AccountId: 011433970860
ContactId: 080a6313-5ecb-4bb5-a926-b9893838a06f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 591309 ms
Total Talk Time (AGENT): 253969 ms
Total Talk Time (CUSTOMER): 228540 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/080a6313-5ecb-4bb5-a926-b9893838a06f_20250505T13:27_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to get eligibility and benefits for a patient. I just spoke with someone, but the patient is actually here, so I hadn't received that fax back just yet.
[AGENT][NEUTRAL] OK, yes, ma'am. Well, it does take just a couple of minutes for it to go through.
[AGENT][NEUTRAL] Um, OK, so you're needing information on a dental policy?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Thank you, and [PII], your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Policy number I have 02346809.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][POSITIVE] I'm very sorry about that.
[AGENT][NEUTRAL] OK, and any information that I provide for you will be a verification of benefits, [PII], and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, so he is a subscriber on this dental plan and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information can I help you with, [PII]? Cause let me verify the fact that they sent that to. It has [PII]?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just wanted to know, I know she said that um 1500 max hadn't been reached or the deductibles, so no benefits has been used yet. Are we in network with her?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is not a network plan. Benefits are based on the, no, it is not. Benefits are based on a percentage of the use cover services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEGATIVE] It's not a network
[CUSTOMER][NEUTRAL] OK, and is there a payer ID for this policy?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] 801. Uh-huh.
[CUSTOMER][NEUTRAL] 6808. I'm sorry, say that one more time. I got confused 6.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][POSITIVE] Thank you so much. 60801 got it. And then also, um, just wanted to know what preventative considered as and was it covered at 100% the cleaning, exam, X-ray.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] It is covered at 100%.
[AGENT][NEUTRAL] Preventative is one, yeah, radiographs and FMXs are covered at 80% of UCR.
[AGENT][NEUTRAL] Subject to the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] Oh, deductible does apply to.
[CUSTOMER][NEUTRAL] X-rays.
[AGENT][NEUTRAL] FMX and radio mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you still haven't received that? because I'm just, I'm curious that
[CUSTOMER][NEUTRAL] I know it's yeah.
[AGENT][NEUTRAL] Cause I've sent, I'm wondering if something may be wrong with your facts.
[CUSTOMER][NEUTRAL] Yeah, I'm looking now let me go back.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Cause I've sent one since I saw the date stamp.
[AGENT][NEUTRAL] And not to you, but to someone else. And it might, I just received notification that it went through.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Could it be me? Let's see.
[CUSTOMER][NEUTRAL] Uh, I'm looking, it looks like our last set.
[CUSTOMER][NEGATIVE] I received at [PII] so no.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII] is our fax number. Yeah, I hadn't received it just yet.
[AGENT][NEUTRAL] What's the number one more time?
[AGENT][NEUTRAL] Your facts.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, wait. Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I'll just try to send it to you, but if you don't res I mean I've also sent you the same fax like you should be.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] You're already getting so like I said I can see that based on the time stamp.
[AGENT][NEUTRAL] From when you called and spoke to someone else on this policy.
[AGENT][POSITIVE] She sent that fax to you before I sent the fax that I have received notification was successfully delivered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It could be on our end it could.
[CUSTOMER][NEUTRAL] OK, so just, just again, because I have a patient on the way and just wanted to see what they were gonna be covered for for this for this visit. Um, is there is fluoride treatment covered for this patient due to age? Usually not, but just wanted to check.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the code?
[CUSTOMER][NEUTRAL] Um, D 1206.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] If fluoride not covered.
[CUSTOMER][NEUTRAL] Um, FMX is covered at 80%. Would you say all radiographs or just SMX then?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It says FMX right on their fax back it says FMX.
[AGENT][NEUTRAL] OK, excuse me. It says radiographs FMX 80% of UCR.
[AGENT][NEUTRAL] So radiographs and FMX, basic, basic, restorative, that's all 80% of UCR major endoperontic, prosthodontic, and oral surgery is 40% of UR. UCR, I can't talk this morning. So sorry, [PII].
[CUSTOMER][NEUTRAL] That's OK, that's OK.
[AGENT][NEUTRAL] And those are all subject to a 12-month waiting period, but that's been satisfied cause this policy went into effect 81 or 23.
[CUSTOMER][NEUTRAL] OK, so no waiting period and you said basic was covered at 1, I'm sorry, so sorry, 100% for basic.
[AGENT][NEUTRAL] No. Basic is 80% of UCR subject to the $50 calendar year. Mhm.
[CUSTOMER][NEUTRAL] 80%
[CUSTOMER][NEUTRAL] OK, and then major.
[CUSTOMER][NEUTRAL] 40
[AGENT][NEUTRAL] 40%. Mhm.
[CUSTOMER][NEUTRAL] And so the cleaning in the exam is covered at 100% or.
[CUSTOMER][NEUTRAL] Can I give you a cleaning code?
[AGENT][NEUTRAL] Yeah, mhm, sure.
[CUSTOMER][NEUTRAL] Right, D1110.
[AGENT][NEUTRAL] One moment
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, that does fall under preventative.
[CUSTOMER][POSITIVE] Perfect. And a comp exam the excuse me, D 0150.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] That's under preventative also.
[CUSTOMER][POSITIVE] Alright, thank you so much. I and and one more question, one more question because you mentioned earlier that the $50 deductible that applies towards radiographs they got radiographs today FMX it'll go, uh, $50 deductible will be included. OK, alright, thank you so much. I'll, I'll try to refresh for that fax and hopefully we, we get that fax back. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's great. Yeah.
[AGENT][POSITIVE] OK. Well, if you need anything else, just give us a call. Is there anything else I can help you with at the moment though?
[CUSTOMER][POSITIVE] Uh, no, I think, I think we're good to go with this patient, thank you.
[AGENT][NEUTRAL] And then I don't know if the person you spoke to before uh told you about our portal or not, but if you do end up filing a claim with APL once it has been processed by us, we do have a portal that you should be able to check claim status in, and the website for that, Tiffany is located at [PII].
[CUSTOMER][POSITIVE] Se [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Got it. Alright, thank you so much. I appreciate it.
[AGENT][POSITIVE] Well, you're certainly very welcome. And again, anything else I can help you with?
[CUSTOMER][POSITIVE] I think that's gonna do it. I'm, I'm gonna try to get through that. Uh, we know what we need for the patient this time. I'll wait on that fax back or call you guys back if I need anything.
[AGENT][POSITIVE] OK, well then, please do. Otherwise, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] All right thank you you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much. Bye bye.