AccountId: 011433970860
ContactId: 07c0b029-ca27-4354-b76c-08f84030950d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 721820 ms
Total Talk Time (AGENT): 237335 ms
Total Talk Time (CUSTOMER): 170449 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/07c0b029-ca27-4354-b76c-08f84030950d_20250320T22:30_UTC.wav
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[AGENT][POSITIVE] Thank you for calling and APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling you from the dental office. Your name spelled like [PII]?
[AGENT][NEUTRAL] It's uh just one [PII], but you've got, you're pretty close.
[CUSTOMER][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] So calling you from the Doctor [PII] office, yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, can I please get your, um, may I please get your callback number, [PII] just in case our call gets dropped while we're on the phone, uh, I can call you back.
[CUSTOMER][NEUTRAL] Yeah, please go on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] And you said you're calling from Doctor [PII]?
[AGENT][NEUTRAL] That's as far as we got.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Doctor [PII]. Do you need the tax ID?
[AGENT][NEUTRAL] No, no, sir, I just need the provider name.
[AGENT][NEUTRAL] OK, how can I help you, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, I do a patient, I need to verify uh the patient have any dental coverage.
[AGENT][NEUTRAL] OK, I can check with the dental benefits for your eligibility. What is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] ID number is 0255.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The first name spelled like [PII], spelled like [PII] and last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do show that Laquan does have an active policy, dental policy, the.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm group name and group number?
[AGENT][NEUTRAL] The group number is 12028.
[CUSTOMER][NEUTRAL] The name
[AGENT][NEUTRAL] Group name is Universal Trucking Intermodal card.
[AGENT][NEUTRAL] Carthage.
[CUSTOMER][NEUTRAL] Universal trucking, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What about the deductible and maximum on this plan?
[AGENT][NEUTRAL] UTBA
[AGENT][NEUTRAL] OK, if you give me your fax number, I can send you over a fax back that has the benefit breakdown and fee schedule for you.
[CUSTOMER][NEUTRAL] No, I, I have some specific questions, ma'am. It can be really quick.
[AGENT][NEUTRAL] Oh, OK. Well, that's fine. Let me look it up real quick.
[AGENT][NEUTRAL] All right. Look at the policy.
[AGENT][NEUTRAL] The insured has the calendar year maximum of 1000 and this is just to verify benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] The benefit maximum is $1500 and the calendar year deductible is $50.
[CUSTOMER][NEUTRAL] Anything has been used?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, the insured has used $372.60.
[CUSTOMER][NEUTRAL] 372 and 60 cents, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what about deductibles have been met or not?
[AGENT][NEUTRAL] Deductible has been met.
[CUSTOMER][NEUTRAL] Has been met. OK. What about the coverages for the preventative, basic and major?
[AGENT][NEUTRAL] Let me look for you.
[AGENT][NEUTRAL] Preventative is 100% of UCR. Basic is 80% of UCR, and major is 40% of UCR.
[CUSTOMER][NEUTRAL] OK, the um
[CUSTOMER][NEUTRAL] Panel 0330 is covered under basic, right? 80%.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And PH 0220 also basic AT.
[AGENT][NEUTRAL] 2822.
[AGENT][NEUTRAL] 0 is what you said?
[CUSTOMER][NEUTRAL] 02200220.
[AGENT][NEUTRAL] Or just
[AGENT][NEUTRAL] Yes. Yes, that's basic.
[CUSTOMER][NEUTRAL] And yeah, do you need the code or description?
[AGENT][NEUTRAL] I need the code.
[AGENT][NEGATIVE] I have to look off at this fax fact.
[CUSTOMER][NEUTRAL] 3310.
[AGENT][NEUTRAL] 3310 or just 310.
[CUSTOMER][NEUTRAL] And the nonte.
[AGENT][NEUTRAL] And adopted, let me see.
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Like it's a periodontics.
[AGENT][NEUTRAL] OK, let me scan through.
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] OK. 4346 is not covered?
[AGENT][NEUTRAL] 4346. Let me look for that code.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] OK, yes, sir.
[AGENT][NEUTRAL] There's a lot of codes here I just have to scroll through them until I find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, it is not on this fax back.
[CUSTOMER][MIXED] OK. And the implants are also not covered.
[AGENT][NEUTRAL] Implants, um, what is the code?
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] No, I do not see that code either.
[CUSTOMER][NEUTRAL] 7140
[AGENT][NEUTRAL] 7140 is basic.
[CUSTOMER][NEUTRAL] OK. And uh 7210?
[AGENT][NEUTRAL] That is considered oral surgery.
[AGENT][NEUTRAL] And it is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Under major.
[CUSTOMER][NEUTRAL] OK, and the orthodontics is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What about last code 9944?
[AGENT][NEUTRAL] 9144 you said?
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] 9944, let me look.
[AGENT][NEUTRAL] That is not on the fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the fee schedule? Are we network or out of network?
[AGENT][NEUTRAL] You're in network they can use anybody they want to.
[CUSTOMER][NEUTRAL] So what's the fee schedule will be?
[AGENT][NEUTRAL] Uh, it's based off of UCR.
[CUSTOMER][NEUTRAL] Uh, actually, the UCR is used for the out of network.
[AGENT][NEUTRAL] That's what we base our fee schedule on is the percentage of the UCR. So like on preventative expenses it's 100% of UCR. Basic is 80% of UCR. Major is 40% of UCR.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's all based on UCR.
[CUSTOMER][NEUTRAL] OK, so do you, do you guys accept assignment of benefits?
[AGENT][NEUTRAL] Assignment of benefits.
[CUSTOMER][NEUTRAL] Like, uh, the check will go to the provider or to the patient.
[AGENT][NEUTRAL] The check, it depends on if you if the provider files and the provider gets paid if the patient files and the patient gets paid.
[CUSTOMER][NEUTRAL] Like if there, if there is a sign on file from the provider.
[CUSTOMER][NEUTRAL] So it will go to the provider, right? The check.
[AGENT][NEUTRAL] Right, there's a box usually on the claim form that you would choose to check if you wanted it to go to the patient.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But if that box is not checked,
[CUSTOMER][POSITIVE] OK. All right. All right. Thank you so much, [PII].
[AGENT][NEUTRAL] Then it goes to the provider.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] All right. So, thank you so much, [PII], and the schedule is UCR. Can I have your reference number for today?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, the reference number is my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. I hope you have a great day. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Nope, that's all for today. Thanks so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. You take care and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye