AccountId: 011433970860
ContactId: 185df519-4e24-4a45-b828-8e390593e4b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668719 ms
Total Talk Time (AGENT): 218610 ms
Total Talk Time (CUSTOMER): 177726 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/185df519-4e24-4a45-b828-8e390593e4b3_20250502T14:59_UTC.wav
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[CUSTOMER][NEUTRAL] I can see a lot.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from uh Dental. Um, I wanted to confirm one of my patients insurance eligibility.
[AGENT][NEUTRAL] OK, well, I can, yes, I can help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] 7,709,494,400, the policy number is.
[CUSTOMER][NEUTRAL] 259-695-2
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax back sent to you or you have particular questions?
[CUSTOMER][NEUTRAL] Both please.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, now [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] Alright, and then what questions did you have in reference to the fax bag?
[CUSTOMER][NEUTRAL] Um, can I get the insurance company is gonna be um.
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Yes, that's the insurance company. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, uh, what's the address?
[AGENT][NEUTRAL] Um, so it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] yes ma'am.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. Payer ID.
[AGENT][NEUTRAL] It's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK, group number?
[AGENT][NEUTRAL] Group number, hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Group number is 24,640.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, see schedule?
[AGENT][NEUTRAL] Um, this is a, this is just a standard fee schedule.
[CUSTOMER][NEUTRAL] OK, group name?
[AGENT][NEUTRAL] Group name is Universal Trucking.
[AGENT][NEUTRAL] Florida Rock.
[CUSTOMER][NEUTRAL] Universal.
[CUSTOMER][NEUTRAL] Trucking Florida.
[AGENT][NEUTRAL] Mhm. Florida Rock.
[CUSTOMER][NEUTRAL] Florida, OK.
[CUSTOMER][NEUTRAL] Hold on one second for me, I'm sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for choosing that piece. So, can I get you to hold a second please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is there annual max?
[AGENT][NEUTRAL] Yes, the calendar year max is $1500.
[CUSTOMER][NEUTRAL] OK. Any been used?
[AGENT][NEUTRAL] And there's a
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Um, so for [PII], they have not used any of the max or met the deductible.
[CUSTOMER][POSITIVE] OK, perfect. How much is the deductible?
[AGENT][NEUTRAL] It's $50.
[CUSTOMER][NEUTRAL] Is that for family as well?
[AGENT][NEUTRAL] Um, it's up to 150 per family.
[CUSTOMER][NEUTRAL] OK, um, preventative, is that covered at 100%?
[AGENT][NEUTRAL] Yes, basic, basic restorative, um, and FMX.
[AGENT][NEUTRAL] Um, we're all at 80, and then all major is at 40%. Major for us is endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] It's a tooth cloth.
[AGENT][NEGATIVE] Um, yes, there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] Is there a waiting period?
[AGENT][NEUTRAL] For um major services, there is a 12-month waiting period. Um, hold on, let me go back to see.
[AGENT][NEUTRAL] This policy has been active, well, the 12 months won't be until [PII].
[CUSTOMER][NEUTRAL] Got you. OK, and is there a waiting period for basic?
[AGENT][NEUTRAL] No, only major.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um, now I have a few frequency questions if that's OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, uh, uh, we are in network, correct?
[AGENT][NEUTRAL] Um, this policy it doesn't have a network.
[CUSTOMER][NEUTRAL] Oh, OK, cool. Alright, so it's gonna be for the FMX and panel.
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, bitely.
[AGENT][NEUTRAL] Once per 12 month period.
[CUSTOMER][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] A PA?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me do it this way.
[AGENT][NEUTRAL] Um, 0220 is under basic um.
[AGENT][NEUTRAL] 80%. I'm sorry, I went blank.
[CUSTOMER][NEUTRAL] And the frequency?
[AGENT][NEUTRAL] There's no frequency on there.
[CUSTOMER][NEUTRAL] Be
[CUSTOMER][NEUTRAL] What about uh prophy?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Profits are preventative 100% once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A periodic exam.
[AGENT][NEUTRAL] Do you have a cold
[CUSTOMER][NEUTRAL] And limited income.
[CUSTOMER][NEUTRAL] Yes, uh, 0120, 0140, and 0 150. Sometimes they share frequencies.
[AGENT][NEUTRAL] Oh yeah, those are all together, um, and it's, hold on.
[AGENT][NEUTRAL] And the preventative at 100 and it's once I'm sorry, 212 month period.
[CUSTOMER][NEUTRAL] OK, um, SIP and all quads, the, uh, can you do all quads the same day?
[AGENT][NEUTRAL] Um, there's no specification on all quads, um, so that's fine. And then do you have a code for the, um, so I can look up the frequency?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] All right, so that's 40% under major and maximum 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK, what about 4910?
[AGENT][NEUTRAL] 910.
[AGENT][NEUTRAL] Um, maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] OK, healing period between 4910 following the 4341.
[AGENT][NEUTRAL] Um, our policy doesn't specify the healing period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] 4346 is a cover code on the fax back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, cool, can I have a reference number for this call and um do you require a PTE?
[AGENT][NEUTRAL] No, um, we don't have to do the estimates. It's not required. Um, if you send one in, we'll complete it though. Um, and what was the, the last question?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A reference number?
[AGENT][NEUTRAL] Oh, so there's no call reference number, but you can use my name and today's date. And again, that's [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much. um, oh, and one last question I, I, I think the answer is no, but I just wanna confirm, is there any um uh dental history on this patient?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] And no, there's no history on file.
[CUSTOMER][POSITIVE] OK perfect thank you so much and you have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye.