AccountId: 011433970860
ContactId: ff94c28e-7399-4311-94e6-d1bc82b5229e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397200 ms
Total Talk Time (AGENT): 118233 ms
Total Talk Time (CUSTOMER): 141345 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/ff94c28e-7399-4311-94e6-d1bc82b5229e_20250131T19:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi sir, my name is [PII]. I would like to check on eligibility and benefits for our patients.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on eligibility and benefits today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] That is 02310638.
[AGENT][POSITIVE] Thank you for that one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. And are we looking for medical coverage or dental?
[CUSTOMER][NEGATIVE] I'm afraid that though.
[AGENT][NEUTRAL] OK, so the patient plan is active. The effective date on this is [PII].
[CUSTOMER][POSITIVE] Thank you and how about for the group number?
[AGENT][NEUTRAL] Group number is 20375.
[CUSTOMER][POSITIVE] OK, great. Thank you so much for that. And how about, how about for the annual tax and deductible, um, how much has been used for both of them?
[AGENT][NEUTRAL] Uh, let me take a look.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, so it looks like the patient has a calendar year maximum of $1500 a calendar year deductible of $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and the patient has the full amount to use.
[CUSTOMER][NEUTRAL] Oh, patient is already used the, uh, 1500 and also the $50 deductible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK. So, patient is maxed out. Thank you so much for that information. And uh, yeah, this is a calendar year, right? I just wanna make sure.
[AGENT][NEUTRAL] That's a calendar year plan, yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And how about for the preventative history that may affect the frequency? Just one, I just need to uh take note for that.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Last day of service on file is going to be for procedure code 1110 and 120 and 220, uh, that was on 85-24.
[CUSTOMER][NEUTRAL] I'm sorry, 1110 0 120, and what is the other one?
[AGENT][NEUTRAL] And then 0220.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's all?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, one moment here. Um, is the patient still eligible with, um, one more exam and cleanings, which is 1110, and 0 120?
[AGENT][NEUTRAL] Mhm. They're, it looks like they're um once every 6 months.
[CUSTOMER][NEUTRAL] OK, every 6 months for 1110. And how about for 0 120? Is it also every 6 months or it's 2 in um every 12 months? Just wanna make sure.
[AGENT][NEUTRAL] Um, let's see, that one is going to be.
[AGENT][NEUTRAL] Uh, once every 6 months, limited to 2 in a 12 month period.
[CUSTOMER][NEUTRAL] OK, so patient is um also eligible with the exam.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm thank you. And how about for panel and put malt Xray just um I wanna make sure since this is every 5 years as far as I know.
[AGENT][NEUTRAL] Yes, it is every 5 years, correct.
[CUSTOMER][NEUTRAL] And there is no history for the past 5 years, right?
[AGENT][NEUTRAL] Let me take a look. One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] So it looks like the patient last had um X-rays on [PII].
[CUSTOMER][NEUTRAL] [PII]. So patient is not eligible with um panel and full mouth X-rays, that's your frequency.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you and uh.
[CUSTOMER][NEUTRAL] Uh, by the way, can I request a copy of fax for this patient's friend?
[AGENT][NEUTRAL] Yeah, we can send a fax back. What's a good fax number?
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] All right, that was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Uh yes, that's correct. Thank you so much for that. Before I ask the reference number, um, is the um waiting period for, uh, this patient is already satisfied?
[AGENT][POSITIVE] Uh, yes, it has been. The waiting period is 12 months, so that's been satisfied.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And yeah, just the reference number.
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name again is [PII], that's [PII] Last initials my name is [PII].
[CUSTOMER][POSITIVE] And today's date. Thank you so much uh [PII] have a good day ahead.
[AGENT][NEUTRAL] You too, [PII]. Bye bye.