AccountId: 011433970860
ContactId: fac22597-0352-4595-8b7b-8b92967e9e53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408899 ms
Total Talk Time (AGENT): 140841 ms
Total Talk Time (CUSTOMER): 73070 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/fac22597-0352-4595-8b7b-8b92967e9e53_20250219T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Rolling Oaks Dental. I'm calling to verify benefits for our patient, [PII].
[AGENT][POSITIVE] I'm sure I can assist you with benefits. Um, first, I'll need your name again and a good callback number.
[CUSTOMER][NEUTRAL] [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure, let me get you that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is 2 I'm sorry 02352784.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and his date of birth is.
[CUSTOMER][NEUTRAL] Let me take a look quick pick here.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 96 [PII].
[AGENT][NEUTRAL] OK, and just submit advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was yeah, [PII], and the policy is still active and for a breakdown of the benefits and the fee schedule, I can fax that over to you.
[CUSTOMER][NEUTRAL] Sure, can I have frequencies and um.
[CUSTOMER][NEUTRAL] History?
[AGENT][NEUTRAL] Um, yes, ma'am. One moment. Pull up these benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm showing that there's a calendar year maximum of $1500 with the $50 deductible that needs to be met first.
[AGENT][NEUTRAL] Um, for preventative, that's covered at 100%.
[AGENT][NEUTRAL] Radiographics, FMSX expenses, 80%.
[AGENT][NEUTRAL] Basic expenses, 80%.
[AGENT][NEUTRAL] Basic restorative.
[CUSTOMER][NEUTRAL] Is this the out of?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Sorry to interrupt you, is this the out of now benefit? because we're not contracted with you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I thought it was 180 and 40.
[AGENT][NEUTRAL] Right, 40 for major expenses.
[CUSTOMER][NEUTRAL] Oh I thought you said 80, OK.
[AGENT][NEUTRAL] Yeah, um, it's 80 for radiographics, FMS expenses, basic expense and basic restorative expenses it's 80%, and then for a major um expenses it's 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, for endodontic expenses, it's 40%. Perdontic expenses, 40%, and oral surgery is 40%, and those have a 12-month waiting period.
[CUSTOMER][NEUTRAL] Did she satisfy it?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Yes, ma'am, she has.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for additional benefits.
[CUSTOMER][NEUTRAL] Uh, does the patient have any history?
[AGENT][NEUTRAL] Um, let's see. Well, this is based on per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, has she met anything yet?
[AGENT][NEUTRAL] No, she hasn't met anything um for the calendar year of [PII].
[CUSTOMER][NEUTRAL] Uh, what about history forparia or panel?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And I'm still waiting on my system. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] No, I'm not showing any of those, those histories on file.
[CUSTOMER][NEUTRAL] No history on file? Hmm, let me see something here really quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for paying maintenance that's also covered at 40%, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so now he's here for by now, OK.
[CUSTOMER][POSITIVE] Alright, Ay, I think that's all. Thank you so much for your help. You have a great day.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Is there anything else that affects frequency coverage?
[AGENT][NEUTRAL] OK. Cleanings, um, one every 6 months, exams.
[AGENT][NEUTRAL] 2 per um 12 month period, bite wings, 1 per 12 month period.
[AGENT][NEUTRAL] X-rays, um, one every 5 years, crowns and bridges, um, 1 every 7 years, and partials and dentures, 1 every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright well thank you so much for your help you have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye bye.