AccountId: 011433970860
ContactId: 29b5a827-abcf-4083-8800-e4c82fc77ba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510269 ms
Total Talk Time (AGENT): 158357 ms
Total Talk Time (CUSTOMER): 152656 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/29b5a827-abcf-4083-8800-e4c82fc77ba7_20250109T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling in from Bella Family Dentistry to get the dental benefits of a patient. Please spell your name.
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And could you please repeat your name and I'll also need a little callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. My name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes. It's 02576502.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active. And for a list of all the benefits and the fee schedule, I can fax that over to you. Um, what's your fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually I just need some details over the call itself so let's continue with it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what so is this a calendar year or a benefit year plan?
[AGENT][NEUTRAL] It's a calendar year plan.
[CUSTOMER][NEUTRAL] Group name group, OK, calendar year. Group name is Man analysis and utilization group number 70056.
[AGENT][POSITIVE] Let's see. Yes, that's correct.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] And uh what is the deductible and max for out of network provider on this and how much has the patient used?
[AGENT][NEUTRAL] OK, there is no network. We work with all providers. We cover up to $500 per calendar year and there's a $50 deductible that needs to be met first. And let's see if the patient has used anything yet. One moment.
[AGENT][NEUTRAL] No, all of the benefits are available. None have been used yet this year.
[CUSTOMER][NEUTRAL] OK, $500 is the max and 50 and $150 is the deductible for individual and family.
[AGENT][NEUTRAL] Right, 50 is the deductible for the individual and $150 per family.
[CUSTOMER][NEUTRAL] 150, yes. And total max is 500, 500.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] Nothing has been met and nothing has been used.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And uh what about the major services, are they covered on the policy?
[AGENT][NEUTRAL] Let's see, one moment.
[AGENT][NEUTRAL] No, only basic and restorative.
[CUSTOMER][NEUTRAL] And the basic and preventive and basic are covered at what percentage?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Preventive is um covered at 100%. Basic is covered at 80%.
[CUSTOMER][NEUTRAL] Endo perio oral services.
[AGENT][NEUTRAL] No, I'm not showing any.
[CUSTOMER][NEUTRAL] Not covered, OK. And any history on file for preventive and diagnostic services?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Any history on file for preventive and diagnostic services?
[AGENT][NEUTRAL] Let's see, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, I'm not showing any claims on file for him actually.
[CUSTOMER][NEUTRAL] No, FMX [PII] also.
[AGENT][NEUTRAL] Right, there are no claims on file. He hasn't used his benefits.
[CUSTOMER][NEUTRAL] OK, no benefits are used. And what are the uh basic services that are covered? Can you take me through that?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So is this is the 2391 covered the posterior com the com fillings?
[AGENT][NEUTRAL] You said 2391?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it is covered.
[CUSTOMER][NEUTRAL] Any frequency?
[AGENT][NEUTRAL] No, I'm not showing any.
[CUSTOMER][NEUTRAL] No frequency 80%. OK. And downgrade is allowed?
[AGENT][NEUTRAL] Yes. And actually for the frequency, I'm showing a maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] 1 for 24 months, 80%.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, 80% and downgrade is allowed, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] From post your composite to amalgam.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And uh 9243, is that covered?
[CUSTOMER][NEUTRAL] The anesthesia, IV sedation.
[AGENT][NEUTRAL] Right, I'm waiting on my system. You said 9243?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, I'm not showing that on the fee schedule.
[CUSTOMER][NEUTRAL] Not covered. Any other any other pro pro uh the basic service that is covered?
[AGENT][NEUTRAL] Any other basic services?
[CUSTOMER][NEUTRAL] Yes, that is covered.
[AGENT][NEUTRAL] Yes, what, um, what's the code? There's several of them. What code?
[CUSTOMER][NEUTRAL] Can you, can you take me through that?
[AGENT][NEUTRAL] Would you like for me to look up?
[AGENT][NEUTRAL] There is, let's see.
[AGENT][NEUTRAL] There's about 40 of them. Like I said, I can fax the fee schedule to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Don't worry, don't worry, don't worry.
[CUSTOMER][NEUTRAL] Most of the services are not covered. I see here in my records, so.
[CUSTOMER][NEUTRAL] So, uh, I was just wanted to check, uh, Peru is not part of that, right? You already mentioned and the peri-oral is not covered, so that is we can leave that, uh.
[CUSTOMER][NEUTRAL] Um, and for for occasion guards, 9944 is not covered.
[AGENT][NEUTRAL] 9940.
[CUSTOMER][NEUTRAL] 44.
[AGENT][NEUTRAL] 9944, let's see.
[AGENT][NEGATIVE] Right, that's not covered, that's not coming up on the list.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, I'm not showing that one either.
[CUSTOMER][NEUTRAL] The reference number for this call?
[AGENT][NEUTRAL] So the reference number, you can use my name and today's date. My name is [PII] um it's spelled [PII] and my last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Oh, that would be thank you and have a nice day. Bye-bye.
[AGENT][NEUTRAL] You do the same and over. Thank you for calling IPL. bye.