AccountId: 011433970860
ContactId: 0f969f5c-2459-44ea-a745-b94ff76465e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1435760 ms
Total Talk Time (AGENT): 287787 ms
Total Talk Time (CUSTOMER): 393888 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/0f969f5c-2459-44ea-a745-b94ff76465e3_20250214T19:20_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling on behalf of the dental office. I'm looking for benefit information uh on a recorded line. Could you please help me?
[AGENT][POSITIVE] Yes, I can help you with and if it's. Can I please get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK. Can I just get your
[CUSTOMER][NEUTRAL] It a
[CUSTOMER][NEUTRAL] Yes. Callback number is [PII].
[AGENT][NEUTRAL] Thank you sir and then what is the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Kraussner Family of dentistry.
[AGENT][NEUTRAL] OK thank you and what is the name of the?
[CUSTOMER][NEUTRAL] [PII]'s name is I'll check.
[CUSTOMER][NEUTRAL] Mhm. Doctor [PII], patient name is [PII]
[AGENT][NEUTRAL] No, the patient's name.
[AGENT][MIXED] OK, but it tastes.
[AGENT][NEUTRAL] Last name?
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Patient, last name is [PII]
[AGENT][NEUTRAL] Ne?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, just a second.
[CUSTOMER][NEUTRAL] Patient date of birth is [PII].
[AGENT][NEUTRAL] And the patient's policy number.
[CUSTOMER][NEUTRAL] Yes, it's 249-4890.
[AGENT][POSITIVE] Thank you, let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] I do show that [PII] have an active policy and her effective date.
[AGENT][NEUTRAL] Pulling in now.
[AGENT][NEUTRAL] It's been one of 2024.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEGATIVE] I don't know why your voice is breaking.
[CUSTOMER][NEGATIVE] Your voice is breaking.
[AGENT][NEUTRAL] OK, hold on real quick.
[AGENT][POSITIVE] OK, thank you so much. I fixed my microphone I think it might be now.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][POSITIVE] Uh, well, yes, it's a bit better.
[AGENT][NEUTRAL] So the um date for the patient is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] you said?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, I think I need to call back. If you give me your fax number. Oh yeah, OK, fax number. Let me give you let's, let's let let me give you the fax number before we disconnect. Give me one second. So you know you can send me the fax.
[AGENT][NEUTRAL] And if you give me your fax number.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So you found this patient coverage active, right?
[AGENT][POSITIVE] Yes, I'll do that.
[CUSTOMER][NEUTRAL] You said this is active, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so note down the fax number. It is [PII].
[CUSTOMER][NEUTRAL] 416
[CUSTOMER][NEUTRAL] 6084.
[AGENT][POSITIVE] OK thank you so much I'm gonna put you on a brief hold while I send that fax back to you.
[CUSTOMER][NEUTRAL] And you're sending dental fax, right? For dental?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, the fax is [PII]. OK, just to just to inform.
[AGENT][POSITIVE] OK, thank you, sir. Thank you so much. I'm gonna put you on a brief by pulling the um facts back for you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What's going on today with all this.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. I have that fax back on the way.
[CUSTOMER][NEUTRAL] OK, you send the fax already?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, checking.
[AGENT][NEUTRAL] Yes, I did.
[CUSTOMER][NEUTRAL] OK 1 2nd.
[AGENT][NEUTRAL] You begin at any time.
[CUSTOMER][NEUTRAL] And can you check the provider network status if the provider is in or out of network?
[AGENT][NEUTRAL] Uh let me look at the policy real quick.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Uh, the insured can go to any provider he chooses, she chooses.
[CUSTOMER][NEUTRAL] Non-ad right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK. So I'll wait for the fax. Give me one second, OK?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] It could, it could be a little while before it gets there. I did um put a tag on it so that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I go and I can resend it.
[CUSTOMER][NEUTRAL] [PII], OK, it's [PII]. So what fax number you have? You have it's [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. But, uh, could you tell me that, uh, is there any history for this patient, for example, he parting.
[AGENT][NEUTRAL] OK, um, let me.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] I'll put you on hold real quick.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK thank you
[AGENT][POSITIVE] Thank you pulled that up now. What is the number the bite wing that you're looking for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] your number?
[AGENT][NEUTRAL] OK, that was done on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, do you have the last [PII] or [PII]?
[AGENT][NEUTRAL] No, neither one.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, 02100330 you said?
[AGENT][NEUTRAL] I got
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] No, no. [PII] and [PII].
[AGENT][NEUTRAL] No, neither one of those has been done.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] None of those. No [PII] you said?
[CUSTOMER][NEUTRAL] OK, do you have a history for the
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Code 01200120.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that was done on liken of [PII].
[CUSTOMER][NEUTRAL] [PII] you said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] That was off the on [PII].
[CUSTOMER][POSITIVE] Perfect. Now, do you have a history for the code 43414342?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you is 4 4355.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No. And 4910.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No 4355, no 4910.
[CUSTOMER][NEUTRAL] Do with the code 0140.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] 0140 no OK perfect.
[CUSTOMER][NEUTRAL] What about history full code 1208 or 1206 fluoride?
[AGENT][NEUTRAL] Neither one.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The code 0367 is covered or not.
[AGENT][NEUTRAL] Uh, let me look on the fax back.
[CUSTOMER][NEUTRAL] Because I did not receive the fax yet. Can you email that? Is that possible?
[AGENT][NEUTRAL] It's still
[AGENT][NEUTRAL] It's still coming through.
[CUSTOMER][NEUTRAL] Still not signed, right?
[AGENT][NEUTRAL] It's sending.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, in process, right?
[AGENT][NEUTRAL] And what was that code?
[CUSTOMER][NEUTRAL] And what was
[AGENT][NEUTRAL] Yes, it's process. What is that code number again?
[CUSTOMER][NEUTRAL] 0367.
[AGENT][NEUTRAL] 067 is not the fax back so it's not a covered expense.
[CUSTOMER][NEUTRAL] Why it's not on the fact it's not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh what is the group number and the name of the policy?
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] Let me pull it up.
[AGENT][NEUTRAL] 25811.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it's for universal Trucking and the name of the policy is American Life.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] What's the group name?
[AGENT][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] Universal tracking, right?
[AGENT][NEUTRAL] Trucking, like a truck that you drive.
[CUSTOMER][NEUTRAL] Like a truck trucking, OK.
[CUSTOMER][NEUTRAL] Perfect. And uh now what is the claim's mailing address and the payer ID?
[AGENT][NEUTRAL] Your ID 0801.
[AGENT][NEUTRAL] Claims address.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] What's the city?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], [PII], right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] Can you tracker.
[CUSTOMER][NEUTRAL] Annual maximum individual deductible on this policy please?
[AGENT][NEUTRAL] Mm, the annual maximum, and this is just verify coverage on a guaranteed payment is $1500.
[AGENT][NEUTRAL] Calendar year deductible is $50.
[CUSTOMER][NEUTRAL] What's remaining out of the maximum and deductible?
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, your benefit is not has not been used and deductible is still left to pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Annual max applies to prevent two basic and major all services.
[CUSTOMER][NEUTRAL] Or just the basic and the major.
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Just the basic and the major?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it does not apply to prevention and diagnostic for annual max, right?
[CUSTOMER][NEUTRAL] What about deductible?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] The deductible does apply.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For preventative because it has to be paid before we pay the 100% of the UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Deductible does apply to the preventative service you said?
[CUSTOMER][NEUTRAL] I never heard that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I mean when the annual max it doesn't apply so the annual max it does not apply to.
[CUSTOMER][NEUTRAL] Doesn't apply to
[CUSTOMER][NEUTRAL] Preventive service you said?
[AGENT][NEUTRAL] I'm sorry, I'm sorry, it does deductible does not apply to preventative expenses. I apologize.
[CUSTOMER][NEUTRAL] OK, so deductible does not apply, right?
[CUSTOMER][NEUTRAL] And the annual maxim does apply, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the annual magazine does apply to the program too.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What are the coinsurance for preventive basic and the service?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] There is no co-insurance.
[CUSTOMER][NEUTRAL] Mhm, so what is it like for 0120? Is there any percentage or what?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0120 is the oral evaluation.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yes, what what percent?
[AGENT][NEUTRAL] Is and that's considered preventative so so preventative service expenses is 100% of UCR.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And the basic filling like 2391?
[AGENT][NEUTRAL] Is 80% of UCR.
[CUSTOMER][NEUTRAL] It's 8% of the.
[CUSTOMER][NEUTRAL] In the major 5110.
[AGENT][NEUTRAL] 40% of UCR.
[CUSTOMER][NEUTRAL] OK, so 18,040, correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And can you check endoperio and oral surgery?
[AGENT][NEUTRAL] Oral surgery is 40% of UCR. Endo is also 40% of UCR.
[AGENT][NEUTRAL] OK it is also for the UCR.
[CUSTOMER][NEUTRAL] And the Perry also 40, right?
[CUSTOMER][NEUTRAL] And that includes uh scaling and planning as well 4341.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Surgical and non-surgical period, both? 40%.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Like 43, 41.
[CUSTOMER][NEGATIVE] I still did not receive the fax.
[AGENT][NEUTRAL] Yes, 4341.
[CUSTOMER][NEUTRAL] 41.
[CUSTOMER][NEUTRAL] OK. What is the percentage?
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 40. OK. What about crowns, bruises, and dentures, and the replacement frequency?
[AGENT][NEUTRAL] Once every 7 years per tooth.
[CUSTOMER][NEUTRAL] And 40, 40% for all three crowns and.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Do you have coverage for orthodontics or ortho is not covered?
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about implant 6010?
[AGENT][NEUTRAL] The 10 implants.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] like