for giving us a call. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you bye bye.