AccountId: 011433970860
ContactId: 1e473138-9f04-4f3f-82e4-50e3ee69a697
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1105040 ms
Total Talk Time (AGENT): 440837 ms
Total Talk Time (CUSTOMER): 486253 ms
Interruptions: 18
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/1e473138-9f04-4f3f-82e4-50e3ee69a697_20250602T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello [PII]. My name is [PII] calling from LC Beyond Smile dental office, and I'm calling for a breakdown of benefits and making sure that we're in network with this plan.
[AGENT][POSITIVE] OK Miss [PII], I can help you with benefits and network. Can I please get your call back number ma'am just in case the call is dropped.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the?
[AGENT][NEUTRAL] Um, member's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] OK, so it's [PII]?
[CUSTOMER][NEUTRAL] And the date of birth, he's the member, it's 10-27-1956.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess he's the policy holder.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the ID number is 02622087.
[AGENT][NEUTRAL] OK, let me pull him up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, and is the um is he also the patient?
[CUSTOMER][NEUTRAL] No, the patient is the wife, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her date of birth?
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Her date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much. I do show that Ms. [PII] does have an active policy.
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And if you can give me your fax number, I'll send that fax back to you with the benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, would you be able to give that breakdown to me over the phone? She's in the chair.
[AGENT][POSITIVE] Oh my goodness, yes, I can.
[AGENT][NEUTRAL] And we don't have an that's OK.
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] That's OK and there's not a certain work that she has to use she can go to any provider she chooses. We use the um UCR.
[AGENT][NEUTRAL] Fee schedule.
[CUSTOMER][NEUTRAL] At all times.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so we don't have to be in network in other words, OK, great, um, the claims mailing address?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] The claims mailing address is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII], [PII].
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] [PII], [PII] is OK.
[AGENT][POSITIVE] Yes, it's OK.
[CUSTOMER][NEUTRAL] The abbreviation? OK.
[AGENT][POSITIVE] Every, yes, everything is OK. Everything.
[CUSTOMER][POSITIVE] It's OK over there.
[AGENT][POSITIVE] It's all OK.
[CUSTOMER][NEUTRAL] And your and your zip code?
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And then the last 4 of it is
[CUSTOMER][NEUTRAL] You you just got cut off [PII].
[AGENT][NEUTRAL] Oh, I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes, and then the last four is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Great and the name of the insurance?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK, so it is APL. I thought they, and they work for American Public Life as well. That's the, the name of.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that's the name of the company the APL is for short.
[CUSTOMER][MIXED] OK, but they work for there, for there, right? For American public life.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, ma'am. Um, they don't work for American Public Life. Let me give you their group number and the name of the, um,
[CUSTOMER][NEUTRAL] No um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Company they work for.
[CUSTOMER][NEUTRAL] Of the group.
[AGENT][NEUTRAL] Yes, the group number is.
[CUSTOMER][NEUTRAL] Oh, that's what I need.
[AGENT][NEUTRAL] Yes, ma'am. That's 70101.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the name of the group is Superior Skilled trades.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You said superior.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Skilled, S K I L S S K I L L E D.
[CUSTOMER][NEUTRAL] What came after that?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Trades.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] ADS OK, so that's who he works for. OK, great, and the payer ID number?
[AGENT][NEUTRAL] That would be 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK, is there a waiting period with this plan?
[AGENT][NEUTRAL] And let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, first I've got their maximum pulled up. Let me go ahead and give that to you while I've got it pulled up because I know you're gonna need, need that also.
[CUSTOMER][POSITIVE] Absolutely, I'm gonna need everything.
[AGENT][NEUTRAL] Yes ma'am. The, um, calendar year maximum.
[CUSTOMER][NEUTRAL] We have a promotion exam and X-rays, no charge. I'm sorry, the yearly maximum? OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] $750.
[AGENT][NEUTRAL] And they have a $50 deductible.
[AGENT][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment and let me get there.
[CUSTOMER][NEUTRAL] To be honest.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there is the remaining benefits are they 750?
[AGENT][POSITIVE] Schedule pulled up so that we can give you some.
[AGENT][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] Put in my yeah.
[AGENT][NEUTRAL] The, um, they still have it left. Yes, ma'am. They, they have not used anything this calendar year.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and you said no waiting period.
[AGENT][NEUTRAL] Let me look. I'm, I'm pulling up their schedule benefits right now for so I can check it with you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna take a second for it to download.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No medical CNA.
[AGENT][NEUTRAL] I'm trying to hurry. I know she's in the chair.
[CUSTOMER][POSITIVE] Oh, take your time, take your time.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] There is no waiting period for preventative radiographs, basic or basic restorative.
[AGENT][NEUTRAL] Um, this plan does not have any major dental.
[AGENT][NEUTRAL] Benefits.
[CUSTOMER][NEGATIVE] No major, they're not covered, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[CUSTOMER][NEUTRAL] For you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, is it a calendar year or policy year?
[CUSTOMER][NEUTRAL] The the the.
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Calendar year and um deductible applies to preventive and basic.
[AGENT][NEGATIVE] Uh, the deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK, just the basic. OK. And um preventive, is it covered at 100%?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You're not here but I.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And basic.
[AGENT][NEUTRAL] 80%
[CUSTOMER][NEUTRAL] What was that?
[AGENT][NEUTRAL] It's covered 80%.
[CUSTOMER][NEUTRAL] 80. OK, we just don't have a good um um OK so now I just need um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Frequencies I couldn't come up with the word uh 0150.
[AGENT][NEUTRAL] Frequencies? OK.
[AGENT][NEUTRAL] OK, let me look this up.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, limited to 2 oral evaluation procedures in any combination.
[AGENT][NEUTRAL] Per 12 month period.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For 12 months. OK, so 2 and 12 months.
[AGENT][NEUTRAL] And that's for
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And 0 120?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] That's also the same, um, 2 oral evaluation procedures and any combination per 12 month period and the combination numbers are.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 120, 140, 150, and 160.
[CUSTOMER][NEUTRAL] OK, so 2 and 12 months and they all share.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can we do treatment the same day as 0140?
[AGENT][NEUTRAL] Let me look up
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] We can OK, bite wings?
[AGENT][NEUTRAL] Bite wings or
[AGENT][NEUTRAL] Once every 12 month period.
[CUSTOMER][NEUTRAL] Perapical X-rays.
[AGENT][NEUTRAL] That's the same as um.
[AGENT][NEUTRAL] Panoramics
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's once every 5 years?
[CUSTOMER][NEUTRAL] 1 in 5 years for the panel and the FMX they share.
[AGENT][NEUTRAL] The FMX is considered um radiographs, um, and it's covered at 80% of allowable.
[CUSTOMER][NEUTRAL] OK, so it's 80% for that and the periapical X-rays, are they 80%?
[AGENT][NEUTRAL] Uh, what is the code for that one?
[CUSTOMER][NEUTRAL] 0220 and 0230.
[AGENT][NEUTRAL] Uh, that's considered basic at 80% and 30% is also considered basic at 80%.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] OK, and um how many films can we take a year?
[CUSTOMER][NEUTRAL] How many of those codes, 0220 and 0230.
[AGENT][NEUTRAL] It doesn't say. It just says it's it's um covered at 80%. There's no limitations on it.
[CUSTOMER][NEUTRAL] OK, so we could take like 4 if we need, uh, Proffi.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] 1 in 6 months, fluoride.
[AGENT][NEUTRAL] Uh, fluoride is limited to 14 years and under.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the frequency.
[AGENT][NEUTRAL] What is the code for the fluoride?
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] Let me look down here and see.
[AGENT][NEUTRAL] It doesn't have a frequency just limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so no frequency sealants 1351?
[CUSTOMER][POSITIVE] And that's at 100% right, sweetie?
[CUSTOMER][NEUTRAL] The fluoride.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] For a child because it has to be under [PII] years.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Based on UCR, it's, yes, it is 100%. It's under preventative.
[AGENT][NEUTRAL] The sealants are also for
[CUSTOMER][NEUTRAL] OK. Seances?
[AGENT][NEUTRAL] Under age [PII].
[AGENT][NEUTRAL] And those are also considered preventative, so it would be the 100.
[CUSTOMER][NEUTRAL] OK, 2393.
[AGENT][NEUTRAL] Uh, that is considered basic restorative, which is 80%, but it does have limitations, and let me see what those are.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months is one of them.
[AGENT][NEUTRAL] And F is
[CUSTOMER][NEUTRAL] OK, 1 in 24 months, and are they downgraded?
[AGENT][NEUTRAL] Maximum
[AGENT][NEUTRAL] Um, no, they're not downgraded and it's a maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] Got it 9910?
[AGENT][NEUTRAL] 9910 is not on the fax back so it's a non-covered procedure.
[CUSTOMER][NEUTRAL] 4921.
[AGENT][NEGATIVE] That's also not on the plan.
[AGENT][NEUTRAL] It's non-covered.
[CUSTOMER][NEUTRAL] 70 to 10.
[AGENT][NEGATIVE] That's not covered either.
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] 7140 is considered basic. It does have a limitation. Let me look at the limitation for you, maximum one time per tooth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh 4355.
[AGENT][NEUTRAL] That's non-covered.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] That's noncovered.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] That is non-covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] That's non-covered.
[CUSTOMER][NEUTRAL] 4381.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] That one is also non-covered.
[CUSTOMER][NEUTRAL] 3330.
[AGENT][NEGATIVE] That's non covered.
[CUSTOMER][NEUTRAL] 3110.
[AGENT][NEUTRAL] That is also non-covered.
[CUSTOMER][NEUTRAL] Uh, so implants are not covered 60, 1060, 65, that's all major.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right, no major expenses.
[CUSTOMER][NEUTRAL] And and you said, yeah, and you said OK, how about the 2950 and the 2954.
[AGENT][NEUTRAL] 2950 is not covered.
[AGENT][NEUTRAL] And 2954 is also non-covered.
[CUSTOMER][NEUTRAL] And 15.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] That is non-covered.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] That is non-covered.
[CUSTOMER][NEUTRAL] OK, so dentures are not covered either, crowns are not covered. And um any history?
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We do have a client that has come in on [PII] but it's not finished processing so I can't see what the codes are on it.
[AGENT][NEUTRAL] It's in progress right now. I'm unable to see, yeah, [PII] for part two for Ms. [PII].
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Well, she, she did a crown you're saying?
[AGENT][NEUTRAL] No, I can't see what it is. It's a claim that came in on [PII].
[CUSTOMER][NEUTRAL] Oh, it could be a it was a claim, yeah, it could be a root canal, OK.
[AGENT][NEUTRAL] I can't, yes.
[CUSTOMER][POSITIVE] Got you. OK. And can I get your name, sweetheart?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII]
[CUSTOMER][NEUTRAL] And reference number?
[AGENT][NEUTRAL] Will be my name and today's date.
[CUSTOMER][POSITIVE] To 6 to 25. OK, great. Thank you so much. You have a great day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a blessed one and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you, [PII], thank you, bye bye.
[AGENT][NEUTRAL] Mm, bye-bye.