AccountId: 011433970860
ContactId: 1d2193d3-d069-4ecc-be87-f0dd241fadff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489640 ms
Total Talk Time (AGENT): 200795 ms
Total Talk Time (CUSTOMER): 183705 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/1d2193d3-d069-4ecc-be87-f0dd241fadff_20250205T16:52_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm good. I have [PII] on the phone. She's a dental provider. She's needing benefits on this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The policy number is 258.
[CUSTOMER][NEUTRAL] 881 2
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I verify the name and date of birth.
[AGENT][NEUTRAL] OK, and you have a call back number for her?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And her name is [PII].
[AGENT][NEUTRAL] [PII], OK, you can send her over.
[CUSTOMER][POSITIVE] All right. Thank you, [PII], and you have a good day.
[AGENT][POSITIVE] You're welcome. You too.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] Um, yes, my name is [PII].
[AGENT][NEUTRAL] Hi [PII], uh, you're calling today for dental benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and would you like a fax back or would you like, um, how would you like to receive those benefits?
[CUSTOMER][POSITIVE] I'm, I'm able to get the benefits over the phone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, please be advised verifying benefits is not guaranteed payment. Uh, the policy has been effective since [PII] and still active.
[AGENT][NEUTRAL] And uh what specific questions do you have?
[CUSTOMER][NEUTRAL] Yeah, and I'm able to get the deductible and uh maximum information first?
[AGENT][NEUTRAL] Yes, so the calendar year deductible is $50.
[AGENT][NEUTRAL] Uh, the calendar year maximum is $500.
[CUSTOMER][NEUTRAL] Alright, and have they used any of their maximum?
[AGENT][NEUTRAL] I show the full everything is available at this time.
[CUSTOMER][POSITIVE] All right, perfect. Do they have any missing tooth cloths?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Let me see the
[AGENT][NEUTRAL] OK, it does have a, uh, missing tooth clause.
[CUSTOMER][NEUTRAL] OK and then um what is the coverage for diagnostic and preventative?
[AGENT][NEUTRAL] Preventative, uh, pays at 80% of the UCR.
[AGENT][NEUTRAL] Um, and diagnostics pays 80%.
[CUSTOMER][NEUTRAL] Alright, and what is the um age limitation for fluoride?
[AGENT][NEUTRAL] Do you have a code for that?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah it would be 1206.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me 12, so I do not show uh 1206 being on the fee schedule.
[CUSTOMER][NEUTRAL] Oh OK, no worries, that one I'm gonna put at 0.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And then what what is the frequency for the exam and cleaning and I can give you a code if needed.
[AGENT][NEUTRAL] I will need the current.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be 0120.
[AGENT][NEUTRAL] 0120.
[AGENT][NEUTRAL] And your question again? I'm sorry.
[CUSTOMER][NEUTRAL] Um, like with the frequency level is, like, um, how often they can be seen.
[AGENT][NEUTRAL] Frequency level, OK.
[AGENT][NEUTRAL] OK, 0120.
[AGENT][NEUTRAL] Uh, this is limited to 2 oral evaluations, um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Per 12 month period.
[AGENT][NEUTRAL] And that is in combination with 012001400150 and 0160.
[CUSTOMER][NEUTRAL] For 12 months, right.
[CUSTOMER][NEUTRAL] OK, next code I have is gonna be um 2393.
[AGENT][NEUTRAL] 239.
[AGENT][NEUTRAL] 2393.
[AGENT][NEUTRAL] And this is resin.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so that is a maximum of one.
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Uh, for per each tooth per 24 months.
[CUSTOMER][NEUTRAL] And then you.
[CUSTOMER][NEUTRAL] Alright, and what is the coverage level for that one?
[AGENT][NEUTRAL] That is let me look 0293.
[AGENT][NEUTRAL] That is going to be.
[CUSTOMER][NEUTRAL] Yeah, no problem. I think they wanted to do for 2, but this is just.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Oh, I'm sorry, 02.
[AGENT][NEUTRAL] That is under the basic paid at 80%.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And then how about for major services like a crown?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] For the he has.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do not show that as a covered service. I don't show any major um.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me make sure basic preventative. I don't show any major uh services allowed on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. What, what about, oh, OK, do you know, like, what about for endodonics, like for a root canal?
[AGENT][NEUTRAL] Mm, I believe Root canal would be covered under major unless you have a, uh, I can look to see if it's on the fee schedule with a.
[AGENT][NEUTRAL] Uh, I'm sorry, on the, uh, covered services. What is the code?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, 3330.
[AGENT][NEUTRAL] 33333. I do not show that as a covered benefit.
[CUSTOMER][NEUTRAL] No worries. How about for um code 4341?
[CUSTOMER][NEUTRAL] Uh, yeah, that's that's all.
[AGENT][NEUTRAL] 4341 is also not a covered uh procedure.
[CUSTOMER][NEUTRAL] Got it. How about 4910?
[AGENT][NEUTRAL] 4910 is not a covered procedure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and then how about for it, um, like oral surgery? I can give you code 7240.
[AGENT][NEUTRAL] OK, 7240 is not a covers uh procedure code.
[CUSTOMER][NEGATIVE] Sounds like a squeaky tray but.
[CUSTOMER][NEUTRAL] Got it. OK, no worries. So only covered services on here would be a diagnostic preventative and then like um basic like a filling, but everything else was um not covered. OK, no worries.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, that is correct.
[CUSTOMER][POSITIVE] Perfect. I think that was all the information I needed. Was there any um waiting periods or anything? OK.
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I do not show a waiting period, uh, on this policy.
[CUSTOMER][POSITIVE] OK perfect alright thank you so much for all your help. I will go ahead and update this on the patient's plan, and then that should be all I needed.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK. You have a wonderful day, [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Of course you too.
[CUSTOMER][NEUTRAL] Bye bye.