AccountId: 011433970860
ContactId: ea667cb2-a377-4d93-9442-f4781e238c34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611270 ms
Total Talk Time (AGENT): 220269 ms
Total Talk Time (CUSTOMER): 189381 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/ea667cb2-a377-4d93-9442-f4781e238c34_20250616T17:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon.
[AGENT][NEUTRAL] Yeah, my name is
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, hi, good morning.
[CUSTOMER][NEUTRAL] Yeah, I would like to verify eligibility and benefits.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the eligibility and benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah. My name is [PII] and our phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII] May. I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number, I have the group number. Oh, the policy certificate is 02621899.
[AGENT][NEUTRAL] OK, you said you needed the eligibility, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII], [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] OK. Uh, can I get the, the, uh, maximum benefits and the frequencies?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So I'm just waiting for it to come up. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's kind of taking its time here. I apologize. So for the calendar year max, the total is $500 per covered insured. There is a $50 deductible up to $150 per family. That does not apply to the um preventative.
[AGENT][NEUTRAL] Preventative, is that 100%?
[CUSTOMER][NEUTRAL] Oh, so the deduct
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the deductible is 250?
[AGENT][NEUTRAL] No, the deductible is $50 per person up to $150 per family, but this is an individual policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] And um preventative is covered at 100%.
[AGENT][NEUTRAL] Radiograph and FMX full mouth X-rays. Basic and basic restorative are all covered at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This
[AGENT][NEUTRAL] This policy does not cover major expenses. Major for us includes endodontic, periodontic, prosodontic, or and oral surgery.
[CUSTOMER][NEUTRAL] So, so, uh, it, it only includes the X-rays, prophylaxis, and fillings.
[AGENT][NEUTRAL] I mean, those are some of the things listed under basic um and preventative, but I mean it covers like your sealants.
[AGENT][NEUTRAL] Um, your fillings like it's your bite wings, it's, it's, it's a list of codes on the facts back.
[AGENT][NEUTRAL] Of covered um codes. Did you need a copy?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh yes. Uh, is it possible to, uh, to fax it to us?
[AGENT][POSITIVE] Yes, it's a good fax number for you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you said the, uh, the one, OK.
[AGENT][NEUTRAL] Alright, sounds
[AGENT][NEUTRAL] No, go ahead, it's OK.
[CUSTOMER][NEUTRAL] Yeah, the one that I gave you the, the, it's the policy number, right? So, what ID should I use? It's the same one?
[CUSTOMER][NEUTRAL] The ID number?
[AGENT][NEUTRAL] What ID should you use in for, I don't know, yes, that is the policy number, but I don't understand what what member ID should you use for what? It is.
[CUSTOMER][NEUTRAL] Yeah, to, to send in the claim.
[AGENT][NEUTRAL] Yes, it would be the policy number, the 2621899. That's the only number.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So this one is an individual, you said it's an individual, uh,
[CUSTOMER][NEUTRAL] Policy. So there will be no dependent.
[AGENT][NEUTRAL] Right, there's no spouse or dependents on file.
[CUSTOMER][NEUTRAL] Oh, OK. So, the spouse has a different, uh, ID number also.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah. Can I, can I, uh, check on the spouse?
[AGENT][NEUTRAL] OK, um, hold on one moment, let me note this policy. So the, the spouse has a different policy, or are you asking if the spouse is on this policy?
[CUSTOMER][NEUTRAL] It's the same I think it's a, it's a different policy number.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I note this policy?
[CUSTOMER][POSITIVE] Yes, please. Thank you.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. And may I have the next um policy number?
[CUSTOMER][NEUTRAL] OK, hold on just a minute. It's uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 026.
[CUSTOMER][NEUTRAL] 21874.
[AGENT][NEUTRAL] 2026.
[AGENT][NEUTRAL] 1874.
[CUSTOMER][NEUTRAL] 21
[AGENT][NEUTRAL] 0 218.
[CUSTOMER][NEUTRAL] No, it's 02621874.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, can you verify um the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy is active, it's been effective since [PII] and the fax back um that I'm sending over is is the same policy. They have the same policy type, so it will be the same fact.
[CUSTOMER][NEUTRAL] Pali type. OK. So it's, it's, the maximum is $500 right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes. OK. And then, uh, where can I send in for the claims?
[AGENT][NEUTRAL] Um, did you, so we have a payer ID, a mailing address, and a fax. That's all on the fax back. I can give it to you now as well.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] OK, which would you prefer? Would you like all three?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Um, which
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Would you like all three?
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] I'm asking if you would like all three of the ways to submit a claim or did you prefer one?
[CUSTOMER][NEUTRAL] Uh, just, just, uh, uh, we, we can do, we can do electronic claims, right?
[AGENT][NEUTRAL] Yes, did you need the payer ID?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's 60.
[AGENT][NEUTRAL] 80.
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] 160801. And, and the address, is it [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Yeah, that's all. Thank you.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL [PII] you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.