AccountId: 011433970860
ContactId: 08956e36-474c-4430-80eb-bb020f4c3a0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1387459 ms
Total Talk Time (AGENT): 467447 ms
Total Talk Time (CUSTOMER): 485468 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/08956e36-474c-4430-80eb-bb020f4c3a0e_20250519T20:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the dental office. [PII], I was just looking for some dental benefits for my patient.
[AGENT][POSITIVE] Sure, I can help you with benefits. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, of course. Let me provide you with that. Give me one second only. Sorry for the delay. Just a second. Hm, here it is. So the callback number would be [PII].
[AGENT][POSITIVE] Thank you so much. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. I got the policy number here. That's going to be mm.
[CUSTOMER][NEUTRAL] 436-560-722
[AGENT][NEUTRAL] Alright, one moment while I look that up for you.
[CUSTOMER][NEUTRAL] Yeah, of course. No way.
[AGENT][NEUTRAL] Alright, it looks like that is too long of a policy number.
[AGENT][NEUTRAL] Do you have the card with you? Does it say the certificate number?
[CUSTOMER][NEUTRAL] Let me double check it. Yeah, of course. Just one thing. Oh yeah, yeah. You're right. I've got another ID number. So yeah, I think I just got uh uh another number. It's 616444.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 616-444
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][POSITIVE] Yeah, yeah, of course.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. The patient's first name, that's going to be [PII], the last name [PII], and the date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] You're welcome, ma'am.
[AGENT][NEUTRAL] It looks like this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And were you wanting a fax back?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, uh, yeah, I need the fax back and I got some additional things need to confirm from you over the phone, if it is OK with you. Kindly help me.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Yeah, of course. Thank you.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, ma'am. First of all, I need to confirm the participation. Do you have any network uh in this plan? Like the provider issuing in network with this plan?
[AGENT][NEUTRAL] I'm sorry, any what?
[CUSTOMER][NEUTRAL] Uh, means the provider is showing in network with this plan. Are there any networks in this plan?
[AGENT][NEUTRAL] Oh, in network?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you know if you're in the [PII] network?
[CUSTOMER][POSITIVE] OK, OK, OK. Oh, I got it here. Got it. I got a note here. Sorry, sorry. Just a second. Actually, we provide is generally out of network. Sorry, I just see that now. I'm extremely sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second. Let me write a note here. Sorry.
[CUSTOMER][NEUTRAL] OK. And uh actually, our providers generally out of network, so they are going to follow like as per UCR uh with maximum allowed amount.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just need to make sure.
[AGENT][NEUTRAL] It looks like they have a calendar year maximum of up to $1000 per covered person with a calendar year deductible of $50 per person or per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] That's perfect.
[CUSTOMER][NEUTRAL] And is there anything else we used to me for this year?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do want to say that that was just a verification of benefits and not necessarily a guarantee of payment, so give me one moment while I look that up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][NEGATIVE] It looks like none of the benefits have been used to date.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, that's perfect. And also with this plan, ma'am, is there any missing clause or any waiting period?
[AGENT][NEUTRAL] This policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] And I am not showing any waiting periods.
[CUSTOMER][NEUTRAL] That's perfect, ma'am. And ma'am, sorry for that, but this kind of plan, there would be like no group number or group name. This is an individual policy, right?
[AGENT][NEUTRAL] This is a couple policy. Let me look and see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Like, is there any group number in this plan?
[AGENT][NEUTRAL] Right, no, there is not.
[CUSTOMER][NEUTRAL] OK, OK. That's perfect. And uh do you see like uh one second, uh yeah. And uh do you see any history regarding this year, [PII], any kind of?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, they haven't used anything yet for this year.
[CUSTOMER][POSITIVE] OK, that's perfect. And uh regarding any previous year, any past history for FMX uhpano, any past?
[CUSTOMER][NEUTRAL] Previous yes.
[AGENT][NEUTRAL] Let me look. Give me 1 2nd.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] It looks like she used.
[AGENT][NEUTRAL] $95 of her calendar year maximum last year, [PII].
[CUSTOMER][NEUTRAL] Last year. OK.
[AGENT][NEUTRAL] And used $44 of her deductible in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for [PII], can you just provide me the history, only for the last year, [PII], if you don't mind.
[AGENT][NEUTRAL] That that's all I have.
[AGENT][NEUTRAL] Is that she used $44 of her deductible and $95 of her calendar year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So you don't have any like uh any procedures that was surrendered?
[CUSTOMER][NEUTRAL] Uh, for [PII], any kind of
[AGENT][NEUTRAL] Right, I can't see the procedures that she used. I can only see how much she spent. Right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much is then? OK, got it there. Putting a note here, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry for the delay.
[CUSTOMER][NEUTRAL] Now, ma'am, uh, actually, this is a very typical plan here. Like this is a co-pay plan. Am I ready for this?
[AGENT][NEUTRAL] Um, I'm not seeing any co-pay on here.
[CUSTOMER][NEGATIVE] You're not showing any copy.
[AGENT][NEUTRAL] Right, only the $50 right.
[CUSTOMER][NEUTRAL] Like a dollar amount, just to make sure.
[AGENT][NEUTRAL] Right, I'm not seeing any co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're not showing any co-pay, uh, but are you showing the like a $1 amount? So this is a dollar amount plan?
[AGENT][NEUTRAL] Yes, this is, this goes by benefit amount.
[CUSTOMER][POSITIVE] Hm, that's perfectly got it there. Ma'am.
[AGENT][NEUTRAL] So depending on the procedure that they do, we have a set amount that goes towards that procedure.
[CUSTOMER][NEUTRAL] Set amount for this. Got it, yeah, ma'am. Now, ma'am, could you please do me a favor? Actually, I already got the amount, sir, in front of me. I need to confirm some codes. I need to confirm if I got the correct amount, sir. So may I provide you those codes all at once or one by one, whichever you prefer.
[AGENT][NEUTRAL] Uh, go ahead and give me, uh, all of the codes.
[CUSTOMER][NEUTRAL] OK, ma'am. OK. One second. Let me just set my tools, sir. Sorry. Just a second.
[CUSTOMER][NEUTRAL] OK. So, ma'am, the code that I need to confirm that's going to be 0120, 0140, 0220.
[CUSTOMER][NEUTRAL] 0274
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0330
[CUSTOMER][NEUTRAL] Then, one second, ma'am. 11:10.
[CUSTOMER][NEUTRAL] 1351 1510 2391 27 40 29 20 295029 60 3120 33 1033 2033 30, then 42 49 4266 4341.
[CUSTOMER][NEUTRAL] 434 6 435549 1060 1060 58, then 7140, 70 to 10, 702 2070 to 30, 70 to 40, 7241, 70 to 50, then 92, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] That that's a lot. So let's go, so since it's that many let's go ahead and go one by one, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. No worry. Yeah.
[AGENT][NEUTRAL] OK, so I have some of them written down, so the first one was 0120. I'm showing that has a benefit amount of $15.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I do want to remind you that this is just a verification of benefits and not a guarantee of payment, OK?
[CUSTOMER][NEUTRAL] Got it yeah. And ma'am, do you have any frequencies? If you got any, then can you provide me the frequency also with the amount, if it is OK with you?
[AGENT][NEUTRAL] It looks like that one is once every 6 months.
[CUSTOMER][NEUTRAL] OK. Got it.
[AGENT][NEUTRAL] 0140 has the benefit amount of $20 I'm sorry, $25.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Every 6 months?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and, hold on one second. The next one is 0220.
[AGENT][NEUTRAL] That has the benefit amount of $10.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Looks like once every 3 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, then I have 0274.
[AGENT][NEUTRAL] As a benefit amount of $20.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Next I have 0330.
[AGENT][NEUTRAL] Has a benefit amount of $35.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next one I have is 1110.
[AGENT][NEUTRAL] Am I correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. 1110. Yeah.
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] I'm not seeing that procedure code on here.
[CUSTOMER][NEUTRAL] This is a coffee cleaning 1110.
[AGENT][NEUTRAL] Oh, it's for a cleaning? OK, that might be a different number then.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, here it is.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] We have a benefit amount of $40.
[CUSTOMER][NEUTRAL] OK. Got it.
[AGENT][NEUTRAL] OK, the next one is 1351.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have a benefit amount of $24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have 15.
[AGENT][NEUTRAL] 1510.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not seeing that one. Do you know what it's for?
[CUSTOMER][NEUTRAL] 1510. Actually, ma'am, this is for space maintenance.
[AGENT][NEUTRAL] Yeah, I'm not seeing that one on here um when I give you the fax back you'll be able to check it as well.
[CUSTOMER][POSITIVE] No problem. OK. No worries. Thank you.
[AGENT][NEUTRAL] OK. And then the next one I have is 2391.
[AGENT][NEUTRAL] Which I am
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I'm also not seeing on here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2740 is next.
[CUSTOMER][NEUTRAL] Yeah, this is actually for the ground. 2740.
[AGENT][NEUTRAL] I have a benefit amount of $215.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Then 2920.
[CUSTOMER][NEUTRAL] $15 OK.
[AGENT][NEUTRAL] 2920 I have as a benefit amount of $15.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next one I have is 2950.
[AGENT][NEUTRAL] I have a benefit amount of $45.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, then the next one I have is 2960.
[AGENT][NEUTRAL] I have a benefit amount of $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] The next one I have is 3120.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I'm not seeing on here.
[AGENT][NEUTRAL] The next one I have is 3310.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have a benefit amount of $125.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3320. I have a benefit amount of $135.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3330. I have a benefit amount of $140.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next one I have is 4249.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have a benefit amount of $30.
[AGENT][NEUTRAL] And the next one I have is 4249.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm not seeing that one on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4266. I'm not showing on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 443 41.
[AGENT][NEUTRAL] I show a benefit amount of $72.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 4346.
[AGENT][NEUTRAL] I'm not seeing on here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4355 I show a benefit amount of $25.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the next one?
[CUSTOMER][NEUTRAL] The next one will be 14, uh yeah, 4910.
[AGENT][NEUTRAL] I show a benefit amount of $35.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the next one?
[CUSTOMER][NEUTRAL] Next 1, 6010, implant.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said 6, what was it?
[CUSTOMER][NEUTRAL] Uh, no, no, sorry, 6010.
[AGENT][NEUTRAL] 6010? OK.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not seeing that one on here.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next one will be 6057.
[AGENT][NEUTRAL] 6057.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't see that one on here.
[CUSTOMER][NEUTRAL] OK. And the next one would be, ma'am, 7140.
[CUSTOMER][POSITIVE] Simple extraction.
[AGENT][NEUTRAL] I see 71.
[AGENT][NEUTRAL] I have a different code for that. So for this policy, it will be 7110 for a single tooth extraction.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I have a benefit amount of $20.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $20. The next one would be 70 to $10 surgical extraction.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] I show a benefit amount of $30.
[CUSTOMER][POSITIVE] That's perfect. 70 to 20.
[AGENT][NEUTRAL] I show a benefit amount of $55.
[CUSTOMER][NEUTRAL] Quarter is 70 to 30.
[AGENT][NEUTRAL] I have a benefit amount of $74.
[CUSTOMER][NEUTRAL] 70 to 40.
[AGENT][NEUTRAL] I have a benefit amount of $85.
[CUSTOMER][POSITIVE] Perfect. 7241.
[AGENT][NEUTRAL] I have a benefit amount of $89.
[CUSTOMER][POSITIVE] Perfect. 7250.
[AGENT][NEUTRAL] I show a benefit amount of $40.
[CUSTOMER][POSITIVE] Perfect. 9223.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] What's it for?
[CUSTOMER][NEUTRAL] Anesthesia.
[CUSTOMER][NEUTRAL] Yeah, this is for anesthesia, general anesthesia.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not seeing that on here.
[CUSTOMER][NEUTRAL] OK. And the next one would be, uh, ma'am, this is for uh consultation. The code is 9310.
[AGENT][NEUTRAL] I show a benefit amount of $15.
[CUSTOMER][NEUTRAL] And the last code would be 9944. Night guard. OK, [PII].
[AGENT][NEUTRAL] I do not show that one on here. Oh wait, you said 9940 or 99451?
[CUSTOMER][NEUTRAL] OK, no way. I, yeah.
[CUSTOMER][NEUTRAL] 994 9944.
[AGENT][NEUTRAL] OK, I don't have 9944 on here.
[CUSTOMER][NEUTRAL] OK. One second. OK. So, ma'am, first of all, can you provide me the facts back for this patient, if you don't mind?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, what's a good fax number?
[CUSTOMER][NEUTRAL] Yeah, ma'am. The fax number would be [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, you're right, ma'am. And ma'am, on the fax back, the copay is also in uh like the dollar amount is also included and the frequencies is also included, right? Like the general things.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, OK. That's perfect. And ma'am, uh can you send me the fax back to another number also, if you don't mind. I've got another number here also.
[AGENT][NEUTRAL] OK, what's the other number?
[CUSTOMER][NEUTRAL] Yeah, the other number would be [PII].
[AGENT][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're right, ma'am. Yeah.
[AGENT][NEUTRAL] OK, is there anything else I can do for you today?
[CUSTOMER][NEUTRAL] No, ma'am. I need now your payer ID first of all, electronic payer ID.
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's perfect, ma'am. And I need your mailing address also and your call reference number.
[AGENT][NEUTRAL] OK, our mailing address for claims is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's perfect. And ma'am, just need to make sure the dollar amounts that you just provided me, uh, that's the insurance responsibility, right? Not the patient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, that's perfectly got it. And for in-network and for out of network provider, the amounts are the same, like the benefits is the same, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, that's perfect. Ma'am, I need to call reference number. Thank you.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date, so [PII], and today's date. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's perfect. [PII], thank you so much again for your time. And again, thank you so much for your help, OK? Take care for now. Thank you.
[AGENT][POSITIVE] OK. Thank you so much and have a great day.
[CUSTOMER][POSITIVE] Have a good day bye.
[AGENT][NEUTRAL] Mm bye.
[CUSTOMER][NEUTRAL] Mhm.