AccountId: 011433970860
ContactId: e65e33f5-3e32-4c1a-9a47-f6ef19d5b817
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218490 ms
Total Talk Time (AGENT): 93141 ms
Total Talk Time (CUSTOMER): 75157 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/e65e33f5-3e32-4c1a-9a47-f6ef19d5b817_20250609T12:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Clover History, and I'm calling to for eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] 569-9979799
[CUSTOMER][NEUTRAL] And the policy number is 02623315.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, just, uh, one, is there a possibility that you can give me a fax back with all the benefits, but I'm looking in right now just for preventative.
[AGENT][NEUTRAL] OK, so yes, I can fax you a copy of the fax back. Um, looking at the policy, there's no history on file, and hold on, I'm waiting for the fax back to come up now. Hold on one second.
[CUSTOMER][NEUTRAL] For now.
[AGENT][NEUTRAL] So on the fax back you'll see the calendar year max deductible, all the percentages, frequencies, exclusions, all the ways to file a claim, the network, um, and a list of covered codes. If the code you're looking for isn't on this list, it wouldn't be um covered by the policy.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, what's their max? I mean, can you tell me right off the bat just so that way I can bring the patient back.
[AGENT][NEUTRAL] And I was
[AGENT][NEUTRAL] Sure. It's $500 per calendar year with the $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And preventative.
[AGENT][NEUTRAL] Preventative is covered at 100% of allowable.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's a good fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, so I just sent that over to you. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, if you can just tell me what basic and nature.
[AGENT][NEUTRAL] Basic is at 80%. This policy doesn't cover major. Major for us includes endodontic, periodontic, prosodontic, and all oral surgery codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, so, um, and crowns would be considered major.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, um, let me see.
[CUSTOMER][POSITIVE] Alrighty, hopefully I get my, my, my, uh, fax back, uh, quickly.
[CUSTOMER][POSITIVE] Alrighty well thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great week.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.