AccountId: 011433970860
ContactId: dd315e23-dd01-4195-bad6-4a8463208081
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337549 ms
Total Talk Time (AGENT): 125738 ms
Total Talk Time (CUSTOMER): 119511 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/dd315e23-dd01-4195-bad6-4a8463208081_20250625T20:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes hello, good afternoon. I'm calling from a provider dental office regarding a patient that's here in the office.
[AGENT][NEUTRAL] OK, are you calling for benefits, claim status, eligibility?
[CUSTOMER][NEUTRAL] I'm calling for benefits. We had um already called before for a fax, but only half of the benefits are being shown in the fax.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Like half of the pages cut off.
[AGENT][NEUTRAL] OK, and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Uh spell your name, please?
[CUSTOMER][NEUTRAL] [PII] A.
[AGENT][NEUTRAL] OK, thank you. And the policy number?
[CUSTOMER][NEUTRAL] It would be 02625768.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, um, it would be 956 area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me one moment please.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh, we also need
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right
[AGENT][POSITIVE] OK, give me one moment, I apologize.
[CUSTOMER][POSITIVE] No problem ma'am.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Give me [PII].
[CUSTOMER][POSITIVE] if you go to this I was like, OK, yeah thank you.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK let me see.
[AGENT][NEUTRAL] You said the benefits were cut off on the on the fax back?
[CUSTOMER][NEUTRAL] Yes ma'am, it just, it just shows like half of the benefits like I'm not able to see the frequency or the maximum.
[AGENT][NEUTRAL] But it should be on the first page. Oh, so the first page it was cut off. OK, give me one moment.
[CUSTOMER][NEUTRAL] No that's what we were
[CUSTOMER][NEUTRAL] Everything but you look like.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] How many
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I can verify that benefit for you. Uh, let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready, miss.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification coverage. The patient has a benefit max up to $750 per calendar year and a $50 deductible that is applied to everything but preventative services.
[AGENT][NEUTRAL] Uh, preventative pays 100% of UCR.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays 80.
[AGENT][NEUTRAL] And under this plan, major services are not covered, and that would include endoperio oral surgery and prosthetic repair.
[CUSTOMER][NEUTRAL] So no coverage for Eo perio is Perry O'Donnell falling under the preventative or basic?
[AGENT][NEUTRAL] Uh, that falls under a major, so ma'am, it's not covered.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] How about restorativeness for fillings?
[CUSTOMER][NEUTRAL] They don't know
[AGENT][NEUTRAL] Fillings are covered as basic, just not any major services like crowns, bridges, partials, dentures, endodontic, periodontic, oral surgery.
[CUSTOMER][NEGATIVE] Understood and you stated that panel and FMX are falling under basic.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Has there been any of the maximum use?
[AGENT][NEUTRAL] Uh, no, ma'am. Uh, the benefits have not been used nor the deductible been met.
[CUSTOMER][POSITIVE] Not bad.
[CUSTOMER][NEUTRAL] And for the other X-rays, are those 100%?
[AGENT][NEUTRAL] Uh, bite wings, uh, fall under prevent it, it's 100% of UCR, uh, PAs and FMX PN that falls on a basic.
[CUSTOMER][NEUTRAL] So it's.
[CUSTOMER][NEUTRAL] Basic and for the fee schedule now would it be under the parenting fee schedule?
[AGENT][NEUTRAL] Well, we just pay the UCR if you participate with Carrington, I guess you would go by what the schedule you have with uh contracted with them.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no problem, I'll go ahead and let my manager know and that was just my question.
[AGENT][POSITIVE] OK. Uh, thank you for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] Likewise, ma'am.
[AGENT][NEUTRAL] Bye.