AccountId: 011433970860
ContactId: 047b6eef-a105-4c5d-9738-57049e84276b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735320 ms
Total Talk Time (AGENT): 275733 ms
Total Talk Time (CUSTOMER): 243645 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/047b6eef-a105-4c5d-9738-57049e84276b_20250424T21:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am calling to verify dental benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the dental benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02558125
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, you need the subscriber or the uh patient?
[AGENT][NEUTRAL] Oh, the patient's fine.
[CUSTOMER][NEUTRAL] Uh [PII] 122305.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. And did you need a copy of the fax faxed to you or you had a you had questions about it?
[CUSTOMER][POSITIVE] Oh perfect yes if I could get the fax back and I do have some additional questions.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] All right, and then [PII], what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and then what questions did you have um in reference to the policy?
[CUSTOMER][NEUTRAL] Uh, yes, can you, um, tell me with my tax ID number, um.
[CUSTOMER][NEUTRAL] If we're an in network provider and also.
[CUSTOMER][NEUTRAL] Also, uh, what the schedule to use?
[AGENT][NEUTRAL] So, so this policy isn't on a network, um, so it's, it, there's no in or out of network, um, and then it's a, it's a standard um Carrington fee schedule?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, we don't use Carrington, so I wouldn't have a fee schedule.
[AGENT][NEUTRAL] OK, so I'm sending you the breakdown of the benefits, but in just in general, it's just a standard um UCR pay schedule.
[AGENT][NEUTRAL] So when you get the
[CUSTOMER][NEUTRAL] Oh, OK, so the UCR.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so they'll pay the difference between our fee and whatever you guys pay, uh, pay on it.
[AGENT][NEUTRAL] The patient
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, um, so once we process the claim and we send you all back the explanation of benefits, it'll list the patient responsibility on there if there is one, if there is some.
[CUSTOMER][NEUTRAL] OK, OK, alright, and um I do have some questions that are normally not on the fax back. Can I ask you those?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Now do you have a, do you have a limit? If you do, I can pick the best ones.
[AGENT][NEUTRAL] A limit in terms of you're going to give me a list of codes?
[CUSTOMER][NEUTRAL] Yeah, uh, do you have a limit on how many you can how many questions you can answer? Like there's some insurances that only answer certain amount of.
[AGENT][NEGATIVE] Oh, no, I'm like, wait, a limit on, no, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect perfect alright so is your claim address the [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, alright, and your payer ID is 60801?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, alright, and can you tell me if this is a calendar year plan?
[AGENT][NEUTRAL] Let me check, yes, this calendar year.
[CUSTOMER][NEUTRAL] And does the max apply to preventative and diagnostic?
[AGENT][NEUTRAL] The calendar year max, yes, it does apply to preventative and diagnostic. Um, the deductible, um, doesn't apply to preventative though.
[CUSTOMER][NEUTRAL] OK, that's just basic and major?
[AGENT][NEUTRAL] Um, this policy does cover major, major for us is endodontic, periodontic, um, prosodontic, and oral surgery, and there is a twelve-month waiting period for the major services. So that will be [PII] of this year, they'll be eligible.
[CUSTOMER][NEUTRAL] [PII]. OK. And so Pero, uh, I'm not sorry, Perry preventative, basic and major, what are those percentages?
[AGENT][NEUTRAL] Alright, so preventative is 100%.
[AGENT][NEUTRAL] Basic is 80.
[AGENT][NEUTRAL] And major is 40.
[CUSTOMER][NEUTRAL] 40. Alright, so you said endoper on oral surgery was 40%.
[AGENT][NEUTRAL] Endopperiorosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK, alright, and are there any waiting period? Oh yeah, you did say, so you said 12 month waiting period on major.
[AGENT][NEUTRAL] Yes, ma'am, just for major.
[CUSTOMER][NEUTRAL] OK, just for major right, um, is there a missing tooth cloth?
[AGENT][NEUTRAL] Um, yes, the policy does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] Alright, and what age does the 1110 turn into an adult trophy?
[AGENT][NEUTRAL] Um, hold on one moment, uh.
[AGENT][NEUTRAL] I'm over [PII].
[CUSTOMER][NEUTRAL] [PII] OK, [PII] [PII], OK, so [PII] old.
[AGENT][NEUTRAL] Yeah, because the, the child is limited to [PII] [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh right, and on the ceilings what teeth are covered?
[AGENT][NEUTRAL] The um fax back doesn't specify that. Um, it just has like the ceiling code and the limitations, but let me, let me double check.
[AGENT][NEUTRAL] When you say teeth, you're not talking about like the like the number, you're talking about like if it's molars or
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, well, there's some insurance plans when we call they give us teeth numbers instead of if the permanent molars or whatever, so yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] OK, let me double check for you. Hold on, hold on one moment.
[CUSTOMER][NEUTRAL] It varies.
[AGENT][NEUTRAL] OK, so yeah, for this one it's, it's um molar teeth only, permanent molar teeth.
[CUSTOMER][NEUTRAL] Permanent molars alright and on your 2391 do you downgrade to amalgam?
[AGENT][NEUTRAL] 2391, hold on, let me find that hold on one second.
[AGENT][NEUTRAL] Um, there's no downgrade.
[CUSTOMER][NEUTRAL] OK, not even on the crowns, the 2740?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mm mm, there is not, hold on one second.
[AGENT][NEUTRAL] Yeah, we don't have, there, there's no downgrades on the policy.
[CUSTOMER][NEUTRAL] OK, no downgrade. Alright, and do you cover the reement, the 2920?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Oh, you know what, let me do it this way. Hold on one second.
[CUSTOMER][NEUTRAL] Uh huh mhm.
[AGENT][NEUTRAL] And what was the code you said again? I'm sorry?
[CUSTOMER][NEUTRAL] The 2920.
[AGENT][NEUTRAL] Um, yes, that's covered under major.
[CUSTOMER][NEUTRAL] Major, alright, let's see and what is the frequency?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Maximum of 1 per seven-year period and limited to the patients aged [PII] and over.
[CUSTOMER][NEUTRAL] OK, 1 in 7 years. OK, so is this plan like a uh like a child's plan?
[AGENT][NEUTRAL] It's for both. Um, it's it's a family policy, so it's for adults and children, depending on the code, it'll be, you know.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, OK, alright, and um do you pay on prep seat date?
[AGENT][NEUTRAL] Either or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] On your 4341, do you have a pocket depth restriction?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The only limitation that it has on the fax back is maximum of 1 each quadrant per 24 months, um, but there's no other specifications to the code.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] All right, and is there any implant coverage?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, no, implants, implants, placement, removal, and all related services are not covered on the policy, on this policy.
[CUSTOMER][NEUTRAL] Not covered, OK. And what about the night guard, the 9944?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 9944 is not listed on the fax bag.
[AGENT][NEUTRAL] So it's not a cover code.
[CUSTOMER][NEUTRAL] Not covered? OK.
[CUSTOMER][NEUTRAL] OK, and the extractions, the 7140 and the 7210 are both considered the major?
[AGENT][NEUTRAL] Mhm. 7140 is considered basic. Let me double check though. It might be preventative.
[AGENT][NEUTRAL] Oh no, it's basic. Yeah, 7140 is basic at 80% and it has a limitation of maximum one time for 2.
[CUSTOMER][NEUTRAL] Alright, and the 7210?
[AGENT][NEUTRAL] He's under oral surgery, so that's major at 40%.
[CUSTOMER][NEUTRAL] 40%? Alright.
[CUSTOMER][NEUTRAL] Oh, but there's a waiting period on there, right? OK, alrighty ma'am. OK, can I get a reference number for this call?
[AGENT][NEUTRAL] Oh, yes, the 12 months.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The um first initial and my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much you have a good day.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No ma'am, that's it.
[AGENT][POSITIVE] Alright, well, thanks for calling APO [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.