AccountId: 011433970860
ContactId: 0c3df336-f078-499c-a08f-9029e35a84de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 725289 ms
Total Talk Time (AGENT): 260679 ms
Total Talk Time (CUSTOMER): 301859 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/0c3df336-f078-499c-a08f-9029e35a84de_20250307T18:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Dayton Comprehensive Dentistry. I have um a patient that just came in with this insurance, and I was hoping I could get a breakdown of their benefits.
[AGENT][POSITIVE] OK, yes, ma'am. I can verify benefits for you.
[AGENT][NEUTRAL] Excuse me, I apologize, Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 025667778.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, and you say you're calling to verify eligibility and a breakdown of benefits?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy.
[AGENT][NEUTRAL] And OK, you just need a general breakdown or I can send you a fax back?
[CUSTOMER][NEUTRAL] Um, can I do a a fax back but also a general since she's in chair right now, um, and then I wanna see if this insurance is even in network with the provider.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Well, we don't have a network. Uh, the policy is open to where they can go to any dental provider. And Ms. [PII], what is your fax number real quick?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All righty then. I will send that off to you in a few moments and um
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1500 per calendar year, and she has a $50 deductible that is applied to everything but preventative services.
[AGENT][NEUTRAL] Um, preventative pays 100% of UCR.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80 and for major services which would include endo perio and oral surgery, it pays at 40% and there is a 12-month waiting period, uh, so she wouldn't be eligible for major services until [PII] of next year.
[CUSTOMER][NEUTRAL] OK, let me write that down.
[CUSTOMER][NEUTRAL] So yes, waiting period, 12 months.
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][POSITIVE] Uh, yes, ma'am. That's when she'll be able to satisfy that wait period.
[CUSTOMER][POSITIVE] Perfect. And then as far as uh missing tooth cloths, is that on this policy?
[AGENT][NEUTRAL] Uh, there is a missing tooth cloths. Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And has she used or met her deductible or max?
[AGENT][NEUTRAL] Uh, let me see. I don't believe so, but let me double check.
[AGENT][NEUTRAL] Uh, no, ma'am, I don't see if she, she used her benefits nor met her deductible.
[CUSTOMER][NEUTRAL] Perfect. OK, not meant.
[CUSTOMER][NEUTRAL] And the name of the insurance is American Public Life, is that right?
[AGENT][POSITIVE] Uh, that is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] American public.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and then with oral surgery, do we need to bill medical primary?
[AGENT][NEUTRAL] Uh, you don't have to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then with uh IV sedation, is there a limitation on whether it's simple surgical or both for the extractions to be covered?
[AGENT][NEUTRAL] Uh, it shows that it's just in conjunction with, um, extractions, and it is considered major as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can all 4 quadrants of scaling and root cleaning be done in one visit?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And is that once every 24 months for the frequency or is it a little bit longer than that?
[AGENT][NEUTRAL] For fillings?
[CUSTOMER][NEUTRAL] For the scaling and planning, uh, code 4341, no, no, you're OK.
[AGENT][NEUTRAL] Oh, I apologize. Uh, yes, ma'am. It's once every 24 months, and I will say it is considered major.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] And then what about perio Maintenance 4910? Is that in shared frequency with profies?
[AGENT][NEUTRAL] Uh, it does not, and it's once every 6 months.
[CUSTOMER][NEUTRAL] And that one's also major?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. Is a full mouth debridement 4355 covered?
[AGENT][NEUTRAL] It is and it is considered major.
[CUSTOMER][NEUTRAL] And what's the frequency on that one?
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Do you downgrade fillings or crowns?
[AGENT][NEUTRAL] Uh, no, ma'am. There are no downgrades.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No downgrade. Do you pay on prep date or seat date?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] I see what is the frequency limitation for crowns and implants?
[AGENT][NEGATIVE] Well, implants are not covered. Uh, crowns are once every 7 years.
[CUSTOMER][NEUTRAL] 17 years and plans not covered perfect. Do you require pre-authorizations for perio or major services?
[AGENT][NEUTRAL] Uh, no, ma'am. It's not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I write this down.
[CUSTOMER][NEUTRAL] And then no history, so she is eligible for an exam bye wings pro fee and a panel or an FMX. Can I give you a few codes to do frequency limits on just to see since she's coming in today for general.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, the first one would be 0120.
[CUSTOMER][NEUTRAL] Oh, do you want them all at the same time or one by one?
[AGENT][NEUTRAL] Uh, all at the same time is fine.
[CUSTOMER][NEUTRAL] OK, so then the 0121 for the exam 0274 bye wings 1351 sealants.
[CUSTOMER][NEUTRAL] 11:10 pro fee.
[CUSTOMER][NEUTRAL] I think she's yeah 11:10 probably um.
[CUSTOMER][NEUTRAL] 0210 or the 0330 for the panel and FMX assuming they share frequency 12:06 for fluoride.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the last two would be 9310 consultation.
[CUSTOMER][NEUTRAL] And 0380 a CBCT scan.
[AGENT][NEUTRAL] OK, uh, give me one moment.
[CUSTOMER][POSITIVE] You're fine take your time.
[AGENT][NEUTRAL] Um, and what was that code after 120?
[CUSTOMER][NEUTRAL] Um, 0274.
[AGENT][NEUTRAL] OK. Well, exams are 2 for 12 month period. All exams share the same frequency, um.
[AGENT][NEUTRAL] Fight wings are 1 per 12-month period, sealants under the age of 14, once every 3 years, permanent molars only.
[AGENT][NEUTRAL] Uh, fluoride under the age of [PII], once every 12 months, uh, cleanings, uh, once every 6 months.
[AGENT][NEUTRAL] FMX pan once every 5 years.
[AGENT][NEUTRAL] And for the 9310, there is not a frequency, but it is considered a basic.
[AGENT][NEUTRAL] And then the other code you said 380?
[CUSTOMER][NEUTRAL] Yes, 0380.
[AGENT][NEGATIVE] I don't show that it's being covered.
[CUSTOMER][NEUTRAL] OK, no coverage, perfect. And then I do have an odd question. So 0, just kidding, code 4342 for scaling and root cleaning can that be completed in conjunction with a profi or does it have to be on a separate day?
[AGENT][NEUTRAL] Uh, it doesn't specify, but it can be done on the same day.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Well, I think that was almost everything. Let me look through here and see if I've got everything.
[CUSTOMER][NEUTRAL] Just to verify, the group number is 14585?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] 44585, yes.
[CUSTOMER][NEUTRAL] Perfect and then the group name would be Group voluntary dental, is that correct?
[AGENT][NEUTRAL] Uh, I'm showing an actual group name is Universal Trucking, Anderson Van.
[CUSTOMER][NEUTRAL] Universal.
[CUSTOMER][NEUTRAL] Tracking
[CUSTOMER][NEUTRAL] You said Anderson van?
[AGENT][NEUTRAL] Anderson Van, yes, ma'am.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And then once the patient's maxed out.
[CUSTOMER][NEUTRAL] Actually that doesn't apply.
[CUSTOMER][NEUTRAL] Do you guys pay the benefits to the provider or the subscriber?
[AGENT][NEUTRAL] Uh, we do take assignments, so, uh, benefits are assigned, we do pay the provider.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And could you just verify the claims mailing address and the payer ID?
[AGENT][NEUTRAL] Sure, sure. Mail address is [PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You gotta work early? Yeah, I was like yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] perfect and then is there a payer ID number?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] 801 perfect and then the phone number I called that was on the back of the card, the [PII], that is the best number for providers.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. [PII]. Wonderful. That was everything I needed. Could I have a reference number for the call today?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] Perfect, could you spell your name for me?
[AGENT][NEUTRAL] Sure, it's [PII], and I have sent that fax back over to you, so hopefully you should have received it.
[CUSTOMER][POSITIVE] Perfect thank you so much I really appreciate your time today.
[AGENT][POSITIVE] Alright, you're welcome, Miss [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye.