AccountId: 011433970860
ContactId: 03e8f1e0-cbb1-4640-8771-53c4cf872e46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471519 ms
Total Talk Time (AGENT): 182217 ms
Total Talk Time (CUSTOMER): 153215 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/03e8f1e0-cbb1-4640-8771-53c4cf872e46_20250103T17:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from a provider's office, Doctor [PII]'s office, and I was calling to verify eligibility and get a breakdown of dental benefits on a patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility and send you a fax back, Ms. [PII]. Uh, what is your call uh back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] OK, and then what's [PII]'s, uh, policy number, please?
[CUSTOMER][NEUTRAL] Her policy number is
[CUSTOMER][NEUTRAL] 02544418.
[AGENT][NEUTRAL] OK, and her date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look her up.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][POSITIVE] And if you give me your fax number, I'll get that fax back right to you that will have the complete benefit breakdown for her.
[CUSTOMER][NEUTRAL] OK, so, um, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll get that right to you, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, so I do still have uh questions regarding her plan because this is the first time that, that we get uh, a patient with this insurance, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, what is the, the insurance name?
[AGENT][NEUTRAL] Uh, APL, American Public Life.
[CUSTOMER][NEUTRAL] OK, and then, um, are we in network with, with uh APL?
[AGENT][NEUTRAL] Uh, yes, ma'am. Uh, we don't have a network. The insureds are free to choose what dentist they want to go to.
[CUSTOMER][NEUTRAL] So then um we just go by the issuing customary fees?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] On the plan, do you have a missing tooth cloth or any waiting periods?
[AGENT][NEGATIVE] Uh yes, ma'am, there is um a missing tooth cloth.
[AGENT][NEUTRAL] And uh for cleanings is once every 6 months, oral evaluations is 2 for 12 month period.
[AGENT][NEUTRAL] And then the bite wings are once per 12-month period and a full mouth x-ray is once every 5 years.
[CUSTOMER][NEUTRAL] OK, so then, um, there is a missing to clause where there is no waiting periods on the plan, is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] Do you cover posterior composites or do you give the alternate benefit of an amalgam?
[AGENT][NEUTRAL] What is uh the CDT code and I can look it up on this fax back that I'm sending you and see uh what it says for it.
[CUSTOMER][NEUTRAL] It is 2393.
[AGENT][NEUTRAL] 2393.
[AGENT][NEUTRAL] OK, so it is basic restorative. Um, it's a resin-based composite, 3 surfaces, posterior. It has, um, so H is.
[AGENT][NEUTRAL] It's replaced existing only if placed with for 24 months.
[AGENT][NEUTRAL] And it's a maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] OK, so then you cover the composite fillings as composite you don't downgrade them to the amalgam rate, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, based composite.
[CUSTOMER][NEUTRAL] All right. And then, um, and the plan is oral surgery paid by dental or medical first?
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] OK, this policy does not have major.
[CUSTOMER][NEUTRAL] There is no major.
[AGENT][NEUTRAL] Right, it's preventative, basic, and basic restorative.
[CUSTOMER][NEUTRAL] Coverage.
[CUSTOMER][NEUTRAL] So then extractions.
[AGENT][POSITIVE] And I, I just sent you that fax uh to your number so um you should be getting it shortly. I just wanna let you know that I've got it on its way already.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so then basically whatever is not included on the fax is not covered? Is that how it is?
[AGENT][POSITIVE] Exactly. That's correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Can I get the, is this a calendar year plan that runs from January to December?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the group name and group number of the policy, please?
[AGENT][POSITIVE] Yes ma'am, you can. It is.
[AGENT][NEUTRAL] The group number is 70,030.
[AGENT][NEUTRAL] And that's Creative Circle LLC.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the address where I should send the claims to?
[AGENT][NEUTRAL] Yes ma'am, that address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then we also have a payer ID number if you'd like it.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] It is 60801.
[CUSTOMER][NEUTRAL] OK. And uh can you repeat the ZIP code, please?
[AGENT][NEUTRAL] Yeah, yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] Alright, and can I just get your name and a reference number or actually does the patient has any history on file?
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] No ma'am, I do not see any previous claims.
[CUSTOMER][NEUTRAL] OK, alright, so can I just get your name and a reference number for the call please?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII] and you can use my name in today's date.
[CUSTOMER][POSITIVE] All right then thank you very much for your help and um have a great day bye.
[AGENT][POSITIVE] You too, Miss [PII] you have a blessed one and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. All right then bye.
[AGENT][NEUTRAL] Bye bye.