AccountId: 011433970860
ContactId: 17ff3e77-7c44-4ef5-bb95-bcd55b34dcad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1100079 ms
Total Talk Time (AGENT): 454738 ms
Total Talk Time (CUSTOMER): 293026 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/17ff3e77-7c44-4ef5-bb95-bcd55b34dcad_20250509T18:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII]. I'm calling from the provider's office to check some benefits on my patient's plan.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My direct line is [PII], no extension.
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from from my notes?
[CUSTOMER][NEUTRAL] Uh, Parkway Dental Care.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02068913
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect. Thank you. And you need this information given to you, Bro, or faxed over to you?
[CUSTOMER][NEUTRAL] Um, can I get it verbal? I've never verified one of these plans before.
[AGENT][NEUTRAL] OK, sure, yes. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And um but this one we have an effective date of [PII]. It is active at the moment and this is a dental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The calendar year maximum for this one is $1500 per cover insured with the calendar year deductible of 50, and deductible does not apply to preventative.
[AGENT][NEUTRAL] Um, we cover, um, preventative 100%, radiograph FMX 80, basic expense and basic restorative expenses 80.
[AGENT][NEUTRAL] And then we have major services including endodontics, periodontics, prosthodontic repair, and oral surgery. They're all pay at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, uh, what is the group name for this patient?
[AGENT][NEUTRAL] OK, let me get that for you, one moment.
[AGENT][NEUTRAL] All right, so we have the group name Universal Trucking PNS Transportation.
[CUSTOMER][NEUTRAL] Alright, the third word after trucking, what was that?
[AGENT][NEUTRAL] P, the letter P, the letter S, Transportation.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, that's uh Papa November Sierra, correct?
[AGENT][NEUTRAL] Uh, it's just like pop up the letter and.
[AGENT][NEUTRAL] Sierra transportation.
[CUSTOMER][NEUTRAL] P and P and S. OK, got you, got you. OK. All right, can I check our network status with this plan?
[AGENT][NEUTRAL] CNN, yes, yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one doesn't have a network. We pay usual and customary rates UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do you pay to the patient or the office?
[AGENT][NEUTRAL] The office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No networks, so the percentages you gave me were correct for out of network?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods or missing tooth clothes?
[AGENT][NEUTRAL] Uh, the waiting period is up on this one because there was a 12-month waiting period, but he has this policy since 21, so he's out of that waiting period. Uh, there is a missing interest clause, yes.
[CUSTOMER][NEUTRAL] OK, what was that waiting period on basic major or both?
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] Major, OK. Was there also one on basic?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just asking for future use in case we get one of these again I can be aware.
[AGENT][NEUTRAL] It's OK. Yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, does this policy downgrade or to less costly services on say fillings or crowns?
[AGENT][NEGATIVE] No, it doesn't downgrade.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, it's 4 I'd covered.
[AGENT][NEUTRAL] Uh, for fluoride, let's see.
[AGENT][NEUTRAL] There is an Asian.
[CUSTOMER][NEUTRAL] And when you search do you search by name or do you prefer to search by code?
[AGENT][NEUTRAL] Code.
[CUSTOMER][NEUTRAL] Code, OK, so then I'll do codes. 1208.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, so that one is limited to dependent children under the age of [PII].
[AGENT][NEUTRAL] And that's maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and when you say up to the age of [PII], does that include the age of [PII] or does it stop at the [PII] birthday?
[AGENT][NEUTRAL] It's gonna be a stop on the [PII].
[CUSTOMER][NEUTRAL] [PII] to [PII], OK, um, do they have orthodontic coverage on the plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] do.
[CUSTOMER][NEUTRAL] Get out of there. Alright, what is the replacement time for crowns?
[AGENT][NEUTRAL] OK, let's see do do do do.
[CUSTOMER][NEUTRAL] If you need a code, it's 2740.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I think that's once every 5 years, but let me double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, no, it's it's maximum of 1 per seven-year period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is that frequency also shared by bridges, dentures, or implants?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no implants um for the portion and dentures is once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK dokey, are crowns paid on Cedar Prep?
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, what is the frequency for the 2391?
[AGENT][NEUTRAL] OK 2391, that's going to be where you replace uh replacement of assisting only in place for 24 months.
[CUSTOMER][NEUTRAL] OK, alright, I know you said X-rays were 80%. Does that include the FMX panel?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and does that include the bite wings?
[AGENT][NEUTRAL] No, by winds is on preventative.
[CUSTOMER][NEUTRAL] OK, that will be 100. OK, what is the frequency for FMX panel?
[AGENT][NEUTRAL] OK. So let's see for the FMX panel we have.
[AGENT][NEUTRAL] OK. Limited to one extra procedure in any combination of 210, 277, or 330 per 5-year period.
[CUSTOMER][NEUTRAL] OK, uh, what is the frequency for exams on this plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For exams, we have 2 for 12 month period and those are also combined. We have two oral evaluation procedures and any combination of 120, 140, 150, 160, or 180.
[CUSTOMER][POSITIVE] And just knocked out about 4 of my questions. That's fantastic. OK, uh, what is the frequency for bite wings?
[AGENT][NEUTRAL] OK, for bye winds, we have a limited to 1 bye with a story procedure in any combination of 270, 272, or 274 per 12 month period.
[CUSTOMER][NEUTRAL] OK, all right, the PA X-rays 0220 and 0230, um, do those have a frequency?
[AGENT][NEUTRAL] Let's see, no.
[CUSTOMER][NEUTRAL] OK, and those are also at 80%.
[AGENT][NEUTRAL] Yes, they're in their basics. Mhm.
[CUSTOMER][NEUTRAL] OK, what
[CUSTOMER][NEUTRAL] Is the frequency for the sealant 1351?
[AGENT][NEUTRAL] OK, for ceilings, there is an age limitation um under the age of [PII], application made to the permanent molar teeth only and every 36 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is the 2920 considered a basic or major code?
[AGENT][NEUTRAL] OK, that's going to be under major.
[CUSTOMER][NEUTRAL] Sure, and is it also one every 7 years?
[AGENT][NEUTRAL] OK, let's see. Yes, maximum of 1 per seven-year period. Mhm.
[CUSTOMER][NEUTRAL] OK, can I file a Crown 2740 on the same day as the build up 2950?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is the 2952 a covered code?
[AGENT][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] 2952.
[AGENT][NEUTRAL] 52. OK, yeah, please.
[AGENT][NEUTRAL] Here it is. Yes, that's also on the major.
[CUSTOMER][NEUTRAL] OK, how about 2962. OK, thank you.
[AGENT][NEUTRAL] And it's gonna be the same limitation.
[AGENT][NEUTRAL] 2 962 it's OK. 2968, 2962 is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, what is the frequency for surgical periodontics? We can use 4240 if you need the code.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that's gonna be under the measure, which is 40%, and that's going to be limited, let's see, maximum of 1 in quad for 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh, what is the frequency for the 4260?
[AGENT][NEUTRAL] All right, so this is going to be also under measure, so it's 40% and the limitation maximum of 1 in quad per 36 months.
[CUSTOMER][NEUTRAL] 36. OK, frequency for 4263.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, 4263 that's let's see, also on the major, so it's 40% and this one is going to be on the maximum of 1 each quad for 24 months.
[CUSTOMER][NEUTRAL] OK, frequency for 4266.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, 4266 is not covered.
[CUSTOMER][NEUTRAL] OK. Uh, full mouth debridement 4355, just the frequency?
[AGENT][NEUTRAL] OK. So that one is going to be
[AGENT][NEUTRAL] 1 each quad for 24 months.
[CUSTOMER][NEUTRAL] OK. Frequency for the SRP 4341.
[AGENT][NEUTRAL] OK, 4341 is gonna be the same limitation for every 24 months.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] And on that one, can I do all 4 quads on the same day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Percentage and frequency for the 4381.
[AGENT][NEUTRAL] OK, 4381, that's under periodonics, which is 40% it's under major and for that one there's no limits.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, how about the 4910, same question.
[AGENT][NEUTRAL] OK, so 4910 is also under the periodontics, which is 40%. Now this one is going to be once every 6 months.
[CUSTOMER][NEUTRAL] OK, and does that share the frequency with the profy?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, you said implants are not covered. How about the implant crown 6057?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK, how about let's see, 6066.
[AGENT][NEGATIVE] 6066 is not covered.
[CUSTOMER][NEUTRAL] OK, 6100.
[CUSTOMER][NEGATIVE] I'm anticipating all of these being not covered.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] 200 that's not covered.
[CUSTOMER][NEUTRAL] OK 7951.
[AGENT][NEUTRAL] 76517951 is not covered.
[CUSTOMER][NEUTRAL] OK. 7953.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] That's not covered?
[CUSTOMER][NEUTRAL] OK, last little stretch 9110.
[AGENT][NEUTRAL] 9110, that's going to be under the basic expense, so that's 80%, no limitation.
[CUSTOMER][NEUTRAL] OK, 9612.
[AGENT][NEUTRAL] 9612 is not covered.
[CUSTOMER][NEUTRAL] Alright and the last one is 9944.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 9944 is not covered.
[CUSTOMER][NEUTRAL] OK, what is the, uh, yes.
[CUSTOMER][NEUTRAL] No, no, no, sorry, going back to the patient, um, have they used any of their max deductibles?
[CUSTOMER][NEUTRAL] Sorry, max or deductibles.
[AGENT][NEUTRAL] OK, let me check on that for you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK it's gonna be one more minute.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No worries, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] OK, so he has not used his benefits as of today for [PII]. He still has the $1500 and the $50 deductible.
[CUSTOMER][NEUTRAL] OK, and does he have any preventative history on file?
[AGENT][NEUTRAL] OK, let me get that for you.
[AGENT][NEUTRAL] All right, so let's see um.
[AGENT][NEUTRAL] He has a 4910 on [PII].
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] He has an oral examination at [PII] on [PII].
[AGENT][NEUTRAL] Panel.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see a 4355 on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And the last bite we now got is in [PII] and the evaluation as well, [PII].
[CUSTOMER][NEUTRAL] OK, no FMX Opana.
[CUSTOMER][NEUTRAL] Oh no, you did say Pana, never mind.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Alright, that looks like everything I needed to check that covers all of my frequencies.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is the payer ID for claims?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and the claims mailing address?
[AGENT][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK perfect and can I get a reference number on the call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you would like.
[CUSTOMER][NEUTRAL] OK, and would you spell your name for me?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][POSITIVE] OK, thank you very much for your help. You have a great rest of your day.
[AGENT][POSITIVE] You as well, Ms. [PII], and thank you for calling APL. mhm Bye-bye.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.