AccountId: 011433970860
ContactId: cc4e02cc-7003-407d-9217-3959a556be4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 748900 ms
Total Talk Time (AGENT): 183289 ms
Total Talk Time (CUSTOMER): 228738 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/cc4e02cc-7003-407d-9217-3959a556be4b_20250423T14:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII] and I'm calling from All in the Family dental to verify the eligibility of a patient.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with eligibility. Uh, can I please get your callback number, ma'am, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you Ms. [PII], and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII] and you asked for the ID number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 02594428
[AGENT][NEUTRAL] OK let me look real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, I do see that [PII] does have an active policy with us. Her effective date is [PII].
[AGENT][NEUTRAL] And it's current.
[CUSTOMER][NEUTRAL] And um can you tell me the group number of this plan?
[AGENT][NEUTRAL] Yes ma'am it's 7005.
[CUSTOMER][NEUTRAL] I'm sorry, you were kind of breaking up. Uh, can you say that again?
[AGENT][NEUTRAL] It's 70054.
[CUSTOMER][NEUTRAL] 54, OK.
[CUSTOMER][NEUTRAL] Uh, could you confirm if the patient is the subscriber?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And just the group name innovative staff Solutions.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Can you tell me the coverage percentage for preventive basic nature and orthodontic services in this plan?
[AGENT][NEUTRAL] Um, what I can do is send you a fax back if you'll give me your fax number, I'll have a complete benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] OK, fax number is [PII].
[CUSTOMER][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me read it back to you. That's [PII] and that's [PII].
[CUSTOMER][NEUTRAL] Did you get that?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, it's not, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh, OK. Thank you so much for helping me with that. I'm gonna put you on a brief hold. I'm gonna get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me Miss [PII]. I've got that on its way to you now.
[CUSTOMER][NEUTRAL] OK. Can you tell me the coordination of benefits of this plan?
[AGENT][NEUTRAL] We do not have coordination of benefits.
[CUSTOMER][NEUTRAL] OK, is there any missing tooth class or waiting period in this plan?
[AGENT][NEUTRAL] Yes ma'am, that's also on your fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Any auto coverage?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you tell me the coverage percentage for 60106057 and 6058 is that in the fax?
[AGENT][NEUTRAL] That is on the fax, yes ma'am.
[CUSTOMER][NEUTRAL] OK, can you check if there is any history for this situation for XM FMX and panel pipe wings, prophy fluoroid sealants, and any imperial services.
[AGENT][NEUTRAL] Let me check to see if she used anything. She just got this policy.
[AGENT][NEUTRAL] There's been no claims on this policy as of today.
[CUSTOMER][NEUTRAL] OK, and the codes that are, that will not be on the fax, are they covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that's all exempt share the frequencies?
[AGENT][NEUTRAL] I'm sorry, I, can you repeat the question?
[CUSTOMER][NEUTRAL] That's all exempt share the frequencies.
[AGENT][NEUTRAL] Yes, all that will be on the fax back.
[CUSTOMER][NEUTRAL] OK, does the Mix and pano share that frequency?
[AGENT][NEUTRAL] That's also on the fax back.
[CUSTOMER][NEUTRAL] OK, age limits, can you tell me the age limit for [PII]?
[AGENT][NEUTRAL] That is also on the fax back?
[CUSTOMER][NEUTRAL] OK, any downgrades for composite or Chrome?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And our crownsts and bridges paid on property to see it.
[AGENT][NEUTRAL] 6
[CUSTOMER][NEUTRAL] She did you, sir?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 1351 and 1352 covered on 3 mos.
[AGENT][NEUTRAL] That is all the codes are on the fax back.
[CUSTOMER][NEUTRAL] No, no, uh, is it covered on 3 more?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] It's 135 and 1352 covered on 3 mola.
[AGENT][NEUTRAL] And that was 1351.
[CUSTOMER][NEUTRAL] And 1352.
[AGENT][NEUTRAL] Uh, sealants are for 14, ages 14 and under.
[CUSTOMER][NEUTRAL] Are they covered on 3s?
[AGENT][NEUTRAL] On Primo, what was Primo?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not if they're over the age of [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 2950 out on the same day it's crown.
[AGENT][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] Yes, is it allowed on the same day as Chrome?
[AGENT][NEUTRAL] Uh, 2950 is not on the fax back. This is just, uh, preventative and basic policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's not covered 2950?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, how many number of quotes can be allowed on the same day for SRP?
[AGENT][NEUTRAL] All of that is on the fax back for you.
[CUSTOMER][NEUTRAL] Is SRP covered then uh I need to know how many number of cards can be done. That's why.
[AGENT][NEUTRAL] OK, and what is the code for the quads?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that is not on the fax back.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, ma'am, that's not covered.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] It's just a basic and, and preventative policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the codes that are not on the fax will not be covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Does 9110 require narrative?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] And that was a great time.
[AGENT][NEUTRAL] That is covered on the fax back.
[CUSTOMER][NEUTRAL] Does it require a narrative?
[AGENT][NEUTRAL] It's basic.
[CUSTOMER][NEUTRAL] OK, does annual maximum apply to all services in this plan?
[AGENT][NEGATIVE] It does not apply to the preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Which also is the deductible applied to.
[AGENT][NEUTRAL] The deductible does not apply to the preventative and this is just to verify benefits it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] I assign enough benefits accepted?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so the payment goes to the patient then?
[AGENT][NEGATIVE] We do not give patient responsibility.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So I'll receive the fax, right, because I haven't received it yet.
[AGENT][POSITIVE] Yes, you'll get the fax it's on its way.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, could you spell out your name and provide me with the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much and have a great day.
[AGENT][POSITIVE] You have a wonderful day too. We appreciate you calling Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Um, no, thank you so much.
[AGENT][POSITIVE] All right. Well, you have a good rest of your week.
[CUSTOMER][NEUTRAL] Yeah. Bye.
[AGENT][POSITIVE] Thanks for calling