AccountId: 011433970860
ContactId: 0a14c128-88fe-4853-a0bc-845e2077ac42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 766559 ms
Total Talk Time (AGENT): 198312 ms
Total Talk Time (CUSTOMER): 174439 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/0a14c128-88fe-4853-a0bc-845e2077ac42_20250428T13:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning [PII]. My name is [PII]. I'm calling today to verify some benefits for a patient of mine.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, 02353771.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and her birthday is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I can send over a fax back or we can also do it over the phone.
[CUSTOMER][NEUTRAL] Um, over the phone would be preferred.
[AGENT][NEUTRAL] It's not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Let me get that pulled up. One moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Sorry, running just a bit slow.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, for this plan, they have a $500 calendar year maximum benefit.
[AGENT][NEUTRAL] Uh, preventive services cover 100%.
[AGENT][NEUTRAL] And then it looks like for radiographs, FMX, basic expenses and basic restorative, it's 80% after a $50 deductible.
[AGENT][NEGATIVE] They do not have any major coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does oral surgery, including extractions fall under major?
[AGENT][NEUTRAL] Um, is it 7140 or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have a code? OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 71,407,240.
[CUSTOMER][NEUTRAL] That should be a simple and a um major.
[CUSTOMER][NEUTRAL] Extractions.
[AGENT][NEUTRAL] Let me look that up.
[AGENT][NEUTRAL] Um, so it looks like under oral surgery, the only one that's covered under the policy is 7140.
[AGENT][NEUTRAL] And it's basic
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or restorative, I should say.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And then, so I'm guessing implants aren't covered since no major?
[AGENT][NEUTRAL] No, they're not
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. And then, um,
[CUSTOMER][NEUTRAL] Is uh general, um, anesthesia or deep sedation, is that covered under major? Well, not covered cause of major or is it considered basic?
[AGENT][NEUTRAL] Uh, let's see, um.
[AGENT][NEUTRAL] Yeah, I do not show that covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] All right, and then, um, OK, I have some code specific questions, um, would you prefer them all at once or one at a time?
[AGENT][POSITIVE] Uh, one at a time, that'd be great.
[CUSTOMER][NEUTRAL] OK, uh 0140.
[AGENT][NEUTRAL] Um, that is basic, and let me look for the frequency.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Limited to two procedures in a 12-month period.
[CUSTOMER][NEUTRAL] OK, does that share with other exams?
[AGENT][NEUTRAL] Yes, it does. Uh, 140, 120 150,160.
[CUSTOMER][NEUTRAL] And then um what's the percentage for 0150?
[AGENT][NEUTRAL] Uh, that, that's under the same.
[CUSTOMER][NEUTRAL] It's still gonna be that 80.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] percent
[CUSTOMER][NEUTRAL] OK. Um 9310.
[AGENT][NEUTRAL] 9310.
[AGENT][NEUTRAL] Uh, that's gonna be 80.
[CUSTOMER][NEUTRAL] Any frequency?
[AGENT][NEGATIVE] No frequency.
[CUSTOMER][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Uh, one for 5-year period, that also includes 00210 and 0277.
[AGENT][NEUTRAL] And that's the 80%.
[CUSTOMER][NEUTRAL] OK, and that
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK and then uh 7111.
[AGENT][NEUTRAL] Uh, that's under basic 80%, no frequency.
[CUSTOMER][NEUTRAL] Alright, um, 731.
[AGENT][NEUTRAL] I'm sorry, you said 73.
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] I'm not pulling that up under the policy.
[CUSTOMER][NEUTRAL] 961 2.
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] And then 7410.
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] 7472.
[AGENT][NEGATIVE] Not pointing that up.
[CUSTOMER][NEUTRAL] OK, 7956.
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 792 1.
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] OK, perfect. All right, and then is there any history on file for exams?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Let's see, um, I will say she has 112 left um for the calendar year, and then for exams, let's see, is that the 0.
[AGENT][NEUTRAL] 120? Or which which code?
[CUSTOMER][NEUTRAL] 0140 and 0150.
[AGENT][NEUTRAL] Uh, don't have anything on file for those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So they are eligible um for exams right now?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then what about for a piano?
[AGENT][NEUTRAL] It's the 330.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I had a panel on [PII].
[CUSTOMER][NEUTRAL] All right, um, you said it was a $500 calendar year max, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Um, has any of that been used?
[AGENT][NEUTRAL] Um, they have 112 left.
[AGENT][NEUTRAL] They've used 338388 sorry.
[CUSTOMER][NEUTRAL] And then what about for their deductible?
[CUSTOMER][NEUTRAL] Has that been met?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, they've met their deductible.
[CUSTOMER][NEUTRAL] OK, what is the coordination of benefits?
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do we need to file to medical first for denial of oral surgery, or do we file straight to dental?
[AGENT][NEUTRAL] The file straight to dental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this a and this is a, is this a calendar year plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And there's, um, you said there was no waiting periods, correct?
[AGENT][NEUTRAL] No waiting period, correct.
[CUSTOMER][NEUTRAL] OK, what is the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then um what is the group number?
[AGENT][NEUTRAL] Um, group number is
[AGENT][NEUTRAL] 70055.
[CUSTOMER][NEUTRAL] OK, and then the group name?
[AGENT][NEUTRAL] A group name is TRC Staffing.
[CUSTOMER][NEUTRAL] T as in Tango.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then what's the good claims address?
[AGENT][NEUTRAL] Claims address is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, do you mind repeating it one more time just to make sure I have it all correct?
[AGENT][NEUTRAL] Uh yeah, it's [PII].
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK, and the payer ID?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] Alright, and then, um, will you be able to, uh, check what fee schedule we use for this plan?
[AGENT][NEUTRAL] Um, it's just based on what's reasonable and customary.
[AGENT][NEUTRAL] Um, it looks like they do use caring.
[CUSTOMER][NEUTRAL] So they're not like
[AGENT][NEUTRAL] They do use Carrington uh for their PPO network. It's not required, but, um, Carrington is the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Well, thank you so much for your help, Miss [PII]. Uh, that's all my questions. All I need now is just a reference number to wrap things up.
[AGENT][NEUTRAL] The reference number is just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Perfect. I hope you have a good rest of your day.
[AGENT][POSITIVE] OK, thank you for calling APLU as well.
[CUSTOMER][NEUTRAL] Bye bye.