AccountId: 011433970860
ContactId: 0294dec6-a1d3-4880-ba83-d559e9ebe36a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1070239 ms
Total Talk Time (AGENT): 296873 ms
Total Talk Time (CUSTOMER): 286634 ms
Interruptions: 1
Overall Sentiment: AGENT=-1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/0294dec6-a1d3-4880-ba83-d559e9ebe36a_20250317T22:24_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you, or good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Marki Dental. How are you doing today?
[AGENT][NEUTRAL] Uh, fine. I just talked to you a few moments, [PII]. Is this for the same patient or a different patient that you're calling for benefits and eligibility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Same patient, same patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ah, you said you didn't an out of network benefits will be the same.
[AGENT][NEUTRAL] We don't have a network, so the benefits I gave you is the benefits that's on the policy.
[CUSTOMER][NEUTRAL] Yes, the the schedule is UCR, right?
[AGENT][NEUTRAL] It pays by UCR.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] OK. Can you just spell your name for me?
[AGENT][NEUTRAL] Sure, it's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] And what will be the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my, uh, my name in today's date. And is there anything else, Ms. [PII] I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, it's just a second, bear with me.
[CUSTOMER][NEUTRAL] Uh, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you just spell the group name?
[AGENT][NEUTRAL] The group name is ATC.
[CUSTOMER][NEUTRAL] A T A C T
[AGENT][NEUTRAL] A as in apple, T as in Tom, C as in Charlie.
[AGENT][NEUTRAL] Healthcare Services.
[CUSTOMER][NEUTRAL] Uh-huh. Healthcare Services.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Healthcare services. OK, just a second.
[CUSTOMER][NEUTRAL] Plan
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, is there anything else, Ms. [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, it's just a second, bear with me please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500 1800.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you just provide all the benefits on the call?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you just provide the benefits on the call?
[CUSTOMER][NEUTRAL] If the patient is a subscriber?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this a calendar plan?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What will be the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And the group number is 70069, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 500 5000.
[CUSTOMER][NEUTRAL] And is it in or out of network?
[AGENT][NEUTRAL] Ma'am, as I explained several times, we don't have a network.
[CUSTOMER][NEUTRAL] Uh, which one should I go with, uh, then?
[AGENT][NEUTRAL] I have no idea. We don't have a network. I don't know what you would put in your system, but this policy does not have a network.
[CUSTOMER][NEUTRAL] OK. What was the effective date you said [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And is orthotic is a covered benefit?
[AGENT][NEUTRAL] I'm sorry, no. Policy does not cover any major services that includes ortho, crowns, bridges, partial, dentures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nothing was used. Nothing was met, right.
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I show the patient has met their deductible for the year and they have used their benefit and they have $294.60 remaining for this year.
[CUSTOMER][NEUTRAL] What was the huge amount from the year Ma?
[AGENT][NEUTRAL] Uh, I can let you know they have remaining $294.60.
[CUSTOMER][NEUTRAL] Uh, user amount is 205.4, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there anything else from the individual deductible?
[AGENT][NEUTRAL] They have met their deductible for the year.
[CUSTOMER][NEUTRAL] 50 was mat, OK.
[CUSTOMER][NEUTRAL] And is there any waiting period for this patient?
[AGENT][NEUTRAL] They've already passed, well, no, there's no waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is another end all covered under the basic or major?
[AGENT][NEUTRAL] Major services are not covered. That includes endodontics, perdontics, oral surgery, prosthetic repair, crowns, bridges, partials, dentures. Any major services are not covered under this policy.
[CUSTOMER][NEUTRAL] And implants are not covered, right?
[AGENT][NEUTRAL] That is major, so it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] What is not covered.
[AGENT][NEUTRAL] Major services are not covered.
[CUSTOMER][NEUTRAL] OK, I have some codes. Can you just provide me the.
[AGENT][NEUTRAL] Are any of those codes major codes?
[CUSTOMER][NEUTRAL] Uh, percentages.
[CUSTOMER][NEUTRAL] Does Missing Tolu apply?
[AGENT][NEGATIVE] There is a missing tooth clause.
[CUSTOMER][NEUTRAL] OK, 2391 is down 2392 will be download as well?
[AGENT][POSITIVE] There's no downgrades because there's no major services covered.
[CUSTOMER][NEUTRAL] OK. Our major pay reposited?
[AGENT][NEUTRAL] Major services are not covered under the policy, ma'am.
[CUSTOMER][NEUTRAL] Yes, then we are not supposed to keep proceed also.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Well it is OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Major services are not covered. So any codes that you have that is for major services, it is not covered under this policy. Would you like me to send you a copy of the policy, uh, fee schedule or the policy faxed back?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, no, just that.
[CUSTOMER][NEUTRAL] No, just a second. What will be the percentage and frequency of 4355?
[AGENT][NEUTRAL] Major services are not covered.
[CUSTOMER][NEUTRAL] These also are covered under the age only. OK. [PII].
[AGENT][NEUTRAL] Major services are not covered.
[CUSTOMER][NEUTRAL] 9222.
[AGENT][NEUTRAL] What is that code for?
[CUSTOMER][NEUTRAL] 9222
[AGENT][NEUTRAL] What is it for? What is the description of that code?
[CUSTOMER][NEUTRAL] We do not have the description for this quote.
[AGENT][NEGATIVE] Looks like that is for IV sedation, not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9223.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9610.
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEUTRAL] The [PII] cards are covered in its plan.
[AGENT][NEUTRAL] I can't hear you. Say again.
[CUSTOMER][NEUTRAL] Acquial cards are covered under this plan.
[AGENT][NEUTRAL] No, it is considered major, so it's not covered.
[CUSTOMER][NEUTRAL] OK, 0150.
[AGENT][NEUTRAL] Uh, exams are 2 for 12 month period and that exam is considered preventative.
[CUSTOMER][NEUTRAL] OK. 1110.
[AGENT][NEUTRAL] Uh, once every 6 months.
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEUTRAL] Exams are 2 for 12 month period and that exam is preventative, so it pays 100% of UCR.
[CUSTOMER][NEUTRAL] 2 to 12 months, right?
[AGENT][NEUTRAL] Every 2 for 12 month period, yes.
[CUSTOMER][NEUTRAL] Uh, FMX and panel shares frequency, right, with 2 to 12 months.
[AGENT][NEUTRAL] FMX and panels once every 5 years.
[CUSTOMER][NEUTRAL] On 5 years.
[CUSTOMER][NEUTRAL] OK, next one is, uh, you said for lender is also 2 to 12 months, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh, for prophylaxis, it is also for 2 to 12 months, right?
[AGENT][NEUTRAL] Cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next one is going to be.
[CUSTOMER][NEUTRAL] 0274
[AGENT][NEUTRAL] Uh, for wings once per 12-month period.
[CUSTOMER][NEUTRAL] Once every 12 months a year. 1351.
[AGENT][NEUTRAL] Uh, space maintainers are under the age of [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, once per lifetime per arch or quadrant.
[CUSTOMER][NEUTRAL] 1351.
[CUSTOMER][NEUTRAL] It's a family that
[AGENT][NEUTRAL] Sealants are under the age of [PII], once every 36 months.
[AGENT][NEUTRAL] Permanent molars only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1208
[AGENT][NEUTRAL] Uh, that is Florida is under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] 44,910 is not covered.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. 2140.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, once for 24 months, and it's considered basic, so it pays at uh 80% UCR.
[CUSTOMER][NEUTRAL] OK. 2920.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. 0220.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And it feels on a basic and there's no frequency.
[CUSTOMER][NEUTRAL] Basic.
[CUSTOMER][NEUTRAL] OK. Now, I have some codes only for the percentages, OK?
[AGENT][NEUTRAL] Are they preventative or basic codes, or if they're major, they're not covered?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, major or not covered, OK.
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] Uh, it falls under basic, so it pays at 80%.
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7220
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7241
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7285.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7310.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Is there any history on file for this patient?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, they show they have a history of an exam in FMX, so they still have one exam remaining and FMX, uh, they had this year, so they wouldn't be eligible for 3 years, so not until [PII].
[CUSTOMER][NEUTRAL] What was the date of service for the FMX?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, February, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] [PII]. FMX and Punisher frequency, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What about which exam, it is a comprehensive exam or periodic exam?
[AGENT][NEUTRAL] Uh, this was 4150.
[AGENT][NEUTRAL] So they're eligible for one.
[CUSTOMER][NEUTRAL] 0150.
[CUSTOMER][NEUTRAL] 0150, right? That's what the history?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What was the date of service?
[AGENT][NEUTRAL] The same date I just gave you.
[CUSTOMER][NEUTRAL] OK. Oh that's the history, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much for helping with this patient. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.