AccountId: 011433970860
ContactId: e389b9ce-f0cb-4a70-aa5e-b8f3264ff647
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397500 ms
Total Talk Time (AGENT): 127031 ms
Total Talk Time (CUSTOMER): 190972 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/e389b9ce-f0cb-4a70-aa5e-b8f3264ff647_20250110T20:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes. Hello. My name is [PII] and I'm calling from dental provider. Um, I would like to check the benefit plan of the patient.
[AGENT][POSITIVE] OK yeah I can check benefits for you [PII] uh can I get a good call back number for me first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, sure. Uh, the phone number will be [PII].
[AGENT][NEUTRAL] Yeah thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. Policy number will be
[CUSTOMER][NEUTRAL] 02408544.
[AGENT][NEUTRAL] Thank you. And then uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yes. Uh, that will be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you the fax back showing all covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Um, actually, I do have the fastback already. I just want to ask some specific questions on the benefit plan.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] Uh, I, I'm checking, it looks like the patient has no waiting period on any services. Is that correct?
[AGENT][NEUTRAL] Um, for this plan there's no waiting period, uh, except for major expenses.
[CUSTOMER][NEUTRAL] Um, yes, I saw.
[AGENT][NEUTRAL] Which is a 12 month waiting period.
[CUSTOMER][NEUTRAL] Yes, I saw on the fact there is 12 month waiting period. Um, but the effective date was [PII], so it's passed already. Is that correct?
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] That's correct, yeah.
[CUSTOMER][NEUTRAL] Yes, OK. Thank you. Um, and, uh, with the annual max of 1500, is diagnostic and preventive will apply to the annual max?
[AGENT][NEUTRAL] The yes it does apply to the annual max.
[AGENT][NEUTRAL] Um, but the deductible, uh, does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] Yes, and the.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, sure, um, and the plan run by calendar year, right?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Calendar year, right? Uh, sorry, I missed the information.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Oh yes. OK, thank you. Um, and, uh, for the filling procedure, is it downgraded or not?
[AGENT][POSITIVE] No, no downgrades.
[CUSTOMER][NEUTRAL] Yes, thank you. And uh for the code 4341 for the deep cleaning, can we perform on for court on the same day?
[AGENT][NEUTRAL] Yes, all for today.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] And uh with the other surgery expenses, uh, service, do we need to submit to medical first?
[AGENT][NEGATIVE] Oh, that's not necessary.
[CUSTOMER][NEUTRAL] Yes. So it will go straight to dental, right?
[AGENT][NEUTRAL] It can, yes.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Um, and, uh, will we pay on sick day or prepay for the crown?
[AGENT][NEUTRAL] Either one
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] And uh I do have the two codes that need to check if they are covered because I don't see the code on the back pack. So can you have to check?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, the first one is uh 9243.
[AGENT][NEUTRAL] 924-3 I will say um if it's not listed on the fax back uh it is not going to be a covered procedure but I'll double check just in case.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] OK, yeah, 9243 is not a covered procedure. What was that other one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, the last one is 9944.
[AGENT][NEUTRAL] 9944, that is not going to be a covered procedure either.
[CUSTOMER][NEUTRAL] Yes, thank you. Um, and, uh, can you have to check if patient has any history that might affect the frequency?
[AGENT][NEUTRAL] Yes, give me just a moment, let me check that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this was just for [PII] correct?
[CUSTOMER][NEUTRAL] Um, actually, I do want to check for the member also, the dependent.
[AGENT][NEUTRAL] Which dependent?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] So, uh, I would like to check for [PII] and [PII].
[AGENT][NEUTRAL] Um, I don't have anyone with that name on this policy. I have [PII], and [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Uh, yes. That should be, uh, current with the date of birth, [PII].
[AGENT][NEUTRAL] OK, so we're needing to check for [PII].
[CUSTOMER][POSITIVE] Yes, [PII] and Chase also, uh, oh, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I don't have any history for any of them on file.
[CUSTOMER][NEUTRAL] Yes, um, and can I also request the faxback for [PII] and Chase also?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What's that fax number for you?
[CUSTOMER][NEUTRAL] Yes. Uh, that will be [PII].
[AGENT][NEUTRAL] OK, let me read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, and would I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Um, let me double check again.
[CUSTOMER][NEUTRAL] Uh, I think that will be all for today's call. And, uh, do we have the reference number for our call?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] Uh, that will be all. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Yes, you too. Thank you.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Yeah.