AccountId: 011433970860
ContactId: 1bcda5a6-2351-449d-a334-aa539d5b15b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354559 ms
Total Talk Time (AGENT): 163673 ms
Total Talk Time (CUSTOMER): 118901 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/1bcda5a6-2351-449d-a334-aa539d5b15b1_20250213T18:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm trying to find out some information on this patient's policy.
[AGENT][NEUTRAL] OK, I can verify that for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 02594145.
[AGENT][POSITIVE] Thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, her date of birth is [PII].
[AGENT][NEUTRAL] OK, and this is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and how may I assist you today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, I just needed to get a breakdown of her benefits.
[AGENT][NEUTRAL] Let's see. OK. Uh, not, excuse me, not a guarantee of payment, just a verification of coverage. Patient has a benefit max up to $500 per calendar year, and she has a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, preventative pays 100% of UCR.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80 and under this plan, major services are not covered, uh, that will include endo perio oral surgery, um, crowns, bridges, partials, and dentures are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright now let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So we're considered out of network with this plan then?
[AGENT][NEUTRAL] Oh no, we don't have a network. Um, we accept assignment from any provider. It's just it's a type of policy she has to limit dental.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, alright, and you said her max was 500, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] All right, ma'am, um, and would there be a group name or a group number for this policy?
[AGENT][NEUTRAL] Yes, um, let's see, group number is 70,030.
[AGENT][NEUTRAL] And the group name is Creative Circle.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get the claims address?
[AGENT][NEUTRAL] Uh, yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 24895, yes, I forgot my wrong address [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And is there a payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] All right, let me see um.
[CUSTOMER][NEUTRAL] Alright, uh, let me see you said the deductible doesn't apply to preventative. Alright, um, if I give you a few of the codes, would you be able to tell me the frequency for those?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see, 11:10. Do you want them all at once?
[AGENT][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] OK, 11 1002200274.
[CUSTOMER][NEUTRAL] 02 10 0 120 0 140 and 0 150.
[AGENT][NEUTRAL] OK, well the exams, the 120, 140, 150 all share the same frequency of 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I thought I knew the codes. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Uh, cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 220.
[AGENT][NEUTRAL] Oh, for the PAs, there's no frequency?
[AGENT][NEGATIVE] And they do fall on our basic, um, light wings are 1 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other one you said 2210, is that correct?
[CUSTOMER][NEUTRAL] Uh, no, 0 to 10.
[AGENT][NEUTRAL] 0, 0210. 0, full mouth, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's once every 3 years and it does share a frequency with the panel, I mean a panoramic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, 2391, is that covered?
[AGENT][NEUTRAL] 2391. Yes, and it is covered uh once every 24 months and it's basic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 80, OK, what about 1208?
[AGENT][NEUTRAL] For a fluoride.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, it's under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright ma'am, and can I get your name and a reference number and I appreciate your help.
[AGENT][NEUTRAL] Oh, you're welcome. Uh my name is [PII], last initial [PII], and we don't give reference numbers, but if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] All right man thank you so much and you have a wonderful rest of your day.
[AGENT][POSITIVE] Oh, you too, and thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] Thank you bye man.