AccountId: 011433970860
ContactId: 0bccda86-8fb1-44a8-ab2f-290e16a0d567
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1005760 ms
Total Talk Time (AGENT): 264523 ms
Total Talk Time (CUSTOMER): 195721 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/0bccda86-8fb1-44a8-ab2f-290e16a0d567_20250417T15:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm just wanting to verify a patient's eligibility.
[AGENT][POSITIVE] Yeah, of course, I can help you with eligibility today. And then can I get your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK [PII], what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Yeah, it's going to be [PII] option two.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number is going to be 026063993.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, and then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] So the patient is [PII].
[CUSTOMER][NEUTRAL] Um, the last name is [PII] Date of birth is going to be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So it looks like this policy is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Perfect. Now is this a discount plan or is this an actual insurance?
[AGENT][NEUTRAL] This is a secondary insurance plan. Oh no, I'm sorry, this is a dental plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it is dental. OK, so a dental and um an actual policy, OK, because they thought it they thought it was going to be um discount so what is going I am going to need a full breakdown if that's OK with you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah, that's fine. Do you need benefits?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment. I'm gonna pull up their dental plan.
[CUSTOMER][POSITIVE] OK yeah not a problem.
[AGENT][NEUTRAL] OK, and then I do want to offer I can send you the fax back as well.
[CUSTOMER][POSITIVE] Um, if I can get both, that'd be great.
[AGENT][NEUTRAL] Yeah, OK, so I have that pulled up and then uh what is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. And then, um,
[AGENT][NEUTRAL] What questions do you have for the benefits?
[CUSTOMER][NEUTRAL] Yeah, what's going to be their maximum and deductible?
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So, it looks like deductibles do not apply for preventative services.
[AGENT][NEUTRAL] And then it looks like calendar year deductible, we will pay $50 per covered insured up to $150 per family.
[AGENT][NEUTRAL] Deductible just doesn't apply for preventative services.
[AGENT][NEUTRAL] And this is a guarantee of payment. This is just the verification of coverage.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, so you said that the deductible is not for diagnostic preventative.
[AGENT][NEUTRAL] Preventative.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so is that like 50?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then the I'm sorry I didn't get the maximum.
[AGENT][NEUTRAL] So it says calendar year deductible $50 per covered insured, and that's up to $150 per family.
[CUSTOMER][NEUTRAL] OK, and what about the coinsurances?
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hey, there's no co-insurance for this policy.
[CUSTOMER][NEUTRAL] A what?
[CUSTOMER][NEUTRAL] Are there any downgrades?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes, there is.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, um, and then what is going to be your fee schedule?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Is that the frequencies?
[CUSTOMER][NEUTRAL] The um fee schedule.
[AGENT][NEUTRAL] I don't see that there's a fee schedule on this policy.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Just a moment. I'm gonna ask a colleague really quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh they're together.
[AGENT][NEUTRAL] While we're on the phone, I'm going to send this over to you too while we're waiting.
[CUSTOMER][NEUTRAL] OK, what is going to be the claims address? maybe I can figure it out through there.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm still pretty new to dental, so.
[AGENT][NEUTRAL] Um, it's just that.
[CUSTOMER][NEUTRAL] OK, no, that's fine.
[AGENT][NEUTRAL] OK, I can give you the claim. OK, the claim address is PO Box.
[AGENT][NEUTRAL] 2489.
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] 73124.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you have the payer ID?
[AGENT][NEUTRAL] Yes, the payer ID is
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK perfect I actually figured it out so no worries.
[AGENT][NEUTRAL] You did? OK. Do you need this faxed back still?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I will send that over right now.
[AGENT][NEUTRAL] Do you have any other questions while we're on the phone?
[CUSTOMER][NEUTRAL] Um, yes, I'm sorry, for the code 4341, how many quadrants can be done one visit?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] People are gonna.
[AGENT][NEUTRAL] So, I do not show that that code is covered on this policy.
[CUSTOMER][POSITIVE] I good how are you?
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] So is it just for preventative then?
[AGENT][NEUTRAL] Yes, so this policy does not cover major.
[CUSTOMER][NEUTRAL] Or or basic it sounds like.
[AGENT][NEUTRAL] So it's just preventative and basic.
[AGENT][NEGATIVE] But the code that you gave me is not on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] So diagnostic and preventative and basic are covered at 100 then, am I correct?
[AGENT][NEUTRAL] So it says that preventative is 100% of allowable.
[AGENT][NEUTRAL] Uh, basic expenses is 80% of allowable.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Um, so could you check another code for me? Um, 40 or I'm sorry, [PII].
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like the limitations for that code, it says maximum 1 time per tooth.
[AGENT][NEGATIVE] And this falls under basic, which is 80% of allowable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said that there is no frequencies for preventative work, is that right?
[AGENT][NEUTRAL] I'm not seeing any frequencies on here.
[AGENT][NEUTRAL] And I did reach out to a colleague, but she hasn't um gotten back to me yet.
[CUSTOMER][NEUTRAL] OK, did you send that fax?
[AGENT][NEUTRAL] Um, I just filled out the top information with the patient's name and the policy number. Um, I can send, I think it's ready to send now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it would have to be in person.
[AGENT][NEUTRAL] And then you said your name was [PII], right?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'll address it to you.
[AGENT][NEUTRAL] OK, and then the fax is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then I just sent it, it might just take a minute.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. Are there any other codes you have that you might need help on?
[CUSTOMER][NEUTRAL] Um, no, that should be it.
[CUSTOMER][NEUTRAL] Um, I just wanted to make sure. I'm sorry, so was there no maximum, just deductible of $50?
[CUSTOMER][NEUTRAL] Because we are private.
[AGENT][NEUTRAL] So it just says the calendar year deductible is $50 per covered insured and that's up to $150 per family.
[CUSTOMER][NEUTRAL] Yeah, that's not maximum though.
[AGENT][NEUTRAL] That's all I see.
[AGENT][NEUTRAL] Um, there's a calendar year maximum 500 per covered insured.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, there we go, there we go 500.
[AGENT][NEUTRAL] Is that what you needed? OK, sorry.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Let me see if they've used anything this year, probably not if the effective date.
[AGENT][NEUTRAL] Was just in March.
[AGENT][NEUTRAL] OK. Yes, they haven't used anything on this policy yet.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][POSITIVE] OK perfect that's actually all the information that I need thank you so much for your help.
[AGENT][POSITIVE] OK, yeah, of course. Thanks for calling APL [PII]. Have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] All right, bye.