AccountId: 011433970860
ContactId: e1570dda-f89b-4807-9b22-0832dcf69f0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519270 ms
Total Talk Time (AGENT): 145821 ms
Total Talk Time (CUSTOMER): 179463 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/e1570dda-f89b-4807-9b22-0832dcf69f0c_20250116T20:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. I was calling in regards to a patient's insurance policy.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] May I ask who's calling?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yes ma'am. It's [PII] with no extension.
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, it is 02117071.
[AGENT][NEUTRAL] Thank you, [PII], hold on one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Uh yes ma'am. I called earlier uh this morning and I've been waiting for a fax back that I haven't received yet.
[AGENT][NEUTRAL] OK, what's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm gonna fax it to you right now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just faxed it to you, um.
[AGENT][NEUTRAL] Would you like for me to give them to you over the phone or?
[CUSTOMER][NEUTRAL] Uh, yeah, well, the last representative I spoke to, she said that it would give.
[CUSTOMER][NEUTRAL] Um, you guys are not like a PPO or an HMO policy. You guys just pay by UCR. So do you have, do they give the exact amount of what they're going to pay for each procedure?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] No, ma'am, I'd have to have the procedure and I have to look up the usual and customary.
[CUSTOMER][NEUTRAL] OK, so it, but does it go by percentages or exact amount?
[AGENT][NEUTRAL] They just give you
[AGENT][NEUTRAL] Percentages, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so their percentages.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, that's, she explained it differently to me. Let me see. So what is the annual maximum for this, uh, policy?
[AGENT][NEUTRAL] OK, any benefits given over the phone is not a guarantee of payment. It was effective [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The maximum is 1500.
[CUSTOMER][NEUTRAL] OK, is there a deductible?
[AGENT][NEUTRAL] $50 on everything but preventative.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and preventative, basic, and major, what are their percentages?
[AGENT][NEUTRAL] Preventative is 100% the usual and customary rate. Basic is 80%, and major is 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, exam X-rays and cleaning, are they all considered preventative?
[AGENT][NEUTRAL] The uh certain exams are under preventative, the 120 and 150 is under preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Trophies are under preventative and bite wings.
[CUSTOMER][NEUTRAL] OK, so are the periicals.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] And full mile series are basic.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that's what I figured.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Extractions and fillings, are they considered basic?
[AGENT][NEUTRAL] Uh, only the simple extraction, the 7140 and the fillings are uh basic.
[AGENT][NEUTRAL] Everything else is major.
[CUSTOMER][NEUTRAL] And that includes uh major includes the periodontics.
[AGENT][NEUTRAL] Yes, ma'am. Endoperio or surgery, crowns, bridges, partials, dentures, implants are not covered, and there's no orthodontic coverage.
[CUSTOMER][NEUTRAL] OK, and then I'd need to ask about a specific code A 4346, a scaling and presence. Is that covered on the policy at all?
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, do you have a missing tooth cloth?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is there a uh huh.
[AGENT][NEUTRAL] I'm not sure why, but that fax is not going through. It's abandoned it. So it was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEGATIVE] It's not going through. That's probably why you didn't get it.
[CUSTOMER][NEUTRAL] Um, [PII], yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That is the only fax number that we have.
[CUSTOMER][NEUTRAL] Is there, um, I'm sorry, is there a replacement clause?
[AGENT][NEUTRAL] Crowns and bridges is 7 years, partials and dentures is 5 years.
[CUSTOMER][NEUTRAL] Is there a night guard coverage?
[AGENT][NEUTRAL] What's the procedure code?
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] Yes, it would be under major.
[CUSTOMER][NEUTRAL] And do you pay on prey date?
[AGENT][NEUTRAL] Either
[CUSTOMER][NEUTRAL] It doesn't matter.
[AGENT][NEUTRAL] It doesn't matter.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, it looks like.
[CUSTOMER][NEUTRAL] That's pretty much what I needed um uh also for that fax back, are you able to maybe email it to me?
[CUSTOMER][NEUTRAL] Or is it only fax?
[AGENT][NEUTRAL] It's usually only fact because our email is not secure enough.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I'm not sure why it's not going through. It just says abandon after. I think it'll try 5 times to see if it will go through. It's tried twice already.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEGATIVE] And it's still not going through.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, alright, uh, I'll, I'll do with this what I can.
[CUSTOMER][POSITIVE] And then if I need it, if I really need it, I'll call back again later.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, ma'am, that's gonna be all. Thank you so much for your help.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.