AccountId: 011433970860
ContactId: 07419a62-2a34-4904-9960-953df62334a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 966059 ms
Total Talk Time (AGENT): 347897 ms
Total Talk Time (CUSTOMER): 171725 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/07419a62-2a34-4904-9960-953df62334a9_20250109T20:53_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII] calling from provider's office to check dental benefits.
[AGENT][NEUTRAL] I can help with benefits and what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 29695
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] I do appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII] direct line.
[AGENT][NEUTRAL] I appreciate that. The policy went into effect on [PII]. It is active. Now, these policies have $1500 maximum per calendar year. That's just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] It covers basic, basic restorative and preventative services as well as major coverage, um.
[AGENT][NEUTRAL] I, what we do is we pay a percentage of the UCR and I do have a fax check that I can send to you if you'd be interested or there's anything in particular that I can tell you about the policy.
[CUSTOMER][NEUTRAL] This this plan runs in the calendar year or contract year.
[AGENT][NEUTRAL] It is a calendar year.
[CUSTOMER][NEUTRAL] Can I get the group name and number?
[AGENT][NEUTRAL] Yes, the group number is 15996.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] You just
[AGENT][NEUTRAL] This is universal trucking.
[AGENT][NEUTRAL] Highway perks. So it's the name Universal Trekking.
[AGENT][NEUTRAL] And the division is highway and then PER.
[AGENT][NEUTRAL] KS
[CUSTOMER][NEUTRAL] OK, and can I get the claim's mailing address as well?
[AGENT][NEUTRAL] It's [PII]. That is in [PII].
[AGENT][NEUTRAL] And our zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you can also fax the uh claims to us or we have an electronic uh.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Filing a number of you would be interested.
[CUSTOMER][NEUTRAL] Uh, I need it verbally, so, um, and is there a waiting period or missing tooth loss?
[AGENT][NEUTRAL] There is a missing tooth clause and the waiting period is 12 months, but that has been met.
[AGENT][NEUTRAL] So it's, it's not in effect anymore.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the deductibles?
[AGENT][NEUTRAL] There's a $50 deductible that does not apply to preventative services, and [PII] hasn't used any of his benefits at all for the current year. It's all available, but the $50 deductible is still due.
[CUSTOMER][NEUTRAL] OK. Is there a family deductible amount?
[AGENT][NEUTRAL] $150.
[CUSTOMER][NEUTRAL] OK. Co-insurance for preventive basic and major.
[AGENT][NEUTRAL] The um preventive, uh, preventative, is it 100% of UCR? The basic and basic restorative, is it 80%?
[AGENT][NEUTRAL] And the major services such as endodontic, periodontic, oral surgery is at 40%.
[CUSTOMER][NEUTRAL] 40, OK, is there an auto benefit on this plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Can I get the frequencies for preventative and diagnostics?
[AGENT][NEUTRAL] Uh yes, the um.
[AGENT][NEUTRAL] Profies are once every 6 months.
[AGENT][NEUTRAL] The exams, and this includes all of the exams.
[AGENT][NEUTRAL] Or 212 month period.
[AGENT][NEUTRAL] The bite wings are once per 12 month period.
[AGENT][NEUTRAL] Full mouth and panel or once every 5.
[AGENT][NEUTRAL] Crowns and bridges are once every 7, that's per 2.
[AGENT][NEUTRAL] Partials and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] OK, what is the frequency for PAs?
[CUSTOMER][NEUTRAL] 0220 and 0240.
[AGENT][NEUTRAL] 0240. I'm sorry, and 0.
[AGENT][NEUTRAL] OK. That's uh 0220, the inner oral X-rays, um, let's see.
[CUSTOMER][NEUTRAL] 220.
[AGENT][NEUTRAL] That is limited to 2 per calendar year.
[CUSTOMER][NEUTRAL] One moment. OK, both are 2 per calendar year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so how many PS or byte wings will convert to an SMX?
[AGENT][NEUTRAL] How you mean whether you can do them on the same day or?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, yes, you can, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do the oral cancer screening cover 0431 and fluoride sealants?
[AGENT][NEUTRAL] Uh, the fluoride and sealants are for, um, uh, patients [PII] old or younger, and the cancer screening is not covered.
[CUSTOMER][NEUTRAL] What is the frequencies for fluid and ceilings?
[AGENT][NEUTRAL] Uh, see the, the, um, fluoride, uh, that is, um,
[AGENT][NEUTRAL] That is uh
[AGENT][NEUTRAL] OK, let's see. A maximum of 1 procedure for 12 months.
[AGENT][NEUTRAL] And the sealants.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] The sealants are um.
[AGENT][NEUTRAL] Yeah. 1 for 36 months.
[CUSTOMER][NEUTRAL] How do the space maintenance cover 1510?
[AGENT][NEUTRAL] Yes, that is covered. The frequency on that.
[AGENT][NEUTRAL] I um
[AGENT][NEUTRAL] For dependent children [PII] old or younger, and that's a maximum of 1 per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] And the code 1354 covered?
[AGENT][NEUTRAL] 1354.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Uh, no, it is not.
[CUSTOMER][NEUTRAL] And do the posterior composites downgraded and the frequency for composites.
[AGENT][NEUTRAL] Uh, they are not downgraded and for the um.
[AGENT][NEUTRAL] That lets you go now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is a replacement of existing only in place for 24 months.
[AGENT][NEUTRAL] And the frequency is a maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] 2991, is that covered benefit?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] 4341 and 4910.
[AGENT][NEUTRAL] OK, 4341. Let me just check.
[AGENT][NEUTRAL] No, that is not covered. And what, what is the other code?
[CUSTOMER][NEUTRAL] Is it 4341 not covered? Could you double check?
[AGENT][NEUTRAL] [PII]. OK, you said 4341. Let me just check.
[AGENT][NEUTRAL] OK, we have 4342. Now, um, the frequency for that.
[AGENT][NEUTRAL] Is a maximum of 1 each quadrant per 24 months, so 4342.
[CUSTOMER][NEUTRAL] OK. 4910.
[AGENT][NEUTRAL] That is uh covered and the frequency is a maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Is that under basic service?
[AGENT][NEUTRAL] Uh no, that would be under major services.
[CUSTOMER][NEUTRAL] And do they share the frequency with prophy?
[AGENT][POSITIVE] Yes they do.
[CUSTOMER][NEUTRAL] What is the healing period between the SRP and PDM maintenance.
[AGENT][NEUTRAL] What is, I mean, sorry, what is the what period? It's
[CUSTOMER][NEUTRAL] He he period.
[AGENT][NEUTRAL] The only thing I'm showing is once every, I'm just showing that 6 months.
[AGENT][NEUTRAL] That's the only, that's the only.
[CUSTOMER][NEUTRAL] OK, 4346.
[AGENT][NEUTRAL] 4346. OK.
[CUSTOMER][POSITIVE] Yeah, OK, no problem.
[AGENT][NEUTRAL] I don't have 4346 uh.
[AGENT][NEUTRAL] 4342.
[CUSTOMER][NEUTRAL] 4355
[AGENT][NEUTRAL] OK, that is covered under major.
[AGENT][NEUTRAL] And the frequency on that.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] A maximum of 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] 923-0, is that covered?
[AGENT][NEUTRAL] Check.
[AGENT][NEUTRAL] That is covered, uh, that is listed under um.
[AGENT][NEUTRAL] The major services and there's no frequency.
[CUSTOMER][NEUTRAL] 7230, just the percentage.
[AGENT][NEUTRAL] At 40%.
[CUSTOMER][NEUTRAL] 7140
[AGENT][NEUTRAL] That is covered at at uh 80%.
[CUSTOMER][NEUTRAL] 9944
[AGENT][NEUTRAL] That's covered at 40%.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The frequency on that is limited to age [PII] and over.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7961 and 7962%.
[AGENT][NEUTRAL] That's at 40%.
[CUSTOMER][NEUTRAL] 9248%.
[AGENT][NEUTRAL] I don't show that that's covered.
[CUSTOMER][NEUTRAL] 3120 and 3220%.
[AGENT][NEUTRAL] And that is covered, they're both covered at 40%.
[CUSTOMER][NEUTRAL] 9420.
[AGENT][NEUTRAL] I don't show that that's covered.
[CUSTOMER][NEUTRAL] OK, 7953%.
[AGENT][NEUTRAL] I don't show that that's covered.
[CUSTOMER][NEUTRAL] 9223%.
[AGENT][NEUTRAL] At 40%.
[CUSTOMER][NEUTRAL] 6058.
[AGENT][NEUTRAL] I don't show that that's covered.
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] I don't show that that's covered.
[CUSTOMER][NEUTRAL] 624-0.
[AGENT][NEUTRAL] At 40%.
[CUSTOMER][NEUTRAL] Uh, next is 2930% and frequency.
[AGENT][NEUTRAL] And it's at 40%.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] That is a maximum of 1 for 7 years.
[CUSTOMER][NEUTRAL] 2931, is that the same?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] That is at 40%.
[AGENT][NEUTRAL] And it's a maximum of 1 for 7 years.
[CUSTOMER][NEUTRAL] Frequency?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do the code 2740 downgraded?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] And 624-0 do they downgrade?
[AGENT][NEGATIVE] Uh, no, they do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you pay the major services on free date or prep date?
[AGENT][NEUTRAL] Either of those two dates.
[CUSTOMER][NEUTRAL] Can I get the reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as a reference. Is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] Yeah, that's it thank you so much for providing me all this information. Have a wonderful day take care bye bye.
[AGENT][POSITIVE] Thanks for contacting APL. Have a good day.