AccountId: 011433970860
ContactId: e568e5ff-defa-489a-b9c8-a89bf1b72e5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422730 ms
Total Talk Time (AGENT): 183294 ms
Total Talk Time (CUSTOMER): 113749 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/e568e5ff-defa-489a-b9c8-a89bf1b72e5f_20250317T18:35_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 [PII], this is [PII] calling on behalf of the dental office to check on eligibility and benefits for a patient on a recorded line. Can you please help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to assist you with the dental benefits. And did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the member ID will be?
[CUSTOMER][NEUTRAL] 02576415.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth will be on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Participation, first, can you just help me with the group name, group number?
[AGENT][NEUTRAL] Sure. The group name is T like Tom, R like Robert, C like cat, Staffing Services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The group number is 70055.
[CUSTOMER][POSITIVE] Thank you so much. And uh can you also, uh also please help me with this COB uh if it's on that one?
[AGENT][NEUTRAL] Um, there's no coordination of benefits on our policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh this is your current plan, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] This is the current plan, right?
[AGENT][NEUTRAL] Yes, it's a calendar year plan.
[CUSTOMER][NEUTRAL] Thank you. And uh can you please help me the annual plan maximum deductible?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, the calendar year max for the policy is up to $500 per calendar year per covered insured, I'm sorry, and the calendar year deductible is $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] Nothing is nothing that, right?
[AGENT][NEUTRAL] Let me double check for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] And so far nothing has been used or met, correct.
[CUSTOMER][POSITIVE] Thank you so much and no missing suit class waiting for it, correct?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] No missing tooth cloths, no wedding trip, right?
[AGENT][NEGATIVE] This policy does have a missing tooth cloth.
[AGENT][NEUTRAL] There is no waiting period because major expenses are not covered on this policy?
[AGENT][NEUTRAL] Major for us includes endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] Oral surgery, OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And uh for diagnostic transitive basic, can you help me?
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly? You said diagnostic and
[CUSTOMER][NEUTRAL] Diagnostic preventative and basic.
[AGENT][NEUTRAL] Preventative is covered at 100%.
[AGENT][NEUTRAL] Radiographs and FMX expenses are covered at 80%.
[AGENT][NEUTRAL] Basic expenses and basic restorative expenses are also covered at 80%.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And for this patient orthodontic, is it covered?
[AGENT][NEUTRAL] But the treatment is not covered.
[CUSTOMER][NEUTRAL] Uh the consultation.
[CUSTOMER][NEUTRAL] 19,310, can you please help me the fre can see?
[AGENT][NEUTRAL] 9310. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, there's no frequency. It's under basic at 80%.
[CUSTOMER][POSITIVE] Got it. Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the rest of the frequencies will remain the same, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The rest of the frequencies will remain the same, right?
[AGENT][NEUTRAL] Can you say that slowly?
[CUSTOMER][NEUTRAL] Can you please help me with the fillings if there's any downgrade?
[AGENT][NEUTRAL] There's no downgrades on the policy.
[CUSTOMER][NEUTRAL] Got it. Thank you. And history, can you please check if there's any history that might affect frequencies?
[AGENT][NEUTRAL] Um, so we've only processed one claim, um,
[AGENT][NEUTRAL] Do you have any particular codes that you're looking in reference to or you want me to just tell you the codes on this claim?
[CUSTOMER][NEUTRAL] Uh, you could go ahead with the codes other games.
[AGENT][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] The codes used is 0015000367.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 00274.
[AGENT][NEUTRAL] 00220
[AGENT][NEUTRAL] 00230.
[AGENT][NEUTRAL] And there's 1234 lines, 4 different 5 different teeth for that have the code 00230.
[AGENT][NEUTRAL] So it's there 5 times in total.
[AGENT][NEUTRAL] This is different teeth
[CUSTOMER][POSITIVE] Thank you. I have it back.
[AGENT][NEUTRAL] Um, those are the only clothes that were used on this claim.
[CUSTOMER][NEUTRAL] OK, can you please check for uh [PII] and [PII] for the last 5 years?
[AGENT][NEUTRAL] These are the only codes, this is the only claim we've processed. So outside of this, there is no other codes that have history. This is the only claim.
[CUSTOMER][NEUTRAL] Uh, alright, got it then. And uh with that, can you please help me to please me the address and that.
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] And with that, [PII], thank you so much for your help today and enjoy the rest of you and have a very good day. Take care. Bye for now.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much. I only have one patient for now. Thank you.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.