AccountId: 011433970860
ContactId: 1a839593-9f98-46aa-a58a-0f7d411c995d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 849710 ms
Total Talk Time (AGENT): 324011 ms
Total Talk Time (CUSTOMER): 464137 ms
Interruptions: 22
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/1a839593-9f98-46aa-a58a-0f7d411c995d_20250620T18:26_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from the dental office to check eligibility for one patient. Can you please help me with that?
[AGENT][NEUTRAL] OK, I'm so sorry. What did, did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Sorry, what did you say your name is [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. I'm sorry. And [PII], you're needing to check eligibility. Is that correct?
[CUSTOMER][NEUTRAL] OK thank you I need to check eligibility is that correct? Yes, that's correct.
[AGENT][NEUTRAL] Do you also need a fax back of benefits sent to you, or you just needing to verify if the policy is active or not?
[CUSTOMER][NEUTRAL] Do you also need a backpack of benefits.
[CUSTOMER][NEUTRAL] No, just the active or not. Just a verbal uh verification over the phone.
[AGENT][NEUTRAL] OK. I can help you. What is your callback number, please?
[CUSTOMER][NEUTRAL] I should call back number.
[CUSTOMER][NEUTRAL] Uh yes, so that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Again, the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Your policy number please [PII].
[CUSTOMER][NEUTRAL] 023 04381.
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] That's for [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], any information that is provided would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. So that's [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Excuse me, he is a subscriber on this policy and it is active with an effective date of [PII].
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] He is a subscriber on this.
[CUSTOMER][NEUTRAL] Uh, so what I say.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Check the provider participation.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] I'm sorry, what was your question? Uh, is, is the provider network?
[AGENT][NEGATIVE] This is not a network plan.
[AGENT][NEUTRAL] So they may just select any provider to to go to.
[CUSTOMER][NEGATIVE] This is not a network plan.
[CUSTOMER][NEUTRAL] OK. Oh, OK. So that means this patient has uh out of network benefits.
[AGENT][NEGATIVE] This plan does not is not a network plan.
[CUSTOMER][NEGATIVE] This plan is not is not a network.
[CUSTOMER][NEUTRAL] OK. Uh, does it have any group name number?
[AGENT][NEUTRAL] It does. The group number is 17626.
[CUSTOMER][NEUTRAL] It does. The group number is 17.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The name is Universal Trucking.
[AGENT][NEUTRAL] Stevens Transport.
[CUSTOMER][NEUTRAL] Stevens transport.
[CUSTOMER][NEUTRAL] Uh, can you spell the second word for me, Universal? Is that trekking as in mountain trekking?
[AGENT][NEUTRAL] Trucking
[AGENT][NEUTRAL] Trucking, like T R U C K I N G.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, it was the trucking after that?
[AGENT][NEUTRAL] Stevens.
[CUSTOMER][NEUTRAL] Steven
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Transport.
[CUSTOMER][NEUTRAL] Transport OK.
[CUSTOMER][NEUTRAL] And this one would be a single coverage.
[AGENT][NEUTRAL] This is employee and spouse.
[CUSTOMER][NEUTRAL] For spouse. OK, so it would be following the, the American, the APL, uh.
[CUSTOMER][NEUTRAL] Free schedule, right?
[AGENT][NEUTRAL] This plan is based on the UCR covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] OK. Uh, do you have any claims address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 550.
[CUSTOMER][NEUTRAL] And the payer ID 60801.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Any deductible, max, auto coverage on the plan?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, there are.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, can you help me with that, the deductible first?
[AGENT][NEUTRAL] Calendar year deductible is $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] covered insurance or the 150 per family.
[CUSTOMER][NEUTRAL] OK. And how about the annual max?
[AGENT][NEUTRAL] For covered out for covered services is $1500 excuse me, $1500 per insured.
[CUSTOMER][NEUTRAL] We're covered for covered services is $1500.
[CUSTOMER][NEUTRAL] $1500 for insured. OK. Nothing new, nothing met?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] That is correct. OK. And would that be for basic and major services or preventative basic major?
[AGENT][NEUTRAL] Preventative is covered at 100% of the UCR. Radiographs, basic and basic restoratives are 80% of UCR subject to the calendar year deductible. Major endoperontic and prosthoontic in oral surgery is covered at 40% of the UCR also subject to the calendar year deductible.
[CUSTOMER][NEUTRAL] Preventative is covered at 100% of the UCR radiograph basic and basic restorative or 80% of UPR subject to the calendar year deductible.
[CUSTOMER][NEUTRAL] Major endo periodontic and protagonic in a work per covered at 40% of you are also subject to the calendar year because that.
[CUSTOMER][NEUTRAL] OK. And crown bridges, dentures and plants are all covered services?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Again, the facts back of the benefits, [PII] has all of the codes that are covered and their limitations and their categories.
[CUSTOMER][NEUTRAL] And the fact that that the benefits.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] And the limitation
[CUSTOMER][NEUTRAL] And their category. So I, I do not need like the entire thing, just a few uh details here and there.
[CUSTOMER][NEUTRAL] Uh, I was asking about the, the deductible. Is that on basic and major services or, or on all services?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] The only category it doesn't apply to is preventative.
[CUSTOMER][NEUTRAL] The $50. Yeah.
[CUSTOMER][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] And can you help me with the frequency for exam cleaning by wings and FMX?
[AGENT][NEUTRAL] What's the first code you want checked [PII]?
[CUSTOMER][NEUTRAL] The first page. Uh 0120. Should I give all at once?
[AGENT][NEGATIVE] You should not
[CUSTOMER][NEGATIVE] We should not
[AGENT][NEUTRAL] OK, that is under
[AGENT][NEUTRAL] That's under preventative and the limitation on that.
[CUSTOMER][NEUTRAL] And that is under
[CUSTOMER][NEGATIVE] Just the the limitation on that.
[AGENT][NEUTRAL] To 2 limited to two or evaluation procedures in any combination of 0 120, 0140, 0150, 0160, 0180 per 12 month period.
[CUSTOMER][NEUTRAL] the two oral evaluation procedures and any combination of 012.
[CUSTOMER][NEUTRAL] 0140 016.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 018 for 12 months.
[CUSTOMER][NEUTRAL] OK. Uh, cleaning 1110.
[AGENT][NEUTRAL] And that falls under preventative?
[CUSTOMER][NEUTRAL] And that falls under prevent.
[AGENT][NEUTRAL] Max of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] That's the one procedure for 6 months.
[CUSTOMER][NEUTRAL] By wings 0270.
[AGENT][NEUTRAL] And also your preventative.
[AGENT][NEUTRAL] And the limitation with that is, one moment, limited to one bite ring X-ray procedure, that's either 0270272, or 0274 for a twelve-month period.
[CUSTOMER][NEUTRAL] aired.
[CUSTOMER][NEUTRAL] And the limitation with that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright, let me get one bite running I picture that's either 0270272 or 0274 for 12 month period. OK, uh, 0210.
[CUSTOMER][NEUTRAL] Full mouth X-ray.
[AGENT][NEUTRAL] That falls under radiographs and FMX expenses and the limitation on that is limited to one X-ray procedure, that's 02 10, 0277 0330 per 5 year period.
[CUSTOMER][NEUTRAL] That also the radiograph and MMX successes and the limitation on that limited to one the procedures at [PII] 0277.
[CUSTOMER][NEUTRAL] 3 per year period.
[CUSTOMER][NEUTRAL] Uh, is this patient eligible for, uh, fluoride 1208?
[CUSTOMER][NEUTRAL] What's the age limit?
[AGENT][NEUTRAL] [PII] is not covered.
[CUSTOMER][NEUTRAL] [PII] is not covered, not covered. OK. Same with the cancer screening.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. Can you check 4910 for me?
[AGENT][NEUTRAL] That falls under periodontics, and that states on here as maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Call in periodontic.
[CUSTOMER][NEUTRAL] And my statement on here as maximum 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] OK. Any missing tooth claws on the plan?
[AGENT][NEUTRAL] There is.
[CUSTOMER][NEUTRAL] Here is
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] That is under periodontics.
[CUSTOMER][NEUTRAL] That it's under period on it.
[AGENT][NEUTRAL] And then the limitation states maximum 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] And then the limitation date.
[CUSTOMER][NEUTRAL] Maximum 1 each quadrant for 24 months. OK, um, simple extension that's 7140. Uh, does that come under basic services?
[AGENT][NEUTRAL] You said 7140?
[CUSTOMER][NEUTRAL] You said 7140.
[AGENT][NEUTRAL] Is under basic.
[AGENT][NEUTRAL] And the limitation on that states maximum one time per tooth.
[CUSTOMER][NEUTRAL] Is under
[CUSTOMER][NEUTRAL] Okation on that.
[CUSTOMER][NEUTRAL] It one time purchase. OK. Crown bridges, dentures, uh, is the frequency 1 in 5?
[AGENT][NEUTRAL] What's the first code you want checked?
[CUSTOMER][NEUTRAL] The first page you want check? Uh, crowns 2721.
[AGENT][NEUTRAL] That holds under major one moment.
[CUSTOMER][NEUTRAL] your major
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum of 1 per 7 year period and limited to patients 16 and over.
[CUSTOMER][NEUTRAL] On 1 or 7 year period and limitation of 16 and over. OK. Is that the same for bridges and dens?
[AGENT][NEUTRAL] What is the code number?
[CUSTOMER][NEUTRAL] 5110
[AGENT][NEUTRAL] One moment. OK. I have to do one.
[CUSTOMER][NEUTRAL] 60 to 1060 to 10.
[AGENT][NEUTRAL] Do you want to do 5110 or are you changing the code?
[CUSTOMER][NEUTRAL] I have to do one
[CUSTOMER][NEUTRAL] Do you wanna do or are you changing the code?
[CUSTOMER][NEUTRAL] Uh, you can take any, I mean both times. 51,106,210. Once you're done with the other, you can check the other one.
[AGENT][NEUTRAL] 5110.
[AGENT][NEUTRAL] That falls under the major.
[CUSTOMER][NEUTRAL] 5110.
[CUSTOMER][NEGATIVE] That falls under the manager.
[AGENT][NEUTRAL] And the limitations maximum of 1 per 5 year period.
[CUSTOMER][NEUTRAL] And the limitation maximum of 1 to 5 year period.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what was the other code?
[CUSTOMER][NEUTRAL] 60 to 10.
[CUSTOMER][NEUTRAL] And what was the 6210.
[AGENT][NEUTRAL] OK. And that has the same limitations as the other as far as maximum of 1 for 7-year period and limited to patients age [PII] and over.
[CUSTOMER][NEUTRAL] And that has the same one to the other as far as I.
[CUSTOMER][NEUTRAL] 7 year period 11.
[CUSTOMER][NEUTRAL] OK. Any downgrades or alternate benefits on the plan for crown or fillings? No, 3D would be suggested, not mandatory.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No downgrade.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, 3D, is that mandatory or suggested?
[AGENT][NEGATIVE] It is not managed. No, ma'am. There is no, no. Mhm.
[CUSTOMER][NEUTRAL] Not uh required.
[CUSTOMER][NEUTRAL] OK, got that. Um, do we have a reference number that I see for this call?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date and if you will end up filing a claim forms for this member with us once the claim has been processed by APL, you all should be able to check the claim status by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Yeah, she would use my name on all with today's pay and then you will end up filing a claim this member with us once the claim is the process by APL should be.
[CUSTOMER][NEUTRAL] Power
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, OK, thank you so much, [PII], for your help today. You have a good weekend. Thank you.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am. Is there any? I hope you have a good weekend too, and if that's all I can help you with, [PII], thank you again for calling APL.
[CUSTOMER][POSITIVE] I hope you have a good weekend too if that's all I can help you with, thank you again for calling ATO. Thank you so much bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][POSITIVE] You're welcome