AccountId: 011433970860
ContactId: e926f5fc-c4a2-4e9d-89d5-742172387dac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506489 ms
Total Talk Time (AGENT): 185468 ms
Total Talk Time (CUSTOMER): 213844 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/e926f5fc-c4a2-4e9d-89d5-742172387dac_20250324T16:35_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the rental office to check the eligibility and benefit for a member on a recorded line. Could you please help about that?
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you repeat your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can I have a callback number for you, [PII], and the policy number.
[AGENT][POSITIVE] I'll be able to assist you.
[CUSTOMER][NEUTRAL] Sure, call back number is.
[CUSTOMER][NEUTRAL] Mhm callback number is [PII] and within policy number of D as in Delta 43509524.
[AGENT][NEUTRAL] I do apologize but that's not pulling up a policy number.
[CUSTOMER][NEUTRAL] Uh, could you please do a name and date of birth sir if possible.
[AGENT][NEUTRAL] You have the member social.
[CUSTOMER][NEUTRAL] Uh, let me check if I'm having that. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I don't see to have that.
[AGENT][NEUTRAL] So, could you provide me with the spelling of the member's last name, then the spelling of the first name?
[CUSTOMER][NEUTRAL] So the number for last name is [PII].
[CUSTOMER][NEUTRAL] Should I spell that to you?
[AGENT][NEUTRAL] Yeah, please. Mhm.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] Sure, it's [PII] [PII] [PII] [PII] [PII] [PII], [PII] [PII] [PII], [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you verify the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility, correct?
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] This policy has been active, [PII], since [PII] and is currently active.
[CUSTOMER][NEUTRAL] [PII] and it's the number the subscriber.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, what about the group name on this plan?
[AGENT][NEUTRAL] Group name is T as in Tom, R as in Romeo, C as in Charlie, Staffing services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Staffing services, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] 70055.
[CUSTOMER][NEUTRAL] 70055 and can I get the correct member ID?
[AGENT][NEUTRAL] The member's ID is [PII].
[CUSTOMER][NEUTRAL] So, it's [PII], right?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] So the correct number ID is 2299572, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Is it a family plan or a single coverage?
[AGENT][NEUTRAL] Sing coverage.
[CUSTOMER][NEUTRAL] OK. And could you please help me know uh what kind of plan it is?
[AGENT][NEUTRAL] This is a dental policy that covers dental benefits, dental services. The policy has a maximum benefit amount of $500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a $50 deductible that does not apply to preventative services, and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Is this the indemnity plan or the UCR plan?
[AGENT][NEUTRAL] This is a UCR user and customary based on user and custom error.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. What about the claiminging address?
[AGENT][NEUTRAL] The claim's mailing address will be addressed to [PII].
[AGENT][NEUTRAL] A [PII]?
[AGENT][NEUTRAL] [PII] that's [PII], [PII].
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and is this the same claiming address for all the American public dental plan?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, what about the, uh, and anything used on that on the deductible and the max?
[AGENT][NEUTRAL] The member has not utilized any of their benefits for [PII] or have any history on file.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] You said it's a Canada plan, right?
[AGENT][NEUTRAL] Yes, that is from January to December, I never said it, but January to December is the calendar plan.
[CUSTOMER][NEUTRAL] OK. Is orthodontic service covered?
[AGENT][NEUTRAL] No, the policy only covers preventative and basic services.
[AGENT][NEUTRAL] And when I say preventative and basic, I mean preventative and basic only. And no major endoperoprosthesis or surgery, crowns, bridges, ortho, none of that is covered under the policy.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK, great. And is there a waiting period on this plan?
[AGENT][NEUTRAL] Um, there is no waiting period, but there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the frequency for preventative services?
[AGENT][NEUTRAL] So profies and cleaners are once every 6 months, or evaluations are 2 for 12 month period. Bite wing is once for 12 months and then full mouth X-rays is considered as basic. Full mouth X-rays and panoramics are once every 5 years.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. What about soroid?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK. What about period maintenance? Is it covered?
[AGENT][NEUTRAL] No, that's not covered under the policy.
[CUSTOMER][POSITIVE] Simple extraction.
[AGENT][NEUTRAL] 7140 is covered on the basic at 80%.
[CUSTOMER][NEUTRAL] And, oral cancer screening, is it covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] And crown residentials won't be covered, right?
[AGENT][NEUTRAL] This October.
[CUSTOMER][NEUTRAL] Any downgrade for filings?
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEGATIVE] No that great and is the authorization mandatory?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and pre-authorization isn't mandatory for all the American public life plan, right? American benefit public life plan, right?
[AGENT][NEUTRAL] No, it's not mandatory. You, if you would like to know how much we will pay on services, then you can send in a pre-treat. [PII], could you spell your name for me?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEGATIVE] Oh, I was gonna spell that wrong.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And could you please help me with your name and the reference number?
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And the reference number?
[AGENT][NEUTRAL] We don't provide those. You can use my name in today's date as reference.
[CUSTOMER][NEUTRAL] And Shia, uh, one last question. Pre-authorization is it mandatory for all the American public life plan, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, great. Thank you for the information.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] Thanks for calling APL and you have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you for your help.
[CUSTOMER][NEUTRAL] Goodbye.