AccountId: 011433970860
ContactId: 1996674c-7c6d-4079-926c-6de82ea00343
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467989 ms
Total Talk Time (AGENT): 147215 ms
Total Talk Time (CUSTOMER): 120018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/1996674c-7c6d-4079-926c-6de82ea00343_20250404T16:56_UTC.wav
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[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from I Smile Dental Clinic. I'm just calling to check one of our, regarding one of our patients benefits for fillings. I just have one code here to check. Can you help me with that?
[AGENT][POSITIVE] Yes, [PII], I can help you with benefits. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Uh sure. This is direct. That would be [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah sure this is for [PII].
[CUSTOMER][NEUTRAL] Date of birth would be [PII] and for the policy number, one moment here, where can I pull up that policy number?
[CUSTOMER][NEUTRAL] Oh yeah, the policy certificate number.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, can you hear
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Your line is cutting in and out. Can you hear me?
[AGENT][NEUTRAL] Yes, I did notice that, sir. And what was the policy number one more time please, sir?
[CUSTOMER][NEUTRAL] Uh yeah, 022-59801.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And if you give me your fax number I can send you a fax back with the benefit breakdown schedule.
[CUSTOMER][NEUTRAL] I mean, I actually, I actually already have here the fax back of the patient's benefits. I just want to double check her his benefits for fillings. I just have here one code to check.
[AGENT][NEUTRAL] JD, can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you now.
[AGENT][NEUTRAL] Oh OK good good good. What is your fax number and I'll send you a fax back with the benefit breakdown and fee schedule.
[CUSTOMER][POSITIVE] Um, yeah, I'm already good with that. I just need to get it verbally for the benefits for feelings.
[AGENT][NEUTRAL] OK, let me pull up that fax real quick.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] You sure
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the code here to check.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is that code, please, sir?
[CUSTOMER][NEUTRAL] Yeah, for the 2392 for tooth number 3 and 15, I just need to get the percentage frequency if there's any downgrade and any history for fillings.
[AGENT][NEUTRAL] OK, and that number was D2392?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK. Let me look.
[AGENT][NEUTRAL] Um, there are no downgrades. I do know that. Let me look as far as the feelings go.
[AGENT][NEUTRAL] I'm still searching. I'll be just a minute.
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] OK, so on and this is just to verify benefits, it's not a guarantee of payment on the code D2392, um, there is limitation replacement of existing only if in place for 24 months.
[AGENT][NEUTRAL] And then also maximum of 1 per 5-year period per tooth.
[AGENT][NEUTRAL] And let me see if.
[CUSTOMER][NEUTRAL] Thank you. Just to make sure, 1 for 5 years because from what we have here from our recent call, it stays here maximum of 1 tooth per 24 months. So now it is 1 per 5 years per tooth.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] 2392.
[AGENT][NEUTRAL] Let me look at the limitations again and make sure I've picked the right ones.
[AGENT][NEUTRAL] Believe but I wanna double check my right, I just wanna double check myself.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is it correct, the letter O and letter L on limitations, right?
[AGENT][NEUTRAL] That's what I'm looking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 23392.
[AGENT][NEUTRAL] O and L.
[AGENT][NEUTRAL] L is maximum of 1 each quadrant per 24 months and O is replacement of existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] So that's the benefit for this code, right?
[AGENT][NEUTRAL] Yes, and then, um,
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Let me give you.
[AGENT][NEUTRAL] Any history
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] That's what you wanted. Let me look on the procedure.
[AGENT][NEUTRAL] I do not show that insurers had history with us for that procedure.
[CUSTOMER][NEUTRAL] I see, so no any history on file for filings?
[AGENT][NEUTRAL] Right, not for that procedure code, no, sir.
[CUSTOMER][NEUTRAL] I see. So yeah, I think that's it for me today and if I can just get a reference number, please.
[AGENT][NEUTRAL] Yes, sir. You can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Thank you for that [PII]. So that's all for me today. Thank you so much have a great weekend and bye for now.