AccountId: 011433970860
ContactId: 1a5f4a87-7f87-4c7d-879e-84b2db2278f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456260 ms
Total Talk Time (AGENT): 167108 ms
Total Talk Time (CUSTOMER): 148128 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/2025/06/13/1a5f4a87-7f87-4c7d-879e-84b2db2278f7_20250613T14:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the provider's office. I was just wanting to get um a verbal uh breakdown of a patient's dental benefits if possible please.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah it's 02482846.
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. Uh date of birth is [PII].
[AGENT][NEUTRAL] OK, [PII] said the policy is active and effective [PII].
[AGENT][NEUTRAL] And then you, you, you need a like a list of codes or?
[CUSTOMER][NEUTRAL] Yeah, just like the, like, yeah, like the percentages of like um uh what like the preventative basic major endo perio is all covered out and like the frequencies as well.
[AGENT][NEUTRAL] OK. Um, let me get that pulled up.
[AGENT][NEUTRAL] It's not a guarantee of payment, basic outline of the policy. Um, preventative services are paid at 100%, and that's just gonna include your cleanings, exams, and then.
[AGENT][NEUTRAL] Fluoride for children, space maintainers for children.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, X-rays, basic expenses, and basic restorative pay 80%.
[AGENT][NEUTRAL] And then major endopperio, prosthodontic, and oral surgery all pay 40% after a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, so you said for basic major perio endo oral surgery, all that is 40% um with a waiting period?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it's going
[AGENT][POSITIVE] Which it's been satisfied so he's effective [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said a 6 month waiting period?
[AGENT][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] 0 12 months. I'm sorry.
[CUSTOMER][NEUTRAL] Um, OK, is there any coverage for orthodontics?
[AGENT][NEGATIVE] Uh, no coverage for Ortho.
[CUSTOMER][NEUTRAL] OK, um, and then what would be the max and the deductible?
[AGENT][NEUTRAL] Uh, deductible is $50 and calendar year maximum is $1500.
[CUSTOMER][NEUTRAL] OK, and the deductible hasn't been met yet, correct?
[AGENT][NEUTRAL] Uh, correct. I don't have any history for him.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, let's see, and then, um, the benefit month, does it start like at the beginning of every year?
[AGENT][NEUTRAL] It runs on a calendar year.
[CUSTOMER][POSITIVE] Got you perfect thank you um.
[AGENT][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] And then for the frequencies for like the full mouth X-ray and like the bite wings.
[AGENT][NEUTRAL] Um, so full mouth and, um, so profies and cleanings are once every 6 months.
[AGENT][NEUTRAL] Exams 2 for 12 month period.
[AGENT][NEUTRAL] Bite wings or once for 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Full mouth and pano is once every 5 years.
[AGENT][NEUTRAL] And crowns and bridges once every 7 years, and then partials and dentures once every 5 years.
[CUSTOMER][NEUTRAL] OK, and then um for fluoride, what would be the frequency, the frequency and the age limit?
[AGENT][NEUTRAL] Um, fluoride is
[AGENT][NEUTRAL] Uh, limited to age [PII], 1 for 12 months.
[CUSTOMER][NEUTRAL] OK, and then the deductible is it waived for um the X-rays and preventative?
[AGENT][NEUTRAL] Um, no, it's only waived for preventative, which would include propies and propies, cleanings, exams, and then fluoride and space maintainers.
[CUSTOMER][NEUTRAL] OK, OK, so it still applies to the X-rays, got it.
[CUSTOMER][NEUTRAL] Um, and then I say for example.
[AGENT][NEUTRAL] Um, actually, like.
[AGENT][NEUTRAL] Uh, for the X-rays, it does, um, under preventative is bite wings, just not the piano and full mouth.
[CUSTOMER][NEUTRAL] Got you. OK, um, and then for crowns is that paid on prep date or seat date?
[AGENT][NEUTRAL] Um, either one.
[CUSTOMER][NEUTRAL] OK and then is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then the coordination of benefits?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and then for sealants, um, is there coverage for that and what would be the age limit?
[AGENT][NEUTRAL] It's [PII] and once every 12 months.
[CUSTOMER][NEUTRAL] OK, um, and then what would be the, the group name?
[AGENT][NEUTRAL] Her name is.
[AGENT][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] OK, and then what's the address to submit the claim to?
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And zip is [PII].
[CUSTOMER][NEUTRAL] OK, I'm sorry, the zip code one more time.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, and then the name of the insurance company again?
[AGENT][NEUTRAL] It's American Public Life.
[CUSTOMER][NEUTRAL] OK, and this is a PPO plan correct?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, no, it's, they can go to any dentist they like. We just pay off what's reasonable and customary.
[CUSTOMER][NEUTRAL] Got you, OK, um, and then the fee schedule who would that fall under?
[AGENT][NEUTRAL] Reasonable and customary, so usual reasonable and customary. There's not a PPO network tied to it, so.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] And then um what would be the payer ID?
[AGENT][NEUTRAL] That's 60801.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK and then um if I can just have a reference number for this call and that'll be all.
[AGENT][NEUTRAL] Uh, reference number is my name, [PII], first initial to last name [PII].
[AGENT][NEUTRAL] In today's date, and Cassandra, I didn't get your callback number. What was that for our records?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK. And all benefits quoted today were not a guarantee of payment, just a basic outline of the policy.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII]or all your help.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye.