AccountId: 011433970860
ContactId: fc636af8-cbf2-4b08-ba84-e6170d023309
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346260 ms
Total Talk Time (AGENT): 185014 ms
Total Talk Time (CUSTOMER): 68697 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/fc636af8-cbf2-4b08-ba84-e6170d023309_20250225T19:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Vicoin Dental. How are you doing today?
[AGENT][POSITIVE] I'm great, [PII] how are you doing today?
[CUSTOMER][POSITIVE] I'm doing good, thanks for asking. Actually, I'm looking for eligibility and benefits for the patient.
[AGENT][NEUTRAL] And um you're needing eligibility and benefits, is that correct, [PII]?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And this is on a dental policy, is that also correct?
[CUSTOMER][NEUTRAL] Yeah, for dental.
[AGENT][POSITIVE] Yes, I can help you with eligibility and then [PII], we have fax backs of all of the members benefit information that I will send to you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But first off, what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Sure, it is [PII]. It's a direct line extension.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, just a second. My policy number is 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 79702.
[AGENT][POSITIVE] OK, [PII], thank you. Give me a couple of moments to get all members information pulled up please.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient name is uh
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this general policy and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] May I know the annual max and coinsurance percentages for preventive basic and major?
[AGENT][NEUTRAL] All of that information will be on the fax back out. The calendar year max is $1500 per covered insured with a calendar year deductible of $50. There's a 12 month waiting period on major endo periodontic, prosthodontic, and oral surgery covered expenses. Preventative is $100 covered at 100% of UCR and radiographs, basic expenses and basic restorative are covered at 80% of UCR subject to the calendar year deductible.
[CUSTOMER][NEUTRAL] And what is your major?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] The major endoperonic prostatontic and oral surgery are 40% of UCR again with a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, so waiting period for only major 12 months, right?
[AGENT][NEUTRAL] No, those 5 categories that I just gave you. Major, endodontic, periodontic, prostatontic, and oral surgery.
[AGENT][NEUTRAL] All of those categories have a twelve-month waiting period.
[CUSTOMER][NEUTRAL] What is the group name and group number?
[AGENT][NEUTRAL] The group number is 16068.
[AGENT][NEUTRAL] The name of the group is Universal Trucking Hirschbach, that is spelled H I R S C H B A C H.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the uh annual max is 1500, right?
[AGENT][NEUTRAL] That is correct. So are you not going to need the fax back with the full benefit information?
[CUSTOMER][NEUTRAL] Yeah. The fax number is 310.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 861-1398.
[AGENT][NEUTRAL] OK. 3108611398. Is that correct?
[CUSTOMER][POSITIVE] That's correct. That's correct.
[AGENT][NEUTRAL] And does it need to have your attention on there or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you put attention [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. All right, so I have just sent that to you, [PII], so you should be receiving that fax very shortly. It has been sent, um.
[AGENT][NEGATIVE] Anything not on the fax fact means it would not be covered under this member's plan and there is no history on file for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No history on file. Got it. May I know the reference number for this conversion?
[AGENT][POSITIVE] That is correct. Uh-huh and then.
[AGENT][NEUTRAL] My name and today's date and one last thing [PII], once if you all file the claim with us, once it has been processed, we do have a portal in which you should be able to check claim status and the website for our portal is [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how do you spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. You're, you're very welcome. So again, if that's all I can help you with, thank you for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you. Thank you for your help. Take care.
[CUSTOMER][POSITIVE] Take care bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.