AccountId: 011433970860
ContactId: f9abbc5b-47a9-488b-8f70-226d1aadf64f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466619 ms
Total Talk Time (AGENT): 210520 ms
Total Talk Time (CUSTOMER): 142938 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f9abbc5b-47a9-488b-8f70-226d1aadf64f_20250117T13:32_UTC.wav
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[AGENT][NEUTRAL] Contacting HTO my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK, my name is. I'm calling from the doctor's office, checking on benefits.
[AGENT][NEUTRAL] I can help with benefits. What is that policy number, please?
[CUSTOMER][NEUTRAL] 02494791.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] My name is [PII], [PII].
[AGENT][POSITIVE] I appreciate that. Is there um a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The [PII]'s policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] You mentioned benefits. This policy has $1500 for calendar year as a balance. Um, that's just a verification of benefits, not a guarantee of payment.
[AGENT][NEGATIVE] It doesn't look like [PII] has used mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, yeah, I'm really sorry to interrupt you. If you don't mind, can you repeat the original effective date for this, ma'am.
[AGENT][NEUTRAL] I, I'm sorry, can I, can I give you what information?
[CUSTOMER][NEUTRAL] Uh, effective date one more time.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Group number?
[AGENT][NEUTRAL] Uh, the group number for the policy?
[AGENT][NEUTRAL] Is, um, excuse me just a moment please.
[AGENT][NEUTRAL] The group number for the policy is 19863.
[CUSTOMER][NEUTRAL] 19863, that's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the group name is?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's universal tracking and then the word Blair, B L A I R.
[CUSTOMER][NEUTRAL] Uh, I'm so sorry. It's, if you don't mind, can you repeat it one more time?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, it's the word universal trucking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the word blair BL.
[AGENT][NEUTRAL] AIR.
[CUSTOMER][NEUTRAL] C L A I R.
[CUSTOMER][NEUTRAL] C L A I R. All right. And uh I have a
[CUSTOMER][NEUTRAL] Uh, same mailing address [PII].
[CUSTOMER][NEUTRAL] [PII]. Sorry, [PII] I'm so sorry, [PII], right?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] [PII]. That is correct.
[CUSTOMER][NEUTRAL] Alright, this maximum applies to which services?
[AGENT][NEUTRAL] That the uh plan that has $1500 per calendar year, that's the maximum. It's just a verification, not a guarantee of payment. It covers preventative, basic.
[AGENT][NEUTRAL] Basically sorted and.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right now that's what it's covered and beginning [PII], it will cover major services, so.
[AGENT][NEUTRAL] There is a 12 month waiting period for major services that has not been met yet.
[CUSTOMER][NEUTRAL] So it will be met in the month of April, right?
[AGENT][NEUTRAL] [PII] is when the major services will be available.
[CUSTOMER][NEUTRAL] will be covered. OK. And there's a deductible, right?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] There is a $50 deductible that does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK. Is that an orthodontic coverage?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] All right. Uh, can you help me with the co-insurance for diagnostic preventive basic measure?
[AGENT][NEUTRAL] Yes, the, uh, preventative services at 100% of UCR.
[AGENT][NEUTRAL] The basic and basic restorative are at 80%.
[AGENT][NEUTRAL] And once the major services are available, that will be at 40%.
[CUSTOMER][NEUTRAL] OK. I have endodontics, periodontics, and oral surgery. All are major 40%, right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Waiting period. And what about missing tooth cloths?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK. The coordination of benefit is standard.
[AGENT][NEUTRAL] Uh, there is no coordination of benefits.
[CUSTOMER][NEUTRAL] OK, I see. I have a replacement period for crown bridges and dentures is 7 years.
[AGENT][POSITIVE] Uh, that is, yes, that is correct.
[CUSTOMER][NEUTRAL] Once in 7 years.
[CUSTOMER][NEUTRAL] All right. Can you help me and are implants code on this plan?
[AGENT][NEGATIVE] No, they are not.
[CUSTOMER][NEUTRAL] All right. Now, if you don't mind, can you help me with the frequency for prophy exam by doing and panic along with PS.
[AGENT][NEUTRAL] Uh, yes, the, uh, prophy is once every 6 months.
[AGENT][NEUTRAL] All of the exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do they all share frequency?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Uh, including limited exam.
[AGENT][NEUTRAL] Yes, that is correct. All the exams show the same frequency.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By wings are once for 12 month period.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The full mouth and panel or once every 5?
[CUSTOMER][NEUTRAL] Uh, what about PS?
[AGENT][NEUTRAL] That once every 5.
[CUSTOMER][NEUTRAL] A period pickles.
[AGENT][NEUTRAL] Oh, I'm sorry. Do you have a uh
[CUSTOMER][NEUTRAL] Once a week
[AGENT][NEUTRAL] Yeah, what is the code again, please?
[CUSTOMER][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] Perios.
[AGENT][NEUTRAL] OK, let me just check here, give me just a minute.
[AGENT][NEUTRAL] OK, so there is, that is under basic expenses at 80% and 0220. I am not showing a uh frequency for.
[CUSTOMER][NEUTRAL] All right. What about pay maintenance?
[AGENT][NEUTRAL] The per maintenance shares the same frequency as the prophy, that's once every 6 months.
[CUSTOMER][NEUTRAL] Once in 6 months. Its share frequency with Ray, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And is there a healing period or a waiting period after SRP and trophy?
[AGENT][NEUTRAL] Uh, for the, uh, per maintenance, yes, it's at 12 months, it is listed as major. So it's under the 12 month waiting period.
[AGENT][NEUTRAL] Now, I do have a fax that I can send to you that has all this information if you would be interested.
[CUSTOMER][NEUTRAL] OK. Uh, that's all I needed. Now, just can you help me with the dental history. Do you have dental history for preventive and diagnostic services?
[AGENT][NEUTRAL] Uh, yes, the, um,
[AGENT][NEUTRAL] History that I have for [PII], the only thing that I have.
[AGENT][NEUTRAL] is from [PII].
[AGENT][NEUTRAL] At that time she had a panoramic film.
[AGENT][NEUTRAL] The bite wings and a comprehensive oral examination.
[AGENT][NEUTRAL] So she would not be.
[CUSTOMER][NEUTRAL] No profy.
[AGENT][NEUTRAL] No prophy, no.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, so, patient is not eligible for biting and panel, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] All right. If you don't mind, can you spell your name for me?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the card reference number?
[AGENT][NEUTRAL] Is my name in today's date. Is there anything else that I can help with, [PII]?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much, [PII]. You have a great weekend. Bye-bye. Take care.
[AGENT][POSITIVE] Thanks for contacting AP