AccountId: 011433970860
ContactId: ef3e6335-3e66-4178-b14f-44d9459705ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232669 ms
Total Talk Time (AGENT): 111722 ms
Total Talk Time (CUSTOMER): 94492 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/ef3e6335-3e66-4178-b14f-44d9459705ff_20250214T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is um [PII] with Anderson and Floyd Dentistry. I have a patient here with, um, your insurance, um, and I'm just trying to find eligibility, um, his eligibility for dental and his, um, coverage.
[AGENT][NEUTRAL] Sure, eligibility and benefits, um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yep, it is let me policy there we go 02589583.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII]'s birthday is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII]. Uh, so this policy is active effective date was [PII].
[AGENT][NEUTRAL] Oh, wait a minute.
[AGENT][NEUTRAL] Yes, uh, let's see, I think this one is actually going to take effect [PII]. Give me just a moment. I was like, we're not there yet.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, yeah, that is what I have as the effective date. um did you want me to send you the uh fax back that shows the covered procedures and benefit information?
[CUSTOMER][NEUTRAL] Would you be able to tell me them? Um, I called yesterday and they're supposed to fax them to me but it never went through so I don't know if there's a weird thing going on um what is his annual max?
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yeah, give me just a moment let me get it pulled up.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so the calendar year maximum is $1500. There is a $50 deductible, uh, that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, what is this coverage for restorative?
[AGENT][NEUTRAL] Um, basic
[AGENT][POSITIVE] What kind of restorative I'm sorry.
[CUSTOMER][NEUTRAL] Oh yep sorry just basic restorative yep.
[AGENT][NEUTRAL] That's OK, yeah, basic is going to be uh 80%. This plan goes off of UCR, uh, so it'd be 80% of UCR.
[CUSTOMER][NEUTRAL] OK, and then endo perio or surgery?
[AGENT][NEUTRAL] That's 40% major, uh, all major is gonna be 40% yes.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK, so Crowns Prostoontics, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then there was a 12 month waiting period if I remember right for what procedures for just all major all major.
[AGENT][POSITIVE] Correct for major.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][MIXED] But OK, but not for restorative.
[AGENT][POSITIVE] Correct, preventative and basic, um, there's no waiting period or for uh radiographs.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, could you tell me, is his son on the policy too, because I think that's why he got it and that's why I'm calling, um, his son is [PII].
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, yes, he is covered, yes.
[CUSTOMER][NEUTRAL] Is he on the policy? OK.
[CUSTOMER][POSITIVE] OK perfect that is all I needed to know.
[AGENT][NEUTRAL] OK, did you want me to try again to send you this fax back, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, would you be able to, please?
[AGENT][NEUTRAL] Of course what's that fax number for you?
[CUSTOMER][NEUTRAL] 641.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I will go ahead and send this to you. You should get it here in maybe 10-15 minutes depending on how busy your machine is. Was there anything else I could help you with?
[CUSTOMER][POSITIVE] Nope, that is it thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you bye bye.