AccountId: 011433970860
ContactId: 003e91ef-3bab-4e30-9446-20f2617bf5a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1604199 ms
Total Talk Time (AGENT): 376652 ms
Total Talk Time (CUSTOMER): 376673 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/003e91ef-3bab-4e30-9446-20f2617bf5a7_20250422T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. Myself, [PII]. I'm calling from Dental Care Alliance.
[AGENT][NEUTRAL] OK, are you needing claim status or?
[CUSTOMER][NEUTRAL] Eligible.
[AGENT][NEUTRAL] OK, I can help you with eligibility and benefits, [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] 1006363
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And uh last time it will be [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And I show the policy is effective [PII]. It's currently active, no term date.
[AGENT][NEUTRAL] And you're needing, you're needing benefits, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, I can fax over a fax back that has everything, or do you need to go over information on the phone?
[CUSTOMER][NEUTRAL] Yeah, uh, I need to call, uh, I need a full breakdown call. Could you please provide me?
[AGENT][POSITIVE] You need a what? I'm sorry.
[CUSTOMER][NEUTRAL] I need a full breakdown uh regarding this policy. If you don't mind, could you please provide me a call?
[AGENT][NEUTRAL] Um, you're needing the benefits?
[CUSTOMER][NEUTRAL] Yeah, I need for breakdown.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Full breakdown.
[AGENT][NEUTRAL] OK, not a guarantee of payment, basic outline of the policy. Plan year maximum is $1250 per covered person.
[AGENT][NEUTRAL] Preventive services pay 100%.
[AGENT][NEUTRAL] Uh, radiographs, basic, basic restorative pay 60% after a $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Major endodontic, periodontic, prosthodontic oral surgery all pays 40%. After that same $50 deductible, there is a 12-month waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For 12 months waiting period, uh, for basic or major.
[AGENT][NEUTRAL] Just for a major?
[CUSTOMER][NEUTRAL] OK, 12 months waiting for major. OK, got it.
[CUSTOMER][NEUTRAL] And just a minute uh and uh
[CUSTOMER][NEUTRAL] And uh uh is there any
[CUSTOMER][NEUTRAL] Um, for this policy.
[AGENT][NEUTRAL] There is a missing tooth clause, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You got it.
[CUSTOMER][NEUTRAL] OK. And uh group name?
[AGENT][NEUTRAL] Uh, group name, let's see.
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Um, yes, we're the insurance, American Public Life, and then the group name is
[AGENT][NEUTRAL] Uwa Shepherd lighting, so it's U as in uniform.
[AGENT][NEUTRAL] R as in Romeo, W as in Whiskey, A as in Alpha.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Shepherd Lighting is the group name.
[CUSTOMER][NEUTRAL] Sorry, last name? [PII].
[AGENT][NEUTRAL] Shepherd, S H E P A R D, lighting.
[AGENT][NEUTRAL] L I G H T I N G.
[CUSTOMER][NEUTRAL] OK, OK, got it. Shepherd Lighting, U R W A Shepherd Lighting.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You got it. Thank you so much for that. And preation is uh recommended mandatory.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The Domo is recommend our man.
[AGENT][NEUTRAL] The dollar amount?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Or I, I still, I didn't, sorry, I didn't understand what you said.
[CUSTOMER][NEUTRAL] Dollar amount is recommended mandatory.
[AGENT][POSITIVE] Recommended and
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] What's the other word?
[CUSTOMER][NEUTRAL] Pre-atation uh dollar amount is uh recommended or mandatory.
[AGENT][NEUTRAL] Oh, no, there's no prior off required.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. And the group number it will, uh, group number, it will be 50011.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh uh it, it is.
[CUSTOMER][NEUTRAL] Uh, affected, it will be [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh it is a uh calendar plan or a physical plan?
[AGENT][NEUTRAL] A calendar or plan years?
[CUSTOMER][NEUTRAL] Starting, uh, starting from January.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Um, let's see what it is.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, calendar year plan.
[AGENT][NEUTRAL] Starting from January, yeah.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEGATIVE] OK. And the Crowns 2740 is downgraded.
[AGENT][NEUTRAL] What was the code?
[CUSTOMER][NEUTRAL] 2740.
[CUSTOMER][NEUTRAL] R
[AGENT][NEUTRAL] Uh, no, they're not, they're not downgraded.
[CUSTOMER][NEUTRAL] OK, got it. And fillings?
[AGENT][NEUTRAL] Are you wondering what, how they cover or what are you needing?
[CUSTOMER][POSITIVE] Fillings, uh, stronger.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] There's no downgrades.
[CUSTOMER][NEUTRAL] OK, got it. And payer ID it will be 06126.
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] 608
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] 060801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 60801, it is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and mailing address [PII], OK, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for that. And
[CUSTOMER][NEUTRAL] Uh, could you please
[CUSTOMER][NEUTRAL] Uh, for my deductibles, individual family ones.
[AGENT][NEUTRAL] Uh $50 for individual, $150 for family.
[CUSTOMER][NEUTRAL] 1,254 an max.
[AGENT][NEUTRAL] 1250 annual max.
[CUSTOMER][NEUTRAL] OK. And anything has been uh met from uh individual family and animal max for this patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, give me one moment, sorry.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] OK, looks like, uh, no, they haven't met anything or used anything.
[CUSTOMER][NEUTRAL] I got it. And
[CUSTOMER][NEUTRAL] Is there any uh Arthurronic for this policy?
[AGENT][NEUTRAL] Any what?
[CUSTOMER][NEUTRAL] Orthodontics, orthole Max.
[AGENT][NEUTRAL] Orthodontics, uh, let me see.
[AGENT][NEGATIVE] Uh, no, no orthodontic benefits.
[CUSTOMER][NEUTRAL] OK, got it. Just a minute.
[CUSTOMER][NEUTRAL] OK, for this policy, there is no uh also coverage.
[AGENT][NEUTRAL] No, what?
[CUSTOMER][NEUTRAL] The luggage and
[AGENT][NEUTRAL] and
[CUSTOMER][NEUTRAL] I have quotes. Could you please provide me frequent and percentages.
[AGENT][NEUTRAL] OK. What's the code?
[CUSTOMER][NEUTRAL] Yeah, all exams 0120.
[CUSTOMER][NEUTRAL] 014001500180.
[CUSTOMER][NEUTRAL] I need, uh, for this, for this policy, I need uh auto rental benefits.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] For this policy, I need out of network benefits.
[AGENT][NEUTRAL] Out of network benefits?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Um, I mean, everything that I'm quoting, they don't have to use the network, so.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That there's benefits for out of network.
[AGENT][NEUTRAL] Uh, for exam for evaluations, oral evaluations, 120 140,150, 1601802 for 12 month period.
[AGENT][NEUTRAL] Um, bite wings, what codes do you need? What other codes?
[CUSTOMER][NEUTRAL] Uh, by twins.
[AGENT][NEUTRAL] White wings are once per 12 months.
[CUSTOMER][NEUTRAL] On the panel?
[AGENT][NEUTRAL] Uh, full mouth or pano is once every 5 years.
[CUSTOMER][NEUTRAL] OK, got it. And code 4249?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, that is.
[AGENT][NEUTRAL] 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] And it will be basic on major?
[AGENT][NEUTRAL] Major
[CUSTOMER][NEUTRAL] And is there any age limit for that code?
[AGENT][NEUTRAL] Uh, just the limit that I gave you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So max of 1 each quadrant per 24 months.
[AGENT][NEUTRAL] Do you have any other codes?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Profi
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] And Flore.
[AGENT][NEUTRAL] Fluoride is.
[AGENT][NEUTRAL] Uh, once every 12 months, children under age [PII].
[CUSTOMER][NEUTRAL] And code is 0220.
[AGENT][NEUTRAL] Uh, there's no, it's under basic, there's no, uh, frequency or duration.
[CUSTOMER][NEUTRAL] Basically, it will be 60%.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And code 1351?
[AGENT][NEUTRAL] One procedure for 36 months.
[AGENT][NEUTRAL] Permanent molar teeth only, children under [PII].
[CUSTOMER][NEUTRAL] Preventative
[AGENT][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] Prevented sir, prevented coverage, uh, this code is covering and prevented 100%.
[AGENT][NEUTRAL] Um, let's see. Yes.
[CUSTOMER][NEUTRAL] 1 in 6 months, preventative and age limit is [PII].
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, got it. And 4 1510?
[AGENT][NEUTRAL] Mm it's preventative.
[AGENT][NEUTRAL] And limited to children under [PII].
[AGENT][NEUTRAL] One per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] OK, got it. Thank you. And code 0364?
[AGENT][NEUTRAL] I'm not pulling up that code.
[CUSTOMER][NEUTRAL] And code is 0431?
[AGENT][NEUTRAL] Max of 1 quadrant for 24 months.
[CUSTOMER][NEUTRAL] Basic major?
[AGENT][NEUTRAL] uh major.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] And frequency?
[AGENT][NEUTRAL] Uh, it is the code you just gave me. It was.
[AGENT][NEUTRAL] One quadrant for 24 months.
[CUSTOMER][NEUTRAL] 43.
[CUSTOMER][NEUTRAL] 0431 and 4341 uh both are uh once for 24 months.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, what was the first code, 0341?
[CUSTOMER][NEUTRAL] 0431.
[AGENT][NEUTRAL] 0431. I'm not pulling up that code.
[CUSTOMER][NEUTRAL] OK. For 4341, uh, you provide me once for 24 months and uh is 40. And for uh for that quarter, how many quarters are done on the same day?
[AGENT][NEUTRAL] Max of 1 quadrant per 24 months.
[AGENT][NEUTRAL] That's all it says, so.
[CUSTOMER][NEUTRAL] OK, got it. And code 4346?
[AGENT][NEUTRAL] I'm not pulling up that code.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 4260
[AGENT][NEUTRAL] One quadrant per 36 months.
[CUSTOMER][NEUTRAL] Basic major
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] 4381
[AGENT][NEUTRAL] How many more codes do you have?
[CUSTOMER][NEUTRAL] I have only uh more uh.
[CUSTOMER][NEUTRAL] 15 cos, 15 to 15, approximately 15 to.
[AGENT][NEUTRAL] I can fax you this information. Do you have a fax number?
[CUSTOMER][NEUTRAL] 310
[CUSTOMER][NEUTRAL] 86
[CUSTOMER][NEUTRAL] 11816.
[AGENT][NEUTRAL] OK. 310.
[AGENT][NEUTRAL] 861
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because this.
[CUSTOMER][NEUTRAL] How much time to, yeah, yeah, yeah, how much time to, to take uh
[AGENT][NEUTRAL] Just takes 2 minutes.
[AGENT][NEUTRAL] 2 minutes.
[CUSTOMER][NEUTRAL] Actually, uh, yeah, understood, and actually, uh, previous representative, uh, she, uh she's, sorry, she sending me fax, but fax has been not came, so that's why I'm making a call for you.
[AGENT][NEUTRAL] You, you didn't receive the fax?
[CUSTOMER][NEGATIVE] Yeah, I did not receive any fax.
[AGENT][NEUTRAL] OK, let me see if.
[CUSTOMER][NEUTRAL] I have only 15 calls now. Could you please provide me a call?
[AGENT][NEUTRAL] Yeah, that's fine. What are, what are they?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEGATIVE] Major, there's no frequency.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's major one quadrant for 24 months.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One procedure for 6 months. Um, based or major.
[CUSTOMER][NEUTRAL] That uh deductibles are apply for 4910?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, got it. Thank you. And
[CUSTOMER][NEUTRAL] 42,950.
[AGENT][NEUTRAL] 1 for 7 year period, limited to patients age [PII] and over.
[AGENT][NEUTRAL] Major
[CUSTOMER][NEUTRAL] 2962
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Over age [PII], once every 7 years, Major.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not pulling up.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Not pulling that up.
[CUSTOMER][NEGATIVE] Both calls are not pulling [PII] and [PII].
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Uh, those are under major, no frequency.
[CUSTOMER][NEGATIVE] Major, there's no frequency, both are.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII] and [PII] and [PII].
[AGENT][NEUTRAL] I only have [PII], the other two I don't have, and that is.
[AGENT][NEUTRAL] Max one time per tooth.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's max one time for two major and I don't, I only have 7140. It's the only code I could pull.
[CUSTOMER][NEUTRAL] On per
[CUSTOMER][NEUTRAL] 7240.
[AGENT][NEUTRAL] OK, 72,407,140. What was the other one?
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] OK, those are under major.
[AGENT][NEUTRAL] Uh, there's no frequency.
[CUSTOMER][NEUTRAL] And code 7953?
[AGENT][NEUTRAL] What was it?
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEUTRAL] I'm not pulling that code.
[CUSTOMER][NEUTRAL] 91,109,230.
[AGENT][NEUTRAL] It's under basic, no frequency.
[CUSTOMER][NEGATIVE] Both are uh uh basic and there's no frequency.
[AGENT][NEUTRAL] Both
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much. And uh 9243 9222?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Major and
[AGENT][NEUTRAL] One procedure for 24 months?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yeah, yeah, I can hear you.
[AGENT][NEUTRAL] 9242 is major.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 92243.
[AGENT][NEUTRAL] I'm not pulling 9243.
[CUSTOMER][NEUTRAL] 9222
[AGENT][NEUTRAL] I'm not pulling that code.
[CUSTOMER][NEUTRAL] 9310
[AGENT][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] Frequency
[AGENT][NEUTRAL] None.
[CUSTOMER][NEUTRAL] 994 4.
[AGENT][NEUTRAL] Not pulling that code.
[CUSTOMER][NEUTRAL] And uh 2391?
[AGENT][NEUTRAL] Uh it's
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] It's basic max of 12th for 24 months.
[CUSTOMER][POSITIVE] OK, thank you so much for that. I don't with patient successfully and bridges, uh, denture partials are all sharing frequent and perages for this policy.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Bridges, partials allow sharing frequency and percentages.
[AGENT][NEUTRAL] Bridges, dentures, and do you have the codes or?
[CUSTOMER][NEUTRAL] Oh it's 6750.
[AGENT][NEUTRAL] Yeah, I, I don't show any coverage for bridges, benches, bridges and dentures.
[CUSTOMER][NEUTRAL] And 5
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much for that. And the dependent age limit is [PII] for this policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And could you please once uh spell out your name?
[AGENT][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And can I get a reference number?
[AGENT][NEUTRAL] A reference number is my name and today's date.
[CUSTOMER][NEUTRAL] It will be uh April 22 025.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much, [PII], and have a great day and take care. Bye.
[AGENT][POSITIVE] Hey, thank you for calling ATL