AccountId: 011433970860
ContactId: 1543ff5a-c9ae-44ff-9dd0-ef5c5aa672d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489149 ms
Total Talk Time (AGENT): 211173 ms
Total Talk Time (CUSTOMER): 236861 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/1543ff5a-c9ae-44ff-9dd0-ef5c5aa672d1_20250505T16:05_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, again, my name is Doctor [PII]. I had called a little bit earlier this morning, but I need to ask you another question. It's about a patient, um, his name is, um, what was my name, [PII]. I don't know if it was you I spoke to or not.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] But I did get all the benefits and everything.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, well, um.
[CUSTOMER][NEUTRAL] Oh, I, I just want to know, um, I'm about to give you all this information again, his, uh.
[CUSTOMER][NEUTRAL] His policy number is 02.
[CUSTOMER][NEUTRAL] 025692888
[AGENT][POSITIVE] Thank you. OK, and miss, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Uh, Doctor [PII], can you please give me your callback number just in case the call is dropped, I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Absolutely, my phone number is area code [PII] mhm.
[AGENT][NEUTRAL] Thank you. And then what is the name of your facility, please?
[CUSTOMER][NEUTRAL] Prosperity, cosmetics, and general dentistry.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Prosperity industry mhm.
[AGENT][NEUTRAL] OK, and I've got the um policy number that you gave me 02569288 and you're calling because you have further questions about the policy is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, yes, absolutely. He they did tell me he gets $1500 and a and a um deductible of $50. OK, but, um, and I, I was, I was calling out to them the uh code numbers and I didn't know this code right here, a 7210. How much is it, is it a, um, is it a is it that a major or basic? A a 7210.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look real let me check the um let me pull up his um fax back. Did you get the fax back this morning that has the um.
[CUSTOMER][NEUTRAL] It's just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, codes and fee schedule on it. OK, good.
[CUSTOMER][NEUTRAL] Yeah, she
[CUSTOMER][NEUTRAL] No, wait, wait, wait, she called it out to me because I told my fax machine it wasn't set up just yet in my office. I had to get a new one and I haven't set it up. So, mhm. So she just read uh she, she just read some um uh some code numbers off for me and then I was just asking about a 70 and I forgot to ask her about a 7210. That's all everything else is fine. That's about 7210. Mhm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, I understand. Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, well, I'm getting it to load right now and I'm looking at the 7210. Let me see if it's on this fax back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a minute while I scroll through.
[CUSTOMER][POSITIVE] You take your time because I know the computers do.
[CUSTOMER][POSITIVE] Easy.
[AGENT][NEUTRAL] OK. Uh, it is under oral surgery expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It does not have a limitation that I see.
[CUSTOMER][NEUTRAL] And, and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me keep looking.
[CUSTOMER][NEUTRAL] Is it under a basic major?
[AGENT][NEUTRAL] Well, the um the policy covers, um, and this is just to verify the benefits, it's not a guarantee of payment. On this policy, it actually has a category called oral surgery expense that pays 40% of UCR and it has a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, you can
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that's considered a major then cause it's 40%. So he had to wait 12 months to get that tooth taken out?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, it's a
[CUSTOMER][NEGATIVE] It's a broken off too.
[AGENT][NEUTRAL] It's 7410. Well, let's see the effective date of this policy.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yes, it is [PII]. Let me look.
[AGENT][NEUTRAL] And the [PII].
[CUSTOMER][NEUTRAL] A [PII].
[AGENT][NEUTRAL] Let me make sure. [PII]. I'm sorry. Let me look for [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Surgical removal of erupted tooth requiring elevation of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Uh, I can't under, I can't pronounce the word of that flap.
[AGENT][NEUTRAL] Muco per
[CUSTOMER][NEUTRAL] Is it a muco flapmco perel still flat?
[AGENT][NEUTRAL] Yes, and removal of bone and or section of tooth.
[CUSTOMER][NEUTRAL] Well, OK. How much is?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it does say that um it falls under oral surgery.
[CUSTOMER][NEUTRAL] Was the following.
[AGENT][NEUTRAL] And it is a 12-month waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, well, if he in pain, he just gonna have to wait. He gonna have to wait 12 months to pay it out of his pocket.
[CUSTOMER][NEUTRAL] And that's something.
[AGENT][NEUTRAL] Yeah, oral surgery expense, 40% of UCR 12 months.
[CUSTOMER][NEUTRAL] Yeah, that's a 12 month waiting period.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So like I tell these patients when they get that um insurance in, in, in the uh in the [PII], you gotta pay into it first if you need something, you know, really done.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 01 more thing, one more thing. What about, what about the root canal?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, 3:30, 3330 33:30.
[AGENT][NEUTRAL] 3330. OK, let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a moment while I scroll through these codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, take your time, take your time.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] The 3330.
[AGENT][NEUTRAL] does not have a limitation and it's endoonic expense. It's covered under endodonic, and let me see what it says up here for endodonic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is 40% of UCR and its 12 month waiting period.
[CUSTOMER][NEUTRAL] That's what I say.
[CUSTOMER][NEUTRAL] Well, OK.
[CUSTOMER][NEUTRAL] Oh, that's it. The only thing you get, yeah, OK, that's what I want to know. That's, that's, that was the main thing.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, mhm, OK, well.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I, I appreciate. Oh, let me wait you one more question. So in order for me, uh, uh, you don't have an in and out of network, do you? You don't have to be in network, do you, to, um, bill you guys, right?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, no, they can use any dentist they choose to use.
[CUSTOMER][NEUTRAL] Do you, yeah.
[CUSTOMER][POSITIVE] Oh, OK, that's good. OK, OK.
[AGENT][NEUTRAL] So and it's billed by UCR so you can you can bill um.
[AGENT][NEUTRAL] Bill
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they can use you they don't have a network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh OK, that sounds good. Oh, OK, thank you so much. I appreciate you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You're welcome, Doctor [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that was it. I appreciate you. I really, I really do appreciate this. I had to call back and ask me.
[AGENT][NEUTRAL] Well, we
[AGENT][POSITIVE] Well, we appreciate you. Yes, ma'am, I understand. Well, you have a blessed week and thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thank you you too thank you mhm bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Uh