AccountId: 011433970860
ContactId: f8b1f27f-9f34-43e9-8bd0-5ec7cf0cfc2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290489 ms
Total Talk Time (AGENT): 108283 ms
Total Talk Time (CUSTOMER): 135950 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/f8b1f27f-9f34-43e9-8bd0-5ec7cf0cfc2c_20250415T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I need, um either a fact back of eligibility and benefits or to ask you at what percent to two services are covered.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the coverage. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][POSITIVE] Yeah, let me pull that up for you one second please, sorry about that.
[AGENT][POSITIVE] Sure, take your time. You're fine.
[CUSTOMER][NEUTRAL] 02579690.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, his name is Mr. [PII] [PII].
[AGENT][NEUTRAL] Thank you for that, and all the information provided is a verification of benefits, not a guarantee of payment. And did you want to give the codes for the two services and I'll tell you the percentage or how do you want to do it, whatever, OK.
[CUSTOMER][POSITIVE] Yes I do.
[CUSTOMER][NEUTRAL] They're both start with a D as in David, 3320.
[CUSTOMER][NEUTRAL] And 9230.
[AGENT][NEUTRAL] All right, and um do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No, I'll be right here waiting. Thank you.
[AGENT][NEUTRAL] OK, you're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3320, there it is in the.
[AGENT][NEUTRAL] In theonic, which is 40.
[AGENT][NEUTRAL] In the major.
[AGENT][NEUTRAL] 40.
[AGENT][NEUTRAL] And 9239, yeah, we gotta make this surgeable.
[AGENT][NEUTRAL] 92.
[AGENT][NEUTRAL] 30, what is this?
[AGENT][NEUTRAL] This is major.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you so much for holding. So they're both under major, um, which is 40%.
[CUSTOMER][NEUTRAL] So you pay 60%?
[AGENT][NEUTRAL] No, we
[CUSTOMER][NEUTRAL] And then the patient
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] The policy would pay up to 40% of
[CUSTOMER][NEUTRAL] So the patient pays. patient pays 60%.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Correct, unless they have another insurance, yes. But I do also want to let you.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I do also want to let you know that this policy um has a twelve-month waiting period for major services and it became effective [PII], so they're not going to be able to use their major expenses until [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I call.
[CUSTOMER][NEUTRAL] OK, uh, waiting period, waiting period will be met on when [PII], or does the day matter?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, so [PII], then he can have root canals, crowns, and all of those major things. What's his yearly max?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] Yearly max is 1100 you said 1000.
[AGENT][NEUTRAL] 105.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for repeating that because I got confused. OK, so once his waiting period has been met, you will cover the nitrous gas at the 40%.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, just making sure because most commercial insurances do not cover it, but that'll be good news, but he has to wait till next year. OK, I will inform. Thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, you've been wonderful have a great day.
[AGENT][POSITIVE] You too. Thanks for calling APL and
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Talk to you later bye bye.