AccountId: 011433970860
ContactId: d0aee57d-b7c9-4b86-b6d1-bf41bd17e639
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 866510 ms
Total Talk Time (AGENT): 215083 ms
Total Talk Time (CUSTOMER): 162827 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/d0aee57d-b7c9-4b86-b6d1-bf41bd17e639_20250618T20:54_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, I am just calling um to verify eligibility and benefits for two mutual patients.
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh huh, it's and it's [PII].
[AGENT][NEUTRAL] Thank you. And what is the name of the facility you're calling from right now, Miss [PII]?
[CUSTOMER][NEUTRAL] Mom Family dentistry.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 632-318.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And is the other member listed as well on the policy or is it a different policy, Missy?
[CUSTOMER][NEUTRAL] Uh, they're, I believe they're both on the same policy. I need one for [PII] and for [PII].
[AGENT][NEUTRAL] OK. What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, um, can you ver
[CUSTOMER][NEUTRAL] Oh, I think I gave you the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so OK, so [PII] is the one, hers is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, so let's see, bear with me.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And you say you need eligibility and benefits for the benefits you need a breakdown of benefits fax over or what information do you need?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, um, one fax over and then one verbally as well, um, I've got a maximum of 1000.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, group number 5475?
[AGENT][NEUTRAL] Um let me check on that.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. Yes, 5475 is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when was this policy effective for [PII]?
[AGENT][NEUTRAL] All right, we have an effective date of [PII] for both of them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you tell me if, um, can you, is it preventative, basic and major services covered at 180 and 50%?
[AGENT][NEGATIVE] No, this one pays flat amounts based on the coding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a waiting period or missing tooth claws?
[AGENT][NEGATIVE] Not on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can you tell me if this patient's eligible for a profi exam, bite wings, pano FMX Flo out or sealants?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so the last profiy on this one is [PII].
[AGENT][NEUTRAL] Last bite when is also [PII]. The last examination was [PII].
[CUSTOMER][NEUTRAL] So is it 2 per year or 1 every 6 months?
[AGENT][NEUTRAL] Um, bear with me, let me, one moment, uh, let me pull another system, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is all in different systems. One moment. OK, uh, let me pull the policy up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 63218.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Option I
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so oral examinations is once every 6 months. Proffe and cleaning is once every 6 months and by wins is once every 6 months.
[CUSTOMER][NEUTRAL] So she is eligible um you said it was December when?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK perfect and then uh what about a panel or FMX?
[AGENT][NEUTRAL] OK, let me.
[AGENT][NEUTRAL] OK, so the last panel I see here is on [PII], um, panel and FMex is once every three years.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and, and, and you said the last one was when?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and then what about floor out or ceilings?
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] OK, so for sealants it's once every 3 years for full mouth it's once every 12 months.
[CUSTOMER][NEUTRAL] What do you guys want?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, sealants and fluoride, is there an age limit?
[AGENT][NEUTRAL] I'm sorry, I gave you the wrong fluoride. Fluoride is once every 12 months. Oh, that's OK. Um, yes, there is an age limit. fluoride is um covered person under the age of [PII]. Seans are limited to cover person under [PII] of age.
[CUSTOMER][NEUTRAL] I don't think he said that.
[CUSTOMER][NEUTRAL] OK, and then for [PII], is he currently eligible for exam cleaning bite wings, pano FMX floor out or sealants?
[AGENT][NEUTRAL] OK, let me check on it.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, it looks like they both went in the same day. So, um, the same thing for him in [PII], um by wins and everything. Um, let me check the panel.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] Um, yeah, panel was also on [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, so yeah, it's gonna be the same thing for both of them.
[CUSTOMER][NEUTRAL] OK, can I have a reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Mr.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII].
[AGENT][NEUTRAL] And do you need the fax, uh, mhm, yes, Ms.
[CUSTOMER][NEUTRAL] And today's date?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes please for um for both of them that are I can give you our fax number.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK, yeah, that's fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Church of pride, Christianity.
[AGENT][POSITIVE] Thank you for holding and being patient for me. I went ahead and sent that over to you, Ms. [PII]. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] So I, I
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Alright, well thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.