AccountId: 011433970860
ContactId: e7ec8224-7760-4210-836c-a9cbb915cc64
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357470 ms
Total Talk Time (AGENT): 108198 ms
Total Talk Time (CUSTOMER): 162784 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/e7ec8224-7760-4210-836c-a9cbb915cc64_20250124T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I, um, previously called to get a patient's eligibility and benefits verified. However, they sent a fax and this fax we received is, you know, we can barely see the, the words on it, so, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I was just, you know, wanting to give you guys a call back to see if basically um we can just do a brief breakdown over the phone it's not gonna take long.
[AGENT][NEUTRAL] Of course, of course.
[CUSTOMER][NEUTRAL] If you have a moment please? OK, OK, alright, alright.
[AGENT][NEUTRAL] Of course, before we get started, I'm sorry, may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and spell that for me for documentation.
[CUSTOMER][NEUTRAL] Um, it's [PII]
[AGENT][POSITIVE] Thank you and your callback number if we are disconnected please [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the policy number, please? Thank you.
[CUSTOMER][NEUTRAL] So it's 02451064.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, it is [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much, [PII], one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I have that number pulled up and I can give you a verbal breakdown over the phone. Give me one second more please, just to check something.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you for your patience. This number shows effective as of [PII]. She is the policy holder.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. She has a $500 calendar year max for covered benefits with a $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Um, do you accept assignment of benefits to non-participating provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Do you participate and provider discount supply if benefits are exhausted.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm assuming that no discounts apply for non-covered services?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does the deductible, does it apply to preventative, basic, and major?
[AGENT][NEGATIVE] Um, there's no major coverage. It only applies to basic.
[CUSTOMER][NEUTRAL] Just basic and OK alright and what is the individual deductible? What is that amount?
[AGENT][NEUTRAL] It's $50.
[CUSTOMER][NEUTRAL] 50, OK, and is there an individual maximum?
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] Individual maximum is $500.
[CUSTOMER][NEUTRAL] 500 benefits used.
[AGENT][NEUTRAL] No benefits have been used for this year?
[CUSTOMER][NEUTRAL] Thank you and is there ortho coverage?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No ortho coverage, OK. And for the diagnostic preventative care, is that at 100%?
[AGENT][NEUTRAL] Um, preventative is covered at 100% of allowable and basic is covered at 80%.
[AGENT][NEUTRAL] In regards to bite wings, I'm sorry.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is uh.
[CUSTOMER][NEUTRAL] Well, you said there's no major, so major wouldn't be on this coverage?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so no majors, just preventative and basic OK alright.
[CUSTOMER][NEUTRAL] And there's no waiting period?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] As far as indo down 6 and payroll dances, will they follow up on the basic?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] They fall under major.
[CUSTOMER][NEUTRAL] OK, so it's not, OK, so it's not covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK give me just a second here. Let me put this information in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and.
[CUSTOMER][NEUTRAL] For perial maintenance, will that be preventive care or basic?
[AGENT][NEUTRAL] That is considered major.
[CUSTOMER][NEUTRAL] That's major. OK, so that's not covered either. OK, and simple extractions will be basic.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] No missing spa.
[AGENT][NEGATIVE] There is a missing tooth clause.
[CUSTOMER][NEUTRAL] There is OK.
[CUSTOMER][NEUTRAL] Alright, and then for the exam and cleaning frequency?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that a twice every per calendar year?
[AGENT][NEUTRAL] Um, proceeds are once every 6 months, and the exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] How about for bite wings?
[AGENT][NEUTRAL] In wings a 1 per 12 month period covered under preventative.
[CUSTOMER][NEUTRAL] For FMX and panel.
[AGENT][NEUTRAL] Um, they share this 1 per 5 year period under basic 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for flu is fluoride covered?
[AGENT][NEUTRAL] Um, Florida is covered and that's one for 12 month period under the age of [PII].
[CUSTOMER][NEUTRAL] And how about for Perio SRP?
[AGENT][NEGATIVE] No, those are not covered.
[CUSTOMER][NEGATIVE] It's not covered OK.
[CUSTOMER][NEUTRAL] And I'm assuming that dentures, bridges, and crowns are not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] And that sums it up for me and thank you so much for your time.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you so much for calling AP. You have a great day and weekends. Thank you.
[CUSTOMER][NEUTRAL] You too bye bye um.
[AGENT][NEUTRAL] Bye.