AccountId: 011433970860
ContactId: 1e7f426a-e72c-4f71-9b00-857dccae8d64
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604119 ms
Total Talk Time (AGENT): 204158 ms
Total Talk Time (CUSTOMER): 225963 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/1e7f426a-e72c-4f71-9b00-857dccae8d64_20250225T17:42_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII] with Seminole Heights Family Dentistry, and I was calling to see if I could get, um, dental plan benefits for a patient.
[AGENT][POSITIVE] Sure, I can look at those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Um, it is 01991714.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy is active effective date was [PII] and if you'd like, I can send you the fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] I got the fax. I just had some additional questions.
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there ortho benefits on this plan?
[AGENT][NEUTRAL] No, ortho treatment is not covered.
[CUSTOMER][NEUTRAL] OK, and then the the policy number that I gave you is that what I use for the subscriber ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 3 and
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me write that down, hold on.
[CUSTOMER][NEUTRAL] And then the group number I have that 14774 and then what about the um group name?
[AGENT][NEUTRAL] Yes, so it's Universal Trucking.
[CUSTOMER][NEUTRAL] the 3 by 4.
[AGENT][NEUTRAL] [PII], uh, that's [PII] Advantage.
[CUSTOMER][NEUTRAL] OK and then um are implants covered on this plan?
[AGENT][NEUTRAL] No, uh, placement removal and all related implant services are not covered.
[CUSTOMER][NEUTRAL] 60 OK.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And then um is there a waiting period or missing tooth cloths? I saw that on the fax there is a 12 month waiting period, but he's, it shows his effective date is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's correct. Um, so yes, there is a missing teeth clause. Um, major expenses did have a waiting period of 12 months, um, so of course he is well past that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then um peri apicals, do they have a frequency?
[AGENT][NEUTRAL] Um, do you have that, uh, procedure code?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEGATIVE] No, they do not have a frequency.
[CUSTOMER][NEUTRAL] And then um with the 0140, are we allowed to do treatment on the same day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the 2950, is that billable the same day as the 2740?
[AGENT][NEUTRAL] Bear with me just a moment, let me check that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But what do you think about that because you know how I feel.
[CUSTOMER][NEUTRAL] Um, and then the 2740 is that paid on prep date or seat date?
[AGENT][NEUTRAL] Either one.
[CUSTOMER][NEUTRAL] And do you downgrade on the 2740?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And then what about on composite fillings?
[AGENT][POSITIVE] No, no downgrades.
[CUSTOMER][NEUTRAL] And then 1354, is that a covered benefit?
[AGENT][NEGATIVE] That is not.
[CUSTOMER][NEUTRAL] And um 4346, is that covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] The SRP can all 4 quads be done in the same day.
[AGENT][POSITIVE] Yes they can.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And is there a healing period with the 4910 after SRP?
[AGENT][NEUTRAL] 4910.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And um the 9944, is that covered?
[AGENT][NEUTRAL] 9944. No, that is not covered.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] Does this patient have any SRP history like the 43, 4143, 42, or 4910?
[AGENT][NEUTRAL] Let's see, I'm sorry, that was uh 4341 and what was the other one? I'm sorry.
[CUSTOMER][NEUTRAL] 4342 or 4910?
[AGENT][NEUTRAL] Let me check that. Give me just a moment.
[AGENT][NEUTRAL] OK, no, we don't have any history for any of those codes.
[CUSTOMER][NEUTRAL] OK and then what about exam?
[CUSTOMER][NEUTRAL] Any of the exam codes or um like FMX by wings?
[AGENT][NEUTRAL] Sure. So I do see, oh, give me just a moment, let me go back there.
[AGENT][NEUTRAL] So for uh [PII], he did have a 0140.
[AGENT][NEUTRAL] But that was the only thing that he had for that date of service.
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] And that was [PII]?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 0270 was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And 0140 was on [PII].
[AGENT][NEUTRAL] Let me see if I can
[CUSTOMER][NEUTRAL] So he's not eligible for an exam because he's had multiples within the last 12 months.
[AGENT][NEUTRAL] That's 1 per 6 months, yeah, uh, um, yes, let's see.
[AGENT][NEUTRAL] I don't see any, um.
[AGENT][NEUTRAL] FMX though.
[CUSTOMER][NEUTRAL] The 02 10 or the 0330?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] In the past 5 years I guess.
[AGENT][NEUTRAL] Oh, well, let's see. uh 0210, yeah, that was [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then um when was his other you said it was in December the 0140 was also done?
[CUSTOMER][NEUTRAL] 12 something 24 I think you said.
[AGENT][NEUTRAL] Yeah, 0140 he had 1 [PII] of this year and then another 0140 that was uh yeah, [PII].
[CUSTOMER][NEUTRAL] And then um what about remaining benefits for the the calendar year and deductible?
[AGENT][NEUTRAL] Let's take a look.
[CUSTOMER][NEUTRAL] Is this a calendar year plan?
[AGENT][NEUTRAL] Yes, it is calendar year. um, OK, so he has met the $50 deductible and of the benefit he has used $43.20.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Minus 4320 OK and then um.
[CUSTOMER][NEUTRAL] I was trying to figure out oh when was his last cleaning then like uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm, just let me go back to that.
[CUSTOMER][NEUTRAL] Was it within the last 6 months?
[AGENT][NEUTRAL] That was 1110, uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then um and then you said there was one bite wing taken. Does that, does that count as his 1 and 12 months for his bite wing frequency?
[AGENT][NEUTRAL] Let me go back to that. Give me just a moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, that does fall under that, um, so that would be uh 02700272 or 0274, so one of those per 12 month period.
[CUSTOMER][NEUTRAL] OK, and what was that date he last had it?
[AGENT][NEUTRAL] That was uh [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, he's a little dentist goer.
[AGENT][NEUTRAL] He's been busy, I know, taking care of those seats as much as he can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, awesome that's all I need. Can I get a reference number please?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Um so my name is spelled [PII] And was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] That's all.
[AGENT][POSITIVE] Alright, well thanks for calling AK I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank you, bye bye.