AccountId: 011433970860
ContactId: f0f07269-b975-4eff-b846-0c9c9b0cae31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316070 ms
Total Talk Time (AGENT): 79630 ms
Total Talk Time (CUSTOMER): 147529 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/f0f07269-b975-4eff-b846-0c9c9b0cae31_20250513T16:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for eligibility and benefits.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. the callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And do you have the policy number of that patient?
[CUSTOMER][NEUTRAL] Yeah, it is 250-288-2.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] I show the policy is active and current on effective date [PII]. Um, I can send over a fax back that outlines everything that's covered or if there's something we need to go over on the phone, I can do that as well.
[CUSTOMER][NEUTRAL] Yeah, I just have, I think it's 8 codes 1234567, yeah, just 8 codes that I just wanted to be sure of. I did already received the fax.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, and it's not a guarantee of payment, basic outline of the policy. What are the codes?
[CUSTOMER][NEUTRAL] OK, you want them one at a time or all at once?
[AGENT][NEUTRAL] Uh, one at a time.
[CUSTOMER][POSITIVE] Yes ma'am, 4341. OK perfect.
[AGENT][NEUTRAL] It's covered under major and max of 1 quadrant for 24 months.
[CUSTOMER][NEUTRAL] Major, so 50%, OK.
[CUSTOMER][NEUTRAL] Um, 4381.
[AGENT][NEUTRAL] Um, did you say 50%? You said major?
[CUSTOMER][NEUTRAL] Yeah, it's, yeah, is that 50%?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No, it's at 40. Do you want me to send you a fax back?
[CUSTOMER][NEUTRAL] Or 40 that's OK.
[CUSTOMER][NEUTRAL] I have it, um, I need to make some adjustments. So on the fax it says preventative for 100, basics for 80, and major for 40.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Just wanna make sure you have the right percentage.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][POSITIVE] Yes ma'am thank you.
[CUSTOMER][NEUTRAL] It is but.
[AGENT][NEUTRAL] Um, 4381 is under Perio services, so it's major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the next code is 7210.
[AGENT][NEUTRAL] Uh, it's covered under oral surgery expenses.
[AGENT][NEUTRAL] And that is.
[CUSTOMER][NEUTRAL] 40%, yes ma'am.
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Um, what about 70,730 excuse me, 7953?
[CUSTOMER][NEUTRAL] you know you're.
[AGENT][NEUTRAL] I'm sorry, what was the code?
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEUTRAL] I don't show that covered.
[CUSTOMER][POSITIVE] Not covered, yes, no worries.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEGATIVE] Um, implants aren't covered.
[CUSTOMER][NEUTRAL] They're not at all? OK.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are clusa guards covered?
[AGENT][NEGATIVE] No, they're not.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then major services, do they pay on prep, I mean prep date or seat date?
[AGENT][NEUTRAL] Uh, prep date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just reviewing everything, make sure I have everything covered. Oh, for arrested 4381, um, is that covered on the plan?
[AGENT][NEUTRAL] 4381, yes, it's covered under period.
[CUSTOMER][NEUTRAL] OK, is there a frequency?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] None OK.
[CUSTOMER][NEUTRAL] Covering at 40%.
[CUSTOMER][POSITIVE] Wonderful. OK, uh, just make sure I have everything on my list.
[CUSTOMER][NEUTRAL] Hm, how I wonder how much fillings are covered. Uh, do you need a code for that?
[AGENT][NEUTRAL] Um, fillings are
[AGENT][NEUTRAL] They're under basic restorative 80%.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][MIXED] That is so odd, but the SRPs are covered at 40.
[CUSTOMER][NEUTRAL] had it
[AGENT][NEUTRAL] Yeah, the, yeah.
[CUSTOMER][NEUTRAL] Yeah I guess so yeah it is OK.
[CUSTOMER][POSITIVE] I just wanna make sure, OK, that will be all for me today thank you so much for your help.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye
[AGENT][NEUTRAL] If you