AccountId: 011433970860
ContactId: cc8c9e38-b3d5-4a60-9873-bfa78eef6d60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424720 ms
Total Talk Time (AGENT): 152370 ms
Total Talk Time (CUSTOMER): 96158 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/cc8c9e38-b3d5-4a60-9873-bfa78eef6d60_20250625T20:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um and
[CUSTOMER][NEUTRAL] Um, hi, yeah, I just need a breakdown of benefits for a patient, please.
[AGENT][POSITIVE] Uh, sure, I can assist you with the breakdown of benefits. May I have your name?
[CUSTOMER][NEUTRAL] [PII], can I have your name again? I'm sorry.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII], last initial [PII]. And may I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number is 02558114.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from from my notes?
[CUSTOMER][NEUTRAL] Dental dreams.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you need this information given to you verbally or faxed over to you for the breakdown?
[CUSTOMER][NEUTRAL] Can you give it to me verbally and then also fax it to me? Is that possible? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, yes, OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, we have an effective date of [PII]. It is active at the moment and we have a calendar year maximum of 1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With the $50 deductible and deductible does not apply to preventative. Preventatives are covered 100%. Radiograph FMX is covered at 80%, basic expense and basic restorative is cover at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we have major service. Major service is after the 12 month waiting period, which I see the 12 month waiting period is gonna be up on [PII]. So after that 12 month waiting period, it's gonna be 40% for any major service including endonics, periodontics, and oral surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, so the only thing that's really covered right now would be fillings, right?
[AGENT][NEUTRAL] Filling simple extraction in radiograph FMX and preventative.
[CUSTOMER][NEUTRAL] OK, and does she have any history of this?
[AGENT][NEUTRAL] Um, let me see. No, she doesn't have any history.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please print this out and
[CUSTOMER][NEUTRAL] 30 of an after max.
[AGENT][NEUTRAL] Um, can you repeat that? You kind of cut off right there.
[CUSTOMER][NEUTRAL] Can I get the frequency of an SMS?
[AGENT][NEUTRAL] Frequency, yes. The frequency for an FMX is once every 5 years.
[CUSTOMER][NEUTRAL] OK, and what about for exams and cleaning? Is it 2 per year or once every 6 months?
[AGENT][NEUTRAL] OK, for cleanings, pro fee is once every 6 months. For exams, it's 2 for 12 month period. For wins, it's once every 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And um may I have the fax number?
[CUSTOMER][NEUTRAL] Yeah, fax number is gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me repeat it back to you. It's [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And how do you spell your name?
[CUSTOMER][NEUTRAL] [PII] N.
[AGENT][NEUTRAL] OK, thank you. Um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] That'll put us around [PII] I can do [PII]
[AGENT][POSITIVE] Thank you for holding and being patient for me. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yeah, you mentioned a week schedule are you guys using for this plan?
[AGENT][NEUTRAL] UCR?
[CUSTOMER][POSITIVE] Oh, OK, got it, so standard. OK, perfect, thank you.
[AGENT][POSITIVE] Mhm. Yeah. You're welcome. You're welcome. Have a good afternoon.
[CUSTOMER][POSITIVE] OK thanks OK bye.