AccountId: 011433970860
ContactId: e01f0d4b-1376-4872-a618-248dcc240c44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262230 ms
Total Talk Time (AGENT): 90108 ms
Total Talk Time (CUSTOMER): 99134 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/e01f0d4b-1376-4872-a618-248dcc240c44_20250403T13:35_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Smile Creations. How are you?
[AGENT][NEUTRAL] I'm doing fine. How are you?
[CUSTOMER][POSITIVE] I'm wonderful. I needed to check a patient's eligibility and benefits.
[AGENT][NEUTRAL] OK. Do you have a callback number I can get in case we get disconnected, I can call you back?
[CUSTOMER][POSITIVE] Absolutely, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is going to be 0259.
[CUSTOMER][NEUTRAL] 7328
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am. Well, number one, is this a PPO policy?
[AGENT][NEUTRAL] OK, I can look that up for you. Yes, sir, it is a PPO policy that goes through [PII], but we do pay to non-providers as well. We do accept assignment.
[CUSTOMER][NEUTRAL] OK, and what is the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And is there a projected end date?
[AGENT][NEUTRAL] It is not, it's still active.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] Um, for preventative, basic, and major, what are the coverages?
[AGENT][NEUTRAL] Any
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment, preventative, is that 100% the usual and customary rate?
[AGENT][NEUTRAL] Basic is 80%.
[AGENT][NEGATIVE] And major is not covered.
[AGENT][NEUTRAL] Endopperio or surgery crowns, bridges, partials, dentures are not covered.
[CUSTOMER][NEUTRAL] OK, not covered.
[CUSTOMER][NEUTRAL] OK, that's what I needed. And what is the maximum?
[AGENT][POSITIVE] It is $500 per calendar year. It applies to everything.
[CUSTOMER][NEUTRAL] OK, and how much of that maximum has been used?
[AGENT][NEUTRAL] Hold on just a moment, I'll check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] He has not used anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this basically has preventative and basic coverage, um, which, um, up under basic with all your resins.
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] And simple extraction.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And simple extractions, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The full mouth, the pan, that falls under basic as well.
[CUSTOMER][NEUTRAL] And as far
[CUSTOMER][NEUTRAL] OK, what about cleanings?
[AGENT][NEUTRAL] Cleanings would be under preventative.
[CUSTOMER][NEUTRAL] And um if the SRP is needed.
[AGENT][NEUTRAL] Was the code
[CUSTOMER][NEUTRAL] Um, 49, 0, hold on.
[AGENT][NEGATIVE] It's not covered. No Perio is covered.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] All right, that's what I needed for now. Um, is there any way I can um get you to fax over a, um, a summary of benefits?
[AGENT][NEUTRAL] Yes, I can fax it to you. What's your fax number?
[CUSTOMER][POSITIVE] Thank you so much. It's gonna be [PII].
[CUSTOMER][NEUTRAL] 786.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll fax that to you. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, ma'am. [PII], you've been such a great help. Thank you so much.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.