AccountId: 011433970860
ContactId: 12d3e73e-537d-4913-aace-f76b1f6abfe0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578880 ms
Total Talk Time (AGENT): 179457 ms
Total Talk Time (CUSTOMER): 115253 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/12d3e73e-537d-4913-aace-f76b1f6abfe0_20250207T17:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], this is [PII]. How are you?
[AGENT][POSITIVE] I'm good. How are you today, [PII]?
[CUSTOMER][POSITIVE] I'm doing good, thank you for asking. I was calling to get some information on a patient's policy for out of network services for dental.
[AGENT][NEUTRAL] OK, let's take a look. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] 592-905
[AGENT][POSITIVE] OK, thank you for that. Let me pull that up here.
[AGENT][NEUTRAL] All right. And then if I could verify please the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you so much. So the patient plan is active. The effective date on this is [PII] or [PII]. Excuse me.
[CUSTOMER][NEUTRAL] It's OK. I refresh.
[CUSTOMER][NEUTRAL] OK, um, can I know her maximum and what's remaining?
[AGENT][NEUTRAL] Yeah, let me pull that up here. One second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] calendar year maximum looks like it's 1250 and then their calendar deductible is going to be $50 up to $150 per family. Let me check and see if they've used anything.
[AGENT][NEUTRAL] Looks like the patient has uh the full $1250 left and the $50 deductible.
[CUSTOMER][NEUTRAL] OK, is this a calendar year plan?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Alright, can I know the percentages for preventative, basic and major for out of network?
[AGENT][NEUTRAL] So looks like preventative is covered at 100% of UCR.
[AGENT][NEUTRAL] Basic is showing at 80% of UCR and then majors 50%.
[CUSTOMER][NEUTRAL] OK, and is she eligible to have a prophy exam, white wings or an FMX?
[AGENT][NEUTRAL] Let's see look at history here.
[AGENT][NEUTRAL] Right, so it looks like the last bite wing that I see um and cleaning was on 7:30 of 24.
[CUSTOMER][NEUTRAL] The Profi.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] Yeah, 7:30 of 24.
[CUSTOMER][NEUTRAL] And that was for the by wings too.
[AGENT][NEUTRAL] Mhm. She had bite wings on that date too.
[CUSTOMER][NEUTRAL] Alright and the exam SMX.
[AGENT][NEUTRAL] Looks like her last exam was also [PII]:30 24.
[CUSTOMER][POSITIVE] OK, so she's eligible to have the perfect in the exam.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] In the by lane correct?
[AGENT][NEUTRAL] Um, bit wing is once per 12 months, so her last bit, yeah, she wouldn't be eligible for that yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] And what about the FMX?
[AGENT][NEUTRAL] Looks like the last FMX that I see was in [PII], so she would be eligible for that. That's once every 5 years.
[CUSTOMER][NEUTRAL] OK um.
[CUSTOMER][NEUTRAL] OK, um, is Ortho covered on this policy?
[AGENT][NEUTRAL] Uh, let's see. Ortho is not covered.
[CUSTOMER][NEUTRAL] What about code D 2950?
[AGENT][NEUTRAL] Do show 2950 is listed under major expenses. Let me see what the limitation is here.
[AGENT][NEUTRAL] It looks like it's a maximum of 1 per 7-year period, limited to patients age over the age of [PII].
[CUSTOMER][NEUTRAL] So once every 7 years, or crowns once every 7 years too.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, once every 7 years per tooth.
[CUSTOMER][NEUTRAL] OK, is code 4346 covered on this policy?
[AGENT][NEUTRAL] 4346 let's see.
[AGENT][NEUTRAL] I do not see 4346 listed.
[CUSTOMER][NEUTRAL] OK, what about 6010?
[AGENT][NEUTRAL] Do you not see 6010 listed?
[CUSTOMER][NEUTRAL] OK, 6057 or 6058?
[CUSTOMER][NEUTRAL] I guess I could just say implants.
[AGENT][MIXED] That's OK. Implants are not covered.
[CUSTOMER][NEUTRAL] OK, that's better, OK, um.
[CUSTOMER][NEUTRAL] On 4910, is that frequency once every 6 months?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][NEUTRAL] And what about the code 5110? Is it once every 7 years like crowns?
[AGENT][NEUTRAL] Uh, yeah, it looks like it's a maximum of 1 per 5 years.
[CUSTOMER][NEUTRAL] 0 145 OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But crowns are 7, right?
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] OK, just make sure I have those two different, right, OK, and is there a waiting period?
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Um, the waiting period is only for major endoimperio, which is 12 months, and she's surpassed that for sure.
[CUSTOMER][NEUTRAL] OK, and is the guys pay on Cedar prep?
[AGENT][NEUTRAL] Um, either, it doesn't matter.
[CUSTOMER][NEUTRAL] And is there a missing 2 cloths?
[AGENT][NEUTRAL] Uh, this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Alright, and can I get a reference number, miss here?
[AGENT][NEUTRAL] Absolutely, that's gonna be my name with my last initial and then today's date. My last initial is [PII].
[CUSTOMER][POSITIVE] Alright, thank you Ms. [PII] have a great weekend.
[AGENT][NEUTRAL] You too [PII], bye bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.