AccountId: 011433970860
ContactId: 28358bae-c807-4d91-8fde-92a4dc8f39b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 936520 ms
Total Talk Time (AGENT): 266690 ms
Total Talk Time (CUSTOMER): 301306 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/28358bae-c807-4d91-8fde-92a4dc8f39b7_20250422T22:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling on behalf of the dental office and uh I'm looking for dental benefits for 3 patients on a recorded line. Can you please help me with that?
[AGENT][NEUTRAL] I'm happy to check on benefits [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, sure. That is 01979122. And sure, can you please spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it, thank you so much for that.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. So, patient is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK. And uh [PII], can you please help me with the uh network status of my provider? I'm not sure if the provider is a network or not.
[AGENT][NEUTRAL] Uh, in-network provider is not required for usage. Uh, the plan does participate in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Carrington. OK, got it. Thank you for that. And uh can you please help me with the group name of this patient's plan?
[AGENT][NEUTRAL] Group name is Universal Trucking.
[CUSTOMER][NEUTRAL] OK. And the group number, please?
[AGENT][NEUTRAL] 13611.
[CUSTOMER][POSITIVE] 3611 got it. Thank you for that.
[CUSTOMER][NEUTRAL] And uh is this a calendar year policy?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. And the coordination of benefits would be standard or not you?
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] OK. And now, can you please help me with the maximum and deductibles?
[AGENT][NEUTRAL] Calendar year maximum is $1500 per covered insured with a calendar year deductible of $50 up to $150 per family.
[CUSTOMER][NEUTRAL] OK. And anything you from that yet?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, looks like the patient has used $628.60. That leaves the remaining balance for the year at $871.40.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The deductibles met already?
[AGENT][NEUTRAL] Yes, deductible has been met.
[CUSTOMER][NEUTRAL] OK. Got it. And do we have a missing tooth loss on the plant?
[AGENT][NEGATIVE] And this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how about Arthur?
[AGENT][NEUTRAL] No ortho.
[CUSTOMER][NEUTRAL] Hm, I see.
[CUSTOMER][NEUTRAL] All right. And can you please help me with the co-insurances for diagnostics, preventive, basic and major?
[AGENT][NEUTRAL] Preventatives covered at 100% of UCR. Basic and FMX are at 80%.
[AGENT][NEUTRAL] Major endopperio and oral surgery are gonna be at 40%.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] All right. And uh do you see any history for this patient that would affect the frequencies?
[AGENT][NEUTRAL] Yeah one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, looks like the last oral evaluation the patient had along with bite wings was Data Service 12825.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I in my right wings.
[AGENT][NEUTRAL] Aside from that, I don't see anything that would affect frequency.
[CUSTOMER][NEUTRAL] And do you see anything for the FMS in past 5 years?
[AGENT][NEUTRAL] Uh, let's see one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Looks like their last FMX was 7224.
[CUSTOMER][NEUTRAL] OK, 724.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 72.
[CUSTOMER][NEUTRAL] On the FMX and Penno, they both share frequencies, right?
[AGENT][NEUTRAL] Oh let me see here what's next.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So for this patient,
[CUSTOMER][NEUTRAL] And also, I'm sorry. Do you see anything for the SRP in the past 24 months?
[AGENT][NEUTRAL] Do not.
[CUSTOMER][NEUTRAL] Perfect. OK. So for this patient, uh, that will be all. I would need a reference number, please.
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK. Can you please move to our next patient then?
[AGENT][NEUTRAL] I need to notate this patient and then I can check another 11 moment.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][NEUTRAL] The next policy number?
[CUSTOMER][NEUTRAL] That is 0244.
[CUSTOMER][NEUTRAL] 1159.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] You should do [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient is active, effective date [PII].
[CUSTOMER][NEUTRAL] OK. And is this station under the same uh employer, Universal uh trucking?
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And what's the group number?
[AGENT][NEUTRAL] 15844.
[CUSTOMER][POSITIVE] Got it. Thank you.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Now, please help me with the maximums and deductibles.
[AGENT][NEUTRAL] Calendar maximum is $1500 with a $50 deductible. The patient still has her $50 deductible remaining, also the full amount for the year of $1500.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Do you see any history that would affect the frequencies?
[AGENT][NEUTRAL] Let's take a look.
[AGENT][NEUTRAL] Last date of service on file for this patient is [PII]. A patient had bite wings and a cleaning.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] That's the only dates of service that I see on file that would affect any frequency.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] And anything for the FMX and Pao in the past 5 years?
[AGENT][NEUTRAL] Not that I see.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK. And on this plan, I would need your help with uh
[CUSTOMER][NEUTRAL] The percentage for the FMX.
[CUSTOMER][NEUTRAL] Is it again uh 80%?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. And what's the frequency for the cleaning, 1110.
[AGENT][NEUTRAL] 11:10, 1 moment.
[AGENT][NEUTRAL] It's a maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this patient is eligible now.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh do we have age limit for fluoride and sealants?
[AGENT][NEUTRAL] Uh, yes, so let's see.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] Fluoride is limited to dependent children under the age of [PII]. It is a maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then sealants are also limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK. I got that.
[CUSTOMER][NEUTRAL] OK. So that would be all for this one as well. Give me one quick moment. Let me save this one. And then we will move to our last patient.
[CUSTOMER][POSITIVE] I'm ready when you are.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, proceed with the next when you're ready.
[CUSTOMER][NEUTRAL] That is 026-03672.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient is active. Effective date on here is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And uh what is the group name?
[AGENT][NEUTRAL] Group name is ATC Healthcare. That's A as in apple, T as in Tango, C as in Charlie, Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] ATC Healthcare Services Limited, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And the group number, please?
[AGENT][NEUTRAL] 70069
[CUSTOMER][NEUTRAL] 10064. All right.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Is this going to be a calendar year plan?
[AGENT][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] OK. And how, please help me with the maximums and deductibles, ma'am?
[AGENT][NEUTRAL] Calendar year maximum on this plan is 500 per covered insured.
[AGENT][NEUTRAL] With a calendar year deductible of $50 per covered insured.
[AGENT][NEUTRAL] Patients still have their yearly deductible and calendar year max remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So, nothing used. So there should be no history as well, right?
[AGENT][NEUTRAL] Uh, let me just double check that.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK. And do you see a missing tooth loss on the plan?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] This policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, please help me with the coinsurances for diagnostics, preventive, basic, and major.
[AGENT][NEUTRAL] Patient's plan has preventative covered at 100% of allowable. FMX and Basic are covered at 80%.
[AGENT][NEGATIVE] Patient does not have any sort of major coverage on here.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][MIXED] OK, no major coverage.
[CUSTOMER][NEUTRAL] OK. So, but endoperio and oral surgery are under the basic, right?
[AGENT][NEGATIVE] No, incorrect. Those are considered major and they're not covered.
[CUSTOMER][NEUTRAL] OK, not the word.
[CUSTOMER][POSITIVE] And the oral. OK. Got it. Thank you for that.
[CUSTOMER][NEUTRAL] And um OK one moment please hold on.
[CUSTOMER][NEGATIVE] Implants are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or as well is not considered, right?
[AGENT][NEUTRAL] Correct. Ortho coverage, not covered.
[CUSTOMER][NEUTRAL] OK. And uh can you please check the uh procedure code 9310?
[CUSTOMER][NEUTRAL] Is it a covered benefit?
[AGENT][NEUTRAL] 9310 is covered under basic.
[CUSTOMER][NEUTRAL] And uh do you see an A frequency limitation on the same?
[CUSTOMER][NEGATIVE] My return
[AGENT][NEUTRAL] No frequency limitation.
[CUSTOMER][POSITIVE] OK, perfect. All right. So, um, so that would be all for this patient as well. I'm done with all the questions and really appreciate your help. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too have a wonderful day bye bye.
[AGENT][NEUTRAL] Bye bye.