AccountId: 011433970860
ContactId: e83795d7-b816-46c2-b9d4-267cc5558afb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556940 ms
Total Talk Time (AGENT): 149739 ms
Total Talk Time (CUSTOMER): 213933 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/e83795d7-b816-46c2-b9d4-267cc5558afb_20250321T18:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling on behalf of the dental office to check on the eligibility and benefits of a patient on a recorded call. Would you please help me with that?
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] The member ID I have here would be 02340041.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name here would be [PII], uh, [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits for this member?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, and would you like a fax back as well?
[CUSTOMER][NEUTRAL] Uh, right. Um, I do have the information. I just need to confirm because here, the one I have would be, uh,
[CUSTOMER][NEUTRAL] Alright, can you just provide me first with the co-insurance, this will clarify.
[AGENT][NEUTRAL] OK, so this policy doesn't have a co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, doesn't have a co-insurance as it.
[AGENT][NEUTRAL] It doesn't have a co-insurance.
[CUSTOMER][NEUTRAL] OK. So, um, so the patient pays the 100%?
[AGENT][NEUTRAL] So for the fax back that you have, it should indicate the calendar year max and then the calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, 500 plan max and 50 deductible.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There is no family deductible. Ortho is not covered.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] And in regards to this member policy verification of coverage does not guarantee the payment of the claim. This is an individual policy though, so there is no family deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh yes, for the co-insurance you mentioned there is no coinsurance. So to confirm here, does the patient.
[AGENT][NEUTRAL] No,
[CUSTOMER][NEUTRAL] So does the patient pay 100%?
[AGENT][NEUTRAL] What do you mean that do they pay 100%? We will pay up to $500 max for their benefits.
[CUSTOMER][NEUTRAL] 100% of the
[CUSTOMER][NEUTRAL] That is the annual max, right?
[AGENT][POSITIVE] Yes, that we would pay out.
[CUSTOMER][NEUTRAL] All right, normally we do have co-insurance like 180, 50, the 1.5 years, 180, so I'm not sure.
[AGENT][NEUTRAL] So for the covered expenses listed down there with the category expenses, that is the percentage that they have for the preventative and then they also have the radiograph, the basic expenses, and the basic restorative expenses and that covers that 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And preventive coverage at 100%.
[AGENT][NEUTRAL] That's how much we will pay towards preventive is 100%.
[CUSTOMER][NEUTRAL] Yes, I mean, that is what I meant. OK, got it. Thank you. And there are no major services covered, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Which also includes endopyio oral surgeries.
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Do you have a code because codes are all listed down there. If that code is not listed on that text back, it is not covered.
[CUSTOMER][POSITIVE] Great. May I, may I know if there's any missing two clause or waiting period?
[AGENT][NEUTRAL] Stated in the common exclusion, this policy does have a missing two clause.
[CUSTOMER][NEUTRAL] OK, and there is no waiting period, right?
[AGENT][NEUTRAL] It says no waiting period listed on the fax back upon the category of expenses and waiting period in months.
[CUSTOMER][NEUTRAL] All right. Great. And for the history, can you please provide me with the history and the accumulation from the 500 if the patient has used anything?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] All right. So no history then, even for uh FMX and panel.
[AGENT][NEGATIVE] As of this year, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] I got it. FMX and panel is 1 for 5 calendar year, so.
[CUSTOMER][NEUTRAL] That's why I'm checking.
[AGENT][NEUTRAL] And you said FMX and panel?
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] And may I have those codes please?
[CUSTOMER][NEUTRAL] That would be 02100330.
[AGENT][NEUTRAL] So for the 0330, the member has used that benefit in 2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the year 2024, so we.
[AGENT][NEUTRAL] And for the 0210?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It's not showing that the member has used that benefit.
[CUSTOMER][NEUTRAL] Alright, but they share frequency, right?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] If it makes and panel. Mhm.
[AGENT][NEUTRAL] Yes, so 0210 and 0330, they do share frequencies which is a period of 5 years.
[CUSTOMER][POSITIVE] Go, yes, you're right. Thank you very much. All right, if that's all the information to check for the group name, group number, is it TRC staffing with the group number 70055?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the claims address [PII] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh just to confirm here, the coordination of benefits, sorry, uh is there any coordination of benefit, Tarika?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][POSITIVE] Oh, got it. And this time runs in my calendar, so thank you very much once again. Uh, I would do appreciate a fax back so I can recheck the information if that is OK with you.
[AGENT][NEUTRAL] OK, may I have a fax number please?
[CUSTOMER][POSITIVE] All right. Thank you. Uh, so,
[CUSTOMER][NEUTRAL] The fax number.
[CUSTOMER][NEUTRAL] That would be [PII]. I repeat, it is [PII].
[AGENT][NEUTRAL] OK, I will get that fax submitted over to you. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, no, just checking. May I know how long will it take for the fax uh for me to receive the appointments today. That's fine.
[AGENT][NEUTRAL] It should be received today.
[AGENT][NEUTRAL] By the end of business today.
[CUSTOMER][NEUTRAL] Alright, got it, I mean.
[CUSTOMER][NEUTRAL] All right. And the reference number of the call will be?
[AGENT][NEUTRAL] The reference number will be my first name [PII], last initial of H and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you once again. Have a wonderful day and bye for now.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too. Bye.