AccountId: 011433970860
ContactId: 29b3dcf6-c6d8-4d85-8c41-5c31ccff7e07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440459 ms
Total Talk Time (AGENT): 142166 ms
Total Talk Time (CUSTOMER): 191440 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/29b3dcf6-c6d8-4d85-8c41-5c31ccff7e07_20250210T22:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I just wanna check benefits and ability of a patient, please.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you and Ms. [PII], what is the policy number?
[CUSTOMER][NEUTRAL] 19735566. I don't know if this is the policy or the member ID.
[AGENT][NEUTRAL] Um, it's too many numbers. What's the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Oh, the name is [PII]. I'll spell it for you. [PII], that's the first name. Last name is [PII].
[CUSTOMER][NEUTRAL] I have another number in here just in case this one's shorter.
[AGENT][NEUTRAL] OK. What's that number?
[CUSTOMER][NEUTRAL] 615341.
[AGENT][NEUTRAL] I don't know what that number is. Let me look by the name. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, that is the number 615341, as I'm showing as the policy number. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth. Oh, you're giving me the name, verify the date of birth.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, and this is for dental, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, uh, [PII], fix the date of [PII], policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, for this plan, uh, hold on, is this a PPO plan?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] They can go to any, we'll accept any claim from any dental provider. They don't need to specifically go to a preferred dental provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see, um, can you help me with the annual maximum and deductible?
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1000 per calendar year, and they have a $50 deductible that applies to everything but the exam and profy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it, thank you. Um, is there an RSL coverage in this plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there a what?
[CUSTOMER][NEUTRAL] Oh, Ortho.
[AGENT][NEUTRAL] Ortho is not covered under the plan.
[CUSTOMER][NEUTRAL] Got it, thank you. Um, can you verify if diagnostic and preventive covered that 100% restorative, I mean they.
[AGENT][NEUTRAL] It pays based on a, it pays based on a policy fee schedule, it doesn't pay by UCR.
[CUSTOMER][NEUTRAL] Oh, and if I'm not mistaken, does it follow the Carrington feey show?
[AGENT][NEUTRAL] No, it pays by their policy fee schedule with our company.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] What about frequencies? Would you be able to help me with the frequencies?
[AGENT][NEUTRAL] Sure, exam exam bite wings and
[AGENT][NEUTRAL] Profies are once every 6 months. Give me a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, pant a full mouth every 3 years and replacement clauses every 5.
[CUSTOMER][NEUTRAL] This OK.
[CUSTOMER][NEUTRAL] What about the um SRP?
[AGENT][NEUTRAL] Um, SRP is once every 12 months.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Fillings, what about fillings 2391?
[AGENT][MIXED] Fillings are what, well, I really don't have it, but we, well, there's no frequency for fillings.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, but is there a downgrade?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] Alright, what about for accounts? Is there a downgrade for accounts?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] For crowns.
[AGENT][POSITIVE] No, there's no downgrades, whether for crowns or fillings.
[CUSTOMER][NEGATIVE] Downgrade.
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][NEUTRAL] Um, for going back to 4341, how many quadrants are allowed per visit?
[AGENT][NEUTRAL] All 4.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][NEUTRAL] Um, those 4910 share the same frequency with bothy.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It's once every 3 months.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, got it. One second.
[CUSTOMER][NEUTRAL] And how long after 4341 can we do 4910?
[AGENT][NEUTRAL] Uh, there's not a time limit or frequency.
[CUSTOMER][NEUTRAL] Got it. Following days, OK. Um, what about bone graft 7953? Can you please check if it's covered?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] We're about 9944.
[AGENT][NEUTRAL] Is that for a loser guard?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, it's covered it once every 6, I'm sorry, once every 24 months.
[CUSTOMER][NEUTRAL] And is it for only?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. No worries. So, there's implants coverage, right, every 5 years as well?
[AGENT][NEUTRAL] No, implants are implant crowns are not covered under the policy.
[CUSTOMER][NEUTRAL] Oh, it's not covered.
[CUSTOMER][NEUTRAL] That's right. Got it. Let me go ahead and take a look if I missed um anything. One moment.
[CUSTOMER][NEUTRAL] Oh, I think I've got it all covered in here since there's no, I mean, it's not based on UCRP. Can I just have a call reference number and if you can check if there's any history on file I'm sorry.
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. You may use my name in today's date and what history are you needing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, any history that might affect the next service, let's say panoramic X-ray.
[AGENT][NEUTRAL] 01 moment.
[AGENT][NEUTRAL] Um, the only thing I see that uh would affect frequency is for a full mouth.
[CUSTOMER][NEUTRAL] Alright, can I have the date?
[AGENT][NEUTRAL] For FMX.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I see, I think I've got it all covered. [PII]. Thank you so much for your time. You have a wonderful day.