AccountId: 011433970860
ContactId: 03faa175-44b8-4e2c-a9ac-79bc12895f26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687570 ms
Total Talk Time (AGENT): 230779 ms
Total Talk Time (CUSTOMER): 150518 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/03faa175-44b8-4e2c-a9ac-79bc12895f26_20250604T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII]. I'm calling from the provider's office to verify some details regarding our patient's benefits.
[AGENT][NEUTRAL] OK, and did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] OK. And you're just needing to verify benefit information, not eligibility. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with benefits and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] 02607936
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're needing benefit information on a dental policy, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes ma'am. Our our dental policies is Pauline, we have fax facts of the member's benefits that I will send to you.
[AGENT][NEUTRAL] Um, they will have their information on it, so just one moment.
[AGENT][NEUTRAL] For me to get all of the members' information pulled up.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And pulling in the information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mhm. [PII]. Date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is a good fax number for you please [PII], so that I can send her information to you?
[CUSTOMER][NEUTRAL] Yes, ma'am. But uh could you please also help me uh confirm the details verbally?
[AGENT][NEUTRAL] OK, would you like for me to
[AGENT][NEUTRAL] So, yes, I will, I will just provide them to you verbally.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. So what type of information do you need?
[CUSTOMER][NEUTRAL] Yes ma'am, for this patient, I need to verify the remaining max and deductible.
[AGENT][NEUTRAL] She has a remaining OK, she has the remaining 2, excuse me, 546.80 for this calendar year.
[AGENT][POSITIVE] And the deductible has been met.
[CUSTOMER][NEUTRAL] You said it's 546 and 80 cents, correct? For the max?
[AGENT][NEUTRAL] That is what she has remaining.
[AGENT][NEUTRAL] No, ma'am. You asked for the remaining.
[CUSTOMER][POSITIVE] Mhm thank you for
[AGENT][NEUTRAL] Uh-huh. That's the remaining.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. Thank you so much for confirming that. And yes, uh could you please also confirm the co-insurance percentage for this plan?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] This, there is no co-insurance on this plan.
[CUSTOMER][NEUTRAL] So everything is covered at 100%, correct?
[AGENT][NEUTRAL] Uh, oh, no, ma'am, it is not. This policy only has service coverage for preventative and basic, and preventative is 100% of the allowable charge and basic is at basic is at 80% of allowable subject to the calendar year deductible.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And yes, actually, I have here a list of procedure codes. If you could please help me with the frequencies for the procedures.
[AGENT][NEUTRAL] How many do you have? How many? OK. And again, only basic and preventative are covered.
[CUSTOMER][NEUTRAL] Mhm. Got it.
[AGENT][NEUTRAL] So any code that does not fall under one of those two categories would not be covered under this policy.
[CUSTOMER][POSITIVE] Got it. Thank you.
[AGENT][NEUTRAL] OK. And how many codes do you have under those two categories?
[CUSTOMER][NEUTRAL] I have here 7 codes.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the first code?
[CUSTOMER][NEUTRAL] First code is 0140.
[AGENT][NEUTRAL] That falls under basic.
[AGENT][NEUTRAL] And the limitation is limited to two or evaluation procedures and any combination of 0120, 0140, 0150 and 0160 for 12 month period.
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Next go we have.
[CUSTOMER][NEUTRAL] Mhm. 1208.
[AGENT][NEUTRAL] That is not covered?
[CUSTOMER][NEUTRAL] Got it. 1351.
[AGENT][NEUTRAL] I'm sorry, what was the code?
[CUSTOMER][NEUTRAL] 1351
[AGENT][NEUTRAL] That falls under preventative.
[AGENT][NEUTRAL] And the limitations on that are maximum of 1 procedure for 36 months, also limited to dependent children under the age of [PII], and applications made to permanent molar teeth only.
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] Next code.
[CUSTOMER][NEUTRAL] 0220
[AGENT][NEUTRAL] That falls under basic with no limitation.
[CUSTOMER][NEUTRAL] Thank you. Next code 2391.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That falls under basic restorative.
[AGENT][NEUTRAL] And the limitation is replaced existing only if in place for 24 months.
[AGENT][NEUTRAL] And also,
[AGENT][NEUTRAL] Maximum of 1 each qua tooth. Let me say that one again. Maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] Got it. Thank you. And uh could you please also confirm if the plan includes any alternate benefits for fillings? Do they downgrade?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you have the next code 4342.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] All right. And last code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] All right. Thank you so much. And yes, ma'am, that's it for the, mhm, that's it for the procedure codes. But before I let you go, could you please also confirm if the plan has a waiting period and a missing tooth cloth?
[AGENT][POSITIVE] You, you're welcome.
[AGENT][NEUTRAL] There is a miss missing tooth cloth, no waiting periods.
[CUSTOMER][NEUTRAL] All right. Thank you. And yes, that's actually it for this patient. And can I please have a call reference number?
[AGENT][NEUTRAL] Yes then you will use my name that I gave you along with today's date and then if you all do file a claim for this member with APO once the claim has been processed, [PII], we do have a portal that you should be able to check the claim status in by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] Mhm. [PII]. Yes ma'am.
[CUSTOMER][POSITIVE] Got it, thank you.
[CUSTOMER][POSITIVE] All right. Thank you so much for your time and for your help and you have a wonderful day.
[AGENT][POSITIVE] Well, you are very, yes ma'am, if that's all I can help you with, thank you again for calling APL and I hope you have a nice day also, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.