AccountId: 011433970860
ContactId: 208f5967-8138-4f0c-a553-1419a35ca26b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 824729 ms
Total Talk Time (AGENT): 293407 ms
Total Talk Time (CUSTOMER): 211960 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/208f5967-8138-4f0c-a553-1419a35ca26b_20250116T14:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental provider's office. I need to see if my patient's plan is active, please.
[AGENT][NEUTRAL] Yeah, sure, I can assist you with the eligibility, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK, the ID number um she gave is 02494791.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] What is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII] and it's [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right, and you just need eligibility today?
[CUSTOMER][NEUTRAL] Yeah, she's a new patient coming to us so I wasn't sure how this insurance worked or if we were actually in network with it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. Um, well, Ms. [PII], this particular policy doesn't have a network that can visit any dentist. Um, the effective date of the policy is [PII], and it is active at the moment. Do you need a tax, um, breakdown of, of benefits?
[CUSTOMER][NEUTRAL] Yeah, I would need um pretty much everything um the group number, the group name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I need like maximum deductible, all that stuff.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, sure, yes, I can give you that information. And um I'm gonna give you the group number and the name of the group um by phone because you don't have those in the fax bag. Everything else should be on that fax bag if you want me to send it, OK? Um, OK. All right. What is the fax number?
[CUSTOMER][POSITIVE] Oh yeah yeah that would be great.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII]. Um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's fine, that's fine.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. OK, I went ahead and send that over to you. Should be there in a few minutes. Um, let me go ahead and give you the group name and group number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready, go ahead.
[AGENT][NEUTRAL] All right, so the group number is 19863.
[AGENT][NEUTRAL] The group name is Universal Trucking Blair Logistics.
[CUSTOMER][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] B L A I R.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] They are logistics.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, and is the husband the policy holder [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, and his birthday you have [PII]?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me check on that for one moment.
[CUSTOMER][NEUTRAL] Just making sure that he's the the policy holder.
[AGENT][NEUTRAL] [PII]. Yes, that is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, alright and then um I just need like what the maximum is the deductible and then the categories prevented basic and major.
[AGENT][NEUTRAL] OK, right, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. The calendar year maximum is 1500 per cover insured.
[AGENT][NEUTRAL] Um, there is a $50 deductible per person, and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, preventative start cover 100% of usual and customary rates, UCR, um, radiograph FMX is 80%, basic expense and basic restorative is 80%. And then we have a major expense including endodontics, periodontics, prosthodontic repair, and oral surgery. They all cover at 40% after a 12 month waiting period. So it looks like the waiting period, 40, 40.
[CUSTOMER][NEUTRAL] 40 you said 4040? OK, OK.
[AGENT][NEUTRAL] Yes, 40. Yes, and it's gonna be, uh, it's OK. The waiting period is gonna be um done on [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um, is that for basic and major or just major?
[AGENT][NEUTRAL] That's gonna be just for major including endodontics and periodontics.
[CUSTOMER][NEUTRAL] OK, alright, um, is there a missing tooth clause?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is one, yes.
[CUSTOMER][NEUTRAL] OK, um, um, for the X-rays, I know the pan and the FMX are at 80. Do you know if PA's, uh, the 0220, um, the perapical X-rays, are those also at 80?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 0220 or 0230?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, those two are under basic expense, which he's aiding.
[CUSTOMER][NEUTRAL] So they are [PII]. OK, so PAs, yeah, so most of the time when the pan or FMX usually they are too. I just wanted to make sure, um, do you guys downgrade fillings or crayons?
[AGENT][POSITIVE] Mhm, correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, we don't downgrade.
[CUSTOMER][NEUTRAL] No, OK, um, and then I need to see um if what the claims address and the payer ID is.
[AGENT][NEUTRAL] OK, sure, yes, and that's also on the fax but but I can give you that information. Um, the address is um [PII] or [PII] and that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] City
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] I'm sorry. Yes. [PII].
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] [PII] OK and then your payer ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, excuse me. I'm sorry, I was gonna see, OK. The electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, my last question is, um, because she's um in actually in the office right now and they're waiting for me um is she eligible for a limited exam, a PA or a PA? Is she eligible for those? The limited exam is 0140.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check our history, bear with me.
[AGENT][NEUTRAL] Mm, OK. So it looks like on the last exam I got here is a 150 and it was on [PII]. The exams are gonna be, let's see, 2 for 12 month period.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and the, the limited exam is, is that include I guess it's included with the regular exams?
[AGENT][NEUTRAL] So she has only had one, so yeah. Mhm.
[AGENT][NEUTRAL] Um, let me, let me check.
[CUSTOMER][NEUTRAL] This the the limited one sometimes it's separate the 0140.
[AGENT][NEUTRAL] OK, let me double check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Evaluation, they are together it's a combination of 120, 140, 150, 160 or 180.
[CUSTOMER][NEUTRAL] OK, and you said the last one was [PII]/27 24, but has she had anything before that? Is she eligible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, um, that's the only one I have here, so yes, she's eligible because it's 2, yes, right.
[CUSTOMER][NEUTRAL] That's the only one OK.
[CUSTOMER][NEUTRAL] OK, um, is there a limit on the PAs, the 0220? Is there a limit of how many, um, like sometimes you only could do 4 in a year or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check on that one.
[AGENT][NEUTRAL] Uh, that is
[AGENT][NEUTRAL] OK, so that one doesn't have any limitations now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the pan the 0330.
[AGENT][NEUTRAL] She has had a pen. So that one was on [PII], and that was, that one is every 5 years. So no, she don't qualify for that one.
[CUSTOMER][POSITIVE] OK awesome all right thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] All right, I think you've answered all my questions. All I need is a reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yes, just the spelling of your name, please.
[AGENT][NEUTRAL] Sure. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] OK, well thank you so much for going over everything with me. I really appreciate your help you have a great day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome.