AccountId: 011433970860
ContactId: ecf5ac86-9b6a-4663-860a-9882abfe28a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316570 ms
Total Talk Time (AGENT): 88669 ms
Total Talk Time (CUSTOMER): 114882 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/ecf5ac86-9b6a-4663-860a-9882abfe28a7_20250513T21:00_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII] calling on behalf of the provider to check on the dental eligibility and benefits for one of my patients. Can you please help me with that?
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the dental um eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure. Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Sure. ID is 02485094.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And did you need a copy of the fax back or did you have questions about the fax back?
[CUSTOMER][NEUTRAL] Um, actually I have some specific questions only if you don't mind, can I go for my questions?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does the plan run on the calendar year and the coordination is it standard?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth or any waiting period?
[AGENT][NEGATIVE] There is a missing tooth cloth. There is no waiting period because major is not covered on this policy.
[CUSTOMER][NEUTRAL] OK. No major and or coverage, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. And the 42393, the poster composites do they downgrade?
[AGENT][NEUTRAL] Um, no, there's no downgrade.
[CUSTOMER][NEUTRAL] Mm. Got it. The annual max for this patient. I have is $500 with $50 individual deductible, $150 for family. Is that correct? And can I have the used amount, please?
[AGENT][NEUTRAL] Hold on one moment
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yes, that is correct, the $500 max, the $50 deductible, and I'm just, um, pulling up the accumulations now. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure. Mhm.
[AGENT][NEGATIVE] Um, so far for 2025, he has not used any of the benefits.
[CUSTOMER][NEUTRAL] Got it. So no history for 2025 for the patient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, any history for diagnostic and preventative services for previous years that might affect the frequency?
[AGENT][NEUTRAL] Um, can you provide codes that you'd like me to check on?
[CUSTOMER][NEUTRAL] Sure. 0120. Should I all the time or one by one?
[AGENT][NEUTRAL] All all together.
[CUSTOMER][NEUTRAL] Mhm. Got it. Uh, the postcode is [PII].
[CUSTOMER][NEUTRAL] 0330 1110 and 1206.
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So the only code that had history was 0330 and that was [PII].
[CUSTOMER][NEUTRAL] 4 2024. Wonderful. And other than that, no history that might affect the frequencies, right?
[AGENT][NEUTRAL] Um, I can only go by the codes because we'll have to go through each claim. Are there any other codes you'd like me to check for you?
[CUSTOMER][NEUTRAL] No, that will be all. Uh, for 1206, can I just have the age limit for that one if there's any?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII] is not a covered code on this policy. It's not listed on the fax back.
[CUSTOMER][POSITIVE] Oh, OK, no problem. And so I'm done with my questions for this patient. I want you. This was the only patient I had today, so thank you so very much for this patient really appreciate it.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Same to us all. Bye-bye.
[AGENT][NEUTRAL] Bye bye.