AccountId: 011433970860
ContactId: d762b707-7c2c-4e55-bb00-b58341fda305
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377640 ms
Total Talk Time (AGENT): 146710 ms
Total Talk Time (CUSTOMER): 127320 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/d762b707-7c2c-4e55-bb00-b58341fda305_20250505T14:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII]. I'm trying to find out if this patient has an active dental policy and this will get a breakdown with history and waiting periods.
[AGENT][NEUTRAL] OK, I can help you. What's, uh, the policy number?
[CUSTOMER][NEUTRAL] 608-796.
[AGENT][NEUTRAL] OK, and I'll get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's direct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][POSITIVE] OK, thank you for that information.
[AGENT][NEUTRAL] I'm showing an effective date of [PII] policy is active. Um, what is your fax number? I can fax the schedule over for it to you and then I could check history as well.
[CUSTOMER][POSITIVE] Perfect, it's [PII].
[AGENT][NEUTRAL] OK, and you're also wanting to know um what amounts have been used so far?
[CUSTOMER][NEUTRAL] Yes, please. Well that and yeah in history.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Let's see, as far as the remaining balance, she's not used any for [PII], so the 1000 is still remaining.
[AGENT][NEUTRAL] And for her history.
[AGENT][NEUTRAL] Um, this is for year [PII]. Um, she had a cleaning, a full mouth, and a comprehensive or evaluation on [PII].
[AGENT][NEUTRAL] And then prior history to that is in [PII].
[AGENT][NEUTRAL] Do you have any specific uh codes?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well she's coming over. She has a broken bridge, and I, all I can tell you is the bridge codes are in the 6,000s, but beyond that I couldn't tell you anything else.
[AGENT][NEUTRAL] Oh, OK. OK, let me see.
[AGENT][NEUTRAL] So crown.
[AGENT][NEUTRAL] Uh, back to [PII], she had some crowns, but I don't see anything for a bridge.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, and let me prepare the schedule for you.
[CUSTOMER][NEUTRAL] OK, so what you're sending over, so the price that's listed is what you're paying or what the patient pays?
[AGENT][NEUTRAL] Uh, let me pull up the schedule.
[CUSTOMER][NEUTRAL] OK, right, make sure I'm on the same page here.
[AGENT][NEUTRAL] Mhm do you have a copy of the schedule?
[CUSTOMER][NEUTRAL] Uh, I have one from last year. I don't know if it's the same or if it's been changed since.
[AGENT][NEUTRAL] Yeah, it's the same schedule and what is the uh procedure code?
[CUSTOMER][NEUTRAL] The new year started.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well, I know she's gonna have a limited, so it'll be a 0 140.
[AGENT][NEUTRAL] Right, so under this particular plan it pays a benefit amount per uh procedure code, so the $25 is what her policy will pay that's the maximum for the D0140 dollars.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so benefit amount is what insurance pays.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And do we send claims in with this policy?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Do we have to sign a claim in with this or is it like a discount plan?
[AGENT][NEUTRAL] Yeah, we need the ADA claim form.
[CUSTOMER][NEUTRAL] OK, that's why I thought I just want to double check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And you, and [PII], you do, you do have the schedule, so I don't have to fax it to you or?
[CUSTOMER][NEUTRAL] Um, and then
[CUSTOMER][NEGATIVE] Yeah, no, it's if it's the same as last year's because I had one come through of [PII], so if it's the same one I'll just reuse that. OK, perfect. I'll just use that one then, so don't waste your time.
[AGENT][NEUTRAL] Yeah, it's the same.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] OK. Very good.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And and then and there's no the frequencies there's what's listed on the very first page.
[AGENT][POSITIVE] Yeah, the frequencies are on the top at the top.
[CUSTOMER][NEUTRAL] OK, alright, and then do we need to.
[AGENT][NEUTRAL] Below the calendar, your max and deductible.
[CUSTOMER][NEUTRAL] Do we need to pre-authorize anything?
[AGENT][NEUTRAL] Yeah, prior authorization is not required uh predetermination is not required either, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah you could send one in but it's not a requirement.
[CUSTOMER][NEUTRAL] OK, and is this a benefit year or uh?
[AGENT][NEUTRAL] Um, it's based on calendar year. I think the benefit it says calendar year maximum is 1000 and then calendar year deductible is 50, so it's calendar year.
[CUSTOMER][NEUTRAL] Calendar.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, let's see.
[CUSTOMER][NEUTRAL] And you guys pay on proper seat.
[AGENT][NEUTRAL] Either or.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Perfect. Alright, so that should do it then since, OK, what was your first name again? I didn't catch you at the very beginning.
[AGENT][POSITIVE] All righty. Thank you.
[AGENT][NEUTRAL] It's [PII] A, first initial last name is [PII] and you'll use my name in today's date as reference for today's call. And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that is everything. Thank you so very much. I appreciate your time.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye. You too.
[AGENT][NEUTRAL] Bye bye.