AccountId: 011433970860
ContactId: cf8b031e-93a1-4736-9e90-32a15537760f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467570 ms
Total Talk Time (AGENT): 178113 ms
Total Talk Time (CUSTOMER): 124655 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/cf8b031e-93a1-4736-9e90-32a15537760f_20250122T15:50_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from Market dental. I need to verify the patient's eligibility and one details. Could you assist me regarding this?
[AGENT][POSITIVE] Yeah, I'd love to help you with eligibility and benefits today. [PII], can I have a good callback number for you please?
[CUSTOMER][NEUTRAL] I can see the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's your member's policy number today?
[CUSTOMER][NEUTRAL] I can see that the member's policy number is 990927231.
[AGENT][NEUTRAL] All right. Unfortunately, that's not a policy number with APL.
[CUSTOMER][NEUTRAL] OK, uh, could you check with the name and date of birth?
[AGENT][POSITIVE] I can search with name, yes.
[CUSTOMER][NEUTRAL] Yeah, I can see the patient's first name is [PII].
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And the last name is, and the last name is [PII], C [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Is there a space between the L and the B?
[CUSTOMER][NEUTRAL] No, there's no space, leave blank.
[AGENT][NEUTRAL] And what did you say the date of birth was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, I was able to find that policy. Can I give you the number?
[CUSTOMER][NEUTRAL] Yeah, could be able to
[AGENT][NEUTRAL] Yes, it is 614-223.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, the policy uh member ID is 614223, right?
[AGENT][NEUTRAL] Mhm, yeah, and are you wanting a copy of the fax back of benefits?
[CUSTOMER][NEUTRAL] I would like to go with the call verbally if you don't mind, could assist me with the deductibles and annual max for this patients plan.
[AGENT][POSITIVE] Yeah, absolutely. I do have to pull it all up though, OK? One second.
[AGENT][NEUTRAL] Alright, and I do have that pulled up. I also want to let you know that any policy information I give over the phone as far as benefits go is just a verification of coverage and never guarantee a payment.
[AGENT][NEUTRAL] And you said.
[AGENT][NEUTRAL] You want to start with the calendar year maximum deductible, is that right?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, go ahead. Would you go with the deductibles and annual max?
[AGENT][NEUTRAL] Yes, the deductible is $50 per person and up to $150 per family. Um, deductibles do not apply to exams or pro fees, and our calendar year maximum for this patient is $1000 per year.
[CUSTOMER][NEUTRAL] OK, uh, can I get the insurance person of preventative services, basic and major?
[AGENT][NEUTRAL] The, so with this plan, there isn't a co-insurance. Every single procedure code has an individual dollar amount benefits.
[CUSTOMER][NEUTRAL] So it's a co-pay plan, right?
[AGENT][NEUTRAL] No, it's not a copay plan so like each individual procedure has a benefit amount, so like a 120 has a $15 benefit and so the.
[CUSTOMER][NEUTRAL] OK, could you, could you assist me with the group number and the group number?
[AGENT][NEUTRAL] Schedule of uh services is included in that.
[AGENT][POSITIVE] The group number? yeah I can absolutely help you with that. Let me go to that for you.
[CUSTOMER][NEUTRAL] Can you spell the group names?
[AGENT][NEUTRAL] Yeah, let me look at that for you one second.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Um, actually there's no group for this plan, an individually owned plan.
[CUSTOMER][NEUTRAL] An individual plan. So could you go with the name one second with the group name Schedule SHE.
[AGENT][POSITIVE] And I'm so sorry. Can you repeat that?
[CUSTOMER][NEUTRAL] Effective date could you go with an effective date, ma'am?
[AGENT][NEUTRAL] Yeah, the effective date is [PII] or [PII].
[CUSTOMER][NEUTRAL] [PII] uh nothing has been used, nothing has been made from the.
[CUSTOMER][NEUTRAL] And Max, right?
[AGENT][NEUTRAL] For this calendar year, there has been nothing um from that animal, uh, the annual maximum.
[CUSTOMER][NEUTRAL] And I need to confirm the, uh, there is no ortho coverage for this patient's plan. Is there any ortho coverage?
[AGENT][NEUTRAL] Um, let me look.
[AGENT][NEGATIVE] There's no ortho on this plan.
[CUSTOMER][NEUTRAL] Is there any history for this patient's file which puts the frequency or is any history for this year?
[AGENT][NEUTRAL] Um, yes, so as far as what affects their frequency, they had a panoramic on 627-2024.
[CUSTOMER][NEUTRAL] The Reformation and panel they do your frequency, right?
[AGENT][NEUTRAL] Uh, yes, they do every 3 years.
[CUSTOMER][NEUTRAL] That's on history.
[AGENT][NEUTRAL] Um, no, I'm so sorry. I, I just have to pull them all one at a time because I don't know their code numbers. Um, they have an oral evaluation 627-2024. It's every 6 months, so they should actually be good again.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, I need to confirm one thing, uh, that's 0140 and uh all exams do share frequency for this patients plan.
[AGENT][NEUTRAL] And I'm so sorry, you said 0140 and what else?
[CUSTOMER][NEUTRAL] Yeah, 0140 share frequency with all exams.
[AGENT][NEUTRAL] Yes, all oral examinations.
[AGENT][NEUTRAL] Every 6 months.
[CUSTOMER][NEUTRAL] OK, I need to confirm that is there any history for, uh, linings, lavanton trophy and bite wings?
[AGENT][NEUTRAL] Uh, last prophy was [PII], so no.
[CUSTOMER][NEUTRAL] OK, is there any history of wide wings?
[AGENT][NEUTRAL] I didn't see bite wings and.
[AGENT][NEUTRAL] No, I mean,
[CUSTOMER][NEUTRAL] OK. Uh, may I have your name, uh, OK. May I have your name and call reference number, please?
[AGENT][NEUTRAL] Yeah, the name is [PII] Call reference number is my name [PII]. Last one she'll be like boy in today's date.
[CUSTOMER][POSITIVE] Thank you [PII]. Thank you for providing valuable information. Have a nice day.
[AGENT][NEUTRAL] You too bye bye.