AccountId: 011433970860
ContactId: d392ec79-5b4f-43b8-8313-a993cb060056
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414019 ms
Total Talk Time (AGENT): 142763 ms
Total Talk Time (CUSTOMER): 197992 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/d392ec79-5b4f-43b8-8313-a993cb060056_20250604T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello [PII]. Um, this is [PII]. I'm calling from the dental office. Um, can you help me to check some information regarding dental benefit?
[AGENT][NEUTRAL] OK, [PII]. Did you say you were needing dental benefit information? Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you, [PII], and for our dental policies, we have fax facts that have the member's benefit information on there for the plan that they have that I will be happy to send to you, and that list everything that's covered under their policy.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Um, actually I have the full breakdown of the umm the.
[CUSTOMER][NEUTRAL] Patient, yeah, um.
[CUSTOMER][NEUTRAL] But uh maybe can you help me um just to check the specific questions for this patient.
[AGENT][NEUTRAL] So you already have the facts back with all of their benefit information, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, but.
[AGENT][NEUTRAL] OK, so I can try and help you. Yes. What is your callback number, please?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, um, it's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] OK. Um, it's 02546508.
[AGENT][NEUTRAL] One moment, [PII] while I get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um yeah.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yeah, it's [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, and so how can I help you today?
[CUSTOMER][NEUTRAL] Um, yeah, so as I mentioned, um, just specific questions only. OK, first is the remaining benefits. Can you check if nothing has been used with that, um, also for the deductible for individual and family?
[AGENT][NEGATIVE] As of, as of now, he has, he has not used any benefits on this policy.
[CUSTOMER][NEUTRAL] So it's still 1500 deductible 50 and 150, nothing has been used, OK.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Copy that, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know because I have the 12 month waiting period for all major services and the barore prosodontic oral surgery, um, may I know the date?
[CUSTOMER][NEUTRAL] The date for the waiting period.
[AGENT][NEUTRAL] The effective date should be on your fax back. What do you show as the effective date on the policy?
[CUSTOMER][NEUTRAL] So they start, so they starting and the end date of the waiting period. So that uh um that they start with the effective date. So it's
[AGENT][NEUTRAL] This policy became, that is correct. So there is a 12 month waiting period on those categories from the date the policy became active.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So it will end with um [PII]. Is that right?
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, um, I assume that.
[CUSTOMER][NEGATIVE] For this plan, um, there's no history at all.
[AGENT][NEUTRAL] There's no history on file, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's nothing else, OK.
[CUSTOMER][NEUTRAL] And OK, yeah, for my last question is for the oh.
[CUSTOMER][NEUTRAL] So I don't have the periodical X-ray um coverage and frequency. So may I have that?
[AGENT][NEUTRAL] I'm sorry, what is, what is the code?
[CUSTOMER][NEUTRAL] Um, 0220 for the code of PA.
[AGENT][NEUTRAL] OK, so 0220, that falls under basic.
[AGENT][NEUTRAL] And that information is gonna, uh-huh, and that's there's not a frequency listed. If you will look over under the basic expenses on the second page of the fax back, you will see that there's not a limitation out there.
[CUSTOMER][NEUTRAL] Basic and the fix.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, copy that, um, and my last question is for the payer IP because I have [PII]. So may I know if
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know if that is capable for electronically?
[AGENT][NEUTRAL] That is the electronic payer ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's yes, OK.
[CUSTOMER][NEUTRAL] Yeah, um, I think that's all for this patient. Uh, maybe can I have the reference number of our call?
[AGENT][NEUTRAL] Uh, yes, [PII], it will be my name along with today's date and then one additional piece of information if you all do file a claim for this member with us once the claim has been processed here at APL, we do have a portal in which you should be able to check claim status and and the website that you would go to to do that is secured.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, OK, copy that, um, if that's all, um, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Well, you're welcome, [PII]. So that is all I can help you with. Thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] OK, bye for now.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] Um, bye bye.