AccountId: 011433970860
ContactId: db6f18ca-acbc-4a51-807d-d23df858fcb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253699 ms
Total Talk Time (AGENT): 93178 ms
Total Talk Time (CUSTOMER): 79537 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/db6f18ca-acbc-4a51-807d-d23df858fcb1_20250618T17:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling in from Doctor [PII]'s office. I was hoping if you could help me out with the patient's eligibility.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, um, it is [PII].
[CUSTOMER][NEUTRAL] And the policy ID I have is um.
[CUSTOMER][NEUTRAL] 0199.
[CUSTOMER][NEUTRAL] 4505.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure it's um [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK, and what's the annual max on the plan?
[AGENT][NEUTRAL] Hold on one moment, let me put the fax back.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, the calendar year max for this policy is $1500.
[AGENT][NEUTRAL] Per person. The deductible is up to $50 per person. I'm sorry, $50 per person up to $150 per family, but it's an individual policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Um, is the patient due for cleaning, um, bite wings, and I, I'm not sure if fluoride has age limit or not.
[AGENT][NEUTRAL] Um, do you have codes for the history you'd like me to search for?
[CUSTOMER][NEUTRAL] Um, yes, um, one moment.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, I can give you the codes or.
[CUSTOMER][NEUTRAL] The one that I see is um the 1206. Is there a coverage on that?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that's not a covered code on the policy.
[CUSTOMER][NEUTRAL] OK, so is there an age limit?
[AGENT][NEUTRAL] Um, I'm not, so since it's not on the policy, I don't have anything to reference.
[CUSTOMER][NEUTRAL] OK, it's OK.
[CUSTOMER][NEUTRAL] OK, the next code is D0120.
[AGENT][NEUTRAL] 020.
[AGENT][NEUTRAL] OK, so that's under preventative at 100% and let me see, I'm limited to two oral evaluations per 12-month period, 120, 40, 50, 60, and 80 are paired together.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] Uh, profi, the 11:10.
[AGENT][NEUTRAL] Um, 11:10 is preventative at 100% max of one procedure per 6 months.
[CUSTOMER][NEUTRAL] OK, and the patient is due for that, right?
[AGENT][NEUTRAL] Um, hold on one moment, let me check the history.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Last day of service for 0110 was [PII].
[CUSTOMER][POSITIVE] OK, so yeah, the patient is active. perfect. I have everything I need. Thanks so much.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APLD. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.