AccountId: 011433970860
ContactId: 2ab7cdb4-7b09-4ffa-a924-aad4d3e82649
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1522339 ms
Total Talk Time (AGENT): 548262 ms
Total Talk Time (CUSTOMER): 750525 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/2ab7cdb4-7b09-4ffa-a924-aad4d3e82649_20250113T20:51_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, this is [PII] from Proactive Dental. I'm calling for the patient [PII], um, to get a breakdown of the benefits.
[AGENT][POSITIVE] You know, I can certainly help with benefits. What is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It might begin with a 01 or 02.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See, uh, group number is what I want to confirm.
[AGENT][NEUTRAL] OK, and what, what numbers do you have there on his, do you have his card there with you or?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh yeah, the group number what I see here on my system is 24702.
[AGENT][NEUTRAL] 24702. OK, thank you. And I'm sorry, you said the insured's name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Thank you. I can look that up and uh
[AGENT][NEUTRAL] Is this for, is this for medical or is it for dental?
[CUSTOMER][NEUTRAL] Del Dental.
[AGENT][NEUTRAL] OK, thank you. And if you could just um give me his date of birth and uh a phone number in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, date of birth is [PII].
[AGENT][NEUTRAL] And is there a phone number um that I could have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. His policy went into effect on [PII]. It is active. His policy number is 02.
[AGENT][NEUTRAL] 46
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0689. Now, you mentioned, yes, uh-huh.
[CUSTOMER][NEUTRAL] So yeah, so the policy number is the same as the group number?
[AGENT][NEUTRAL] Um, the, uh, the policy, uh, let's see, the group number for this is 24702.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the policy number is 02.
[AGENT][NEUTRAL] 460689.
[CUSTOMER][NEUTRAL] 02460689 once again um.
[AGENT][NEUTRAL] And that went into effect
[AGENT][NEUTRAL] Yes, and it went into effect on [PII].
[CUSTOMER][NEUTRAL] Yeah, just one moment 0246 0689.
[CUSTOMER][NEUTRAL] OK and um can I get the um he is the subscriber, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK date of date of birth.
[CUSTOMER][NEUTRAL] Is [PII] group name?
[AGENT][NEUTRAL] Uh, let's see. The group name for this is um,
[AGENT][NEUTRAL] Uh, just waiting for that to come up, sorry.
[AGENT][NEUTRAL] It's universal tracking.
[AGENT][NEUTRAL] Open force.
[AGENT][NEUTRAL] Universal trucking open force.
[CUSTOMER][NEUTRAL] OK, that's the uh it says group OK.
[CUSTOMER][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] Open source.
[CUSTOMER][MIXED] OK no good plan OK.
[CUSTOMER][NEUTRAL] Um, can I get the ID of the subscriber ID?
[AGENT][NEUTRAL] The, the subscriber ID is 0246.
[AGENT][NEUTRAL] 06889 number.
[CUSTOMER][NEUTRAL] Oh, that's the same as the policy number.
[AGENT][POSITIVE] Right, that that's correct. That's, that's what we use as a subscriber number.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um, the insurance name is American Public Life.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And the telephone number to reach you is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And the claims address?
[AGENT][NEUTRAL] Our claims address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And our zip code
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 24-8950 payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Yeah and I need the group number.
[AGENT][NEUTRAL] OK, the, the group, yeah, the group number for the policy is 24702.
[CUSTOMER][NEUTRAL] So you said yeah.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, yeah, I've got that same.
[CUSTOMER][NEUTRAL] Alright um.
[CUSTOMER][NEUTRAL] 24702 OK and it's effective date you said March?
[AGENT][NEUTRAL] The [PII] [PII].
[CUSTOMER][NEUTRAL] OK, and it's for the calendar year?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and missing tooth cloth is applied?
[AGENT][NEUTRAL] There is a missing tooth cloth, that is correct.
[CUSTOMER][NEUTRAL] OK, um, is there any, uh, anything for the missing tooth cloth in specifications?
[AGENT][NEUTRAL] No, no, there's not.
[CUSTOMER][NEUTRAL] Nothing. OK, bathing period?
[AGENT][NEUTRAL] There is a 12-month waiting period that will, um, uh, be met on [PII].
[CUSTOMER][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] Waiting period.
[CUSTOMER][NEUTRAL] And that'll that'll be met on [PII].
[AGENT][POSITIVE] This of this year, that's correct.
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] OK, Plan Max.
[AGENT][NEUTRAL] It's $1500 per calendar year and that's just a verification of the benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] How much? $50,000.
[AGENT][NEUTRAL] Uh, no, no, uh.
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] 1,
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] $500.
[AGENT][NEUTRAL] Yes, uh-huh, yes.
[CUSTOMER][NEUTRAL] 1500 OK, used to, uh, how much is used until today?
[AGENT][NEUTRAL] Uh, nothing has been used for the calendar year [PII].
[CUSTOMER][NEUTRAL] OK, and here for waiting period it says previous basic and major.
[AGENT][NEUTRAL] Yes, the preventative, basic, and major, uh, yeah, the.
[CUSTOMER][NEUTRAL] Uh, yeah, preventative basic images.
[AGENT][NEUTRAL] Yeah, preventative, basic and basic restorative are available now. The, uh, the, uh, major services will be available [PII].
[CUSTOMER][NEUTRAL] OK, so the waiting period is applies for the major basically.
[AGENT][POSITIVE] That's right, yes.
[CUSTOMER][NEUTRAL] OK, I'll circle mea.
[CUSTOMER][NEUTRAL] Then and uh the plan maximum the benefits um oh.
[CUSTOMER][NEUTRAL] 1500.
[AGENT][POSITIVE] Now I have a fence that I can.
[CUSTOMER][NEUTRAL] It's available only.
[AGENT][NEUTRAL] Yeah, I'm sorry, please go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's, it's for the employee only the employees, the spouse, dependents, uh.
[AGENT][NEUTRAL] Uh, this is a family plan. Yeah, this is for family.
[CUSTOMER][NEUTRAL] Employee and family OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I do have a fax so I can send to you if you'd be interested.
[CUSTOMER][NEUTRAL] Um, yeah, I have, I've got the fax, but, uh, I just wanted to verify, um, for the percentage.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The percentage is uh preventative is at 100% of UCR. The basic and basic restorative are at 80%, and once the major services are available, there'll be 40% of the um UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, diagnostic?
[AGENT][NEUTRAL] Uh, that would be, that would be 80% of the, of the UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, or.
[AGENT][NEGATIVE] There's no orthodontic coverage on these policies.
[CUSTOMER][NEUTRAL] OK, and do.
[CUSTOMER][NEUTRAL] And it was 40%.
[AGENT][NEUTRAL] Yes, that, that would be considered a major service.
[CUSTOMER][NEUTRAL] OK, OK, and Peru?
[AGENT][NEUTRAL] Um, that would be covered at 40%.
[CUSTOMER][NEUTRAL] Oral surgery is also 40 years major.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Dental and.
[CUSTOMER][NEUTRAL] Age limit for auto uh you don't have there's no coverage so it doesn't apply.
[AGENT][POSITIVE] That, that's right.
[CUSTOMER][NEUTRAL] And um no banding I don't have to ask about that retainers, nothing like that and Invisalign.
[AGENT][NEUTRAL] Uh, no, that's not covered either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then uh I wanted the frequencies for the exam.
[CUSTOMER][NEUTRAL] Um, how many?
[AGENT][NEUTRAL] Uh, all of the exams, um,
[CUSTOMER][NEGATIVE] What a freak
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Or 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is there anything else that
[CUSTOMER][NEUTRAL] Does the limited 0140 share the same frequency?
[AGENT][NEUTRAL] Uh yes, it does.
[CUSTOMER][NEUTRAL] That's the pro fee, yes, and that's uh same as like 2 for 2 for 12 months.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, pro fee.
[AGENT][NEUTRAL] And the cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] Once in 6 months, OK.
[CUSTOMER][NEUTRAL] By wings.
[CUSTOMER][NEUTRAL] My heart rate was like
[AGENT][NEUTRAL] The bright wings are once every 12 month period.
[CUSTOMER][NEUTRAL] OK, and for child, is there anything specific for a child?
[AGENT][NEUTRAL] No, that it would be the same.
[CUSTOMER][NEUTRAL] Same, OK, FMX and panel.
[AGENT][NEUTRAL] That's once every 5 years.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] PA.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That, uh, do you have a, um,
[AGENT][NEUTRAL] A number for a uh CPT code for that or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know the code.
[CUSTOMER][NEUTRAL] To the exam by doing onemo is.
[CUSTOMER][NEUTRAL] The M and panel once in 5 years you said um PA I don't see it in the fax um.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Code for the CAA.
[CUSTOMER][NEUTRAL] 022 200,220 sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that is.
[CUSTOMER][NEUTRAL] It's not there in the fax, mhm.
[AGENT][NEUTRAL] Um, yeah, it should be under basic services, and there's no frequency for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] So 80+ OK but uh what is no frequency, right.
[CUSTOMER][NEUTRAL] Then fluoride.
[AGENT][NEUTRAL] The uh fluoride, right, that it, which is also in the facts. Now, that is covered uh for a child, um, that is [PII] and under and uh that is, um, uh, the coverage for that is uh limited uh to one procedure for 12 months. Uh, for adults, it's uh [PII] and under and then sealants are 14 and under and that's once every 36 months. Sure.
[CUSTOMER][NEUTRAL] I don't see the fluoride in the fact.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look at
[CUSTOMER][NEUTRAL] One moment, just a moment, so you said fluoride, uh, age limit is 14 and under, and adults also for children, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For children.
[AGENT][NEUTRAL] Yes, for, yeah, for children, it's, it's [PII] and under and for adults, it's [PII] and under.
[CUSTOMER][NEUTRAL] [PII] and under, OK, so both, OK, and uh the frequency is the same once in 12 months for both.
[AGENT][POSITIVE] Right, that's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, how about ceilings.
[AGENT][NEUTRAL] The sealants are for patients 14 and under and that's once every 36 months.
[CUSTOMER][NEUTRAL] 36 months.
[CUSTOMER][NEUTRAL] 14 and then under OK and for molars or premolars, how is it molars and pre-molars.
[AGENT][NEUTRAL] Uh, it would just be permanent molars. That's.
[CUSTOMER][NEUTRAL] Only the molas OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and 2391 fillings.
[AGENT][NEUTRAL] The um fillings are covered uh at um
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] 80% and the frequency on that, see if I can get that.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The frequency for the fillings, that is uh
[CUSTOMER][NEUTRAL] So I said
[AGENT][NEUTRAL] A replacement of existing only in place for 24 months and 1.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 2 for 24 months.
[CUSTOMER][NEUTRAL] New filling is 1 for 24 months, is it?
[AGENT][POSITIVE] That's correct. That's correct.
[CUSTOMER][NEUTRAL] And if it is replacement?
[AGENT][NEUTRAL] It's only if it's been in place for 24 months.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Sorry? I didn't get that.
[AGENT][NEGATIVE] The replacement is only if the existing moller had been in place for 24 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, so otherwise they need to be there that long.
[CUSTOMER][NEUTRAL] OK, the existing has to be there for 24 months. Only then it is covered, uh, yeah, the replacement is covered and the replacement is one filling in 24 months. Is that correct?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's that's correct.
[CUSTOMER][NEUTRAL] Well that's too low, isn't it?
[AGENT][NEUTRAL] Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 1 in 1 2nd, 24 months, so 80% and 1 in 24 months, OK, uh, downgrading.
[AGENT][NEUTRAL] Uh, no, they don't downgrade to amalgam.
[CUSTOMER][NEGATIVE] Oh OK, no download and uh um the fillings are for the molars only or premolar and molar.
[AGENT][NEUTRAL] Maybe for the molars.
[CUSTOMER][NEUTRAL] Only for the molas, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] One second ma'am replacement.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 24 months.
[CUSTOMER][NEUTRAL] OK, then SRP?
[CUSTOMER][NEUTRAL] She knows where her phone is.
[AGENT][NEUTRAL] Uh, that is, um, once every 24 months.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] And frequency?
[CUSTOMER][NEUTRAL] Oh yeah, 124 months, and what is the percentage? It's a basic or major like?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh that let's see, let me just check.
[AGENT][NEUTRAL] That is um listed at a major.
[CUSTOMER][NEUTRAL] So that's uh 40%?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] And uh all 4 quads on the same day, OK?
[AGENT][NEUTRAL] Yes, as long as the patient has available benefits and their policy is active, then yes. All 4 quads can be done.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and main pay maintenance?
[AGENT][NEUTRAL] That shares the same frequency as the as the cleaning and that is uh 40%.
[CUSTOMER][NEUTRAL] Percentage
[CUSTOMER][NEUTRAL] 124 months.
[CUSTOMER][NEUTRAL] As cleaning that's 1 in 6 months?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Um, in 6 months.
[CUSTOMER][NEUTRAL] Um, it's either or or or combined in addition, how was it?
[AGENT][NEUTRAL] It's it's either or, yeah.
[CUSTOMER][NEUTRAL] In addition to profit.
[CUSTOMER][NEUTRAL] either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, the veneers.
[AGENT][NEGATIVE] Oh, those are not covered.
[CUSTOMER][NEUTRAL] Uh, the 2962 not covered, OK.
[AGENT][NEUTRAL] Uh, yeah, the nerds aren't covered.
[CUSTOMER][NEGATIVE] Not covered on this.
[CUSTOMER][NEUTRAL] Basic.
[AGENT][NEGATIVE] No, uh, the veneers, veneers, um, are not, are not covered, so the veneers are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On on lease.
[CUSTOMER][NEUTRAL] Only a major?
[AGENT][NEUTRAL] Um, OK, you're talking about the veneers on the teeth that it's like cosmetic den.
[CUSTOMER][NEUTRAL] No, no, on, on crowns.
[AGENT][NEUTRAL] Uh, oh, OK, OK. So, uh, crowns, the crowns bridges, um, those, uh, those are covered at 40%, and, uh, those are, um, once every 7 years.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 7 years, OK, OK, and uh downgraded?
[AGENT][NEGATIVE] And no, they're not.
[CUSTOMER][NEUTRAL] No, they're not downgraded. OK, is there a code or something?
[AGENT][NEUTRAL] Well, there, there are multiple codes for them. I mean, um, is there anything in particular that we're looking for, uh, um.
[AGENT][NEUTRAL] A resin with a noble metal, uh, porcelain ceramic, um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Poland posting and posting ceramic 2740.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Uh, that, um, now that, that is covered at 40% and the frequencies on that, um, that's a maximum of 1 for 7 years and it's limited to patients 16 and over.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh right so that's for.
[CUSTOMER][NEUTRAL] OK, I need to write that.
[CUSTOMER][NEUTRAL] Limited to patient 16 and.
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right, um
[CUSTOMER][NEUTRAL] Seed crown rap and seat.
[AGENT][NEUTRAL] Uh, that's, it's paid on either day.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] That it's paid on either the prep or receipt date. It's either of those two days.
[CUSTOMER][NEUTRAL] OK, so it's paid, OK.
[CUSTOMER][NEUTRAL] OK. How about the build up?
[AGENT][NEUTRAL] Is there a code that
[CUSTOMER][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] but it's.
[AGENT][NEUTRAL] OK, that is uh at 40%.
[AGENT][NEUTRAL] Um, that is a maximum of 1 for 7-year period and limited to patients [PII] and older.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] up
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, we do have a fax that we can send to you if you would be interested.
[CUSTOMER][NEUTRAL] OK, same
[CUSTOMER][NEUTRAL] Yeah, I have, I have a fax, but you know a fax doesn't have all the details like so many things that you told me.
[CUSTOMER][NEUTRAL] Um, and is the crown build up covered on the same day of the crown correct?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] Um, how about gingerectomy?
[AGENT][NEUTRAL] Is there a code that I can look up?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have uh periodontal expenses. Now, I do have uh code 4210 and 4211. Uh those are covered at 40% and the frequent.
[CUSTOMER][NEUTRAL] That's gingerectomy.
[AGENT][NEUTRAL] Uh yes, those are the two codes that I have and it's 1 each quadrant for 24 months at 40%.
[CUSTOMER][NEUTRAL] Yeah, ginger to me uh 4211 and 4210, yeah, so that is.
[CUSTOMER][NEUTRAL] So what did you say? um that what is the percentage?
[AGENT][NEUTRAL] It's covered at 40, 40%.
[CUSTOMER][NEUTRAL] 40%, OK.
[AGENT][NEUTRAL] And it's the maximum.
[CUSTOMER][NEUTRAL] And frequency?
[AGENT][NEUTRAL] Of one each quadrant.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] For 24 months.
[CUSTOMER][NEUTRAL] 24 months OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, crown lengthening.
[AGENT][NEUTRAL] Is there a, a code that uh for that?
[CUSTOMER][NEUTRAL] 39.
[CUSTOMER][NEUTRAL] It comes under surgery I guess might come under surgery.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yeah, clinical crown lengthening heart tissue, it's 4249.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, still checking.
[AGENT][NEUTRAL] OK, that is uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At 40% and it's once for 24 months.
[CUSTOMER][NEUTRAL] Once in 24 months, OK.
[CUSTOMER][NEUTRAL] Uh, implants.
[AGENT][NEGATIVE] Uh, the implants are not covered.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] But, uh, I mean that is not covered. How about the crown the crown for implants?
[AGENT][NEUTRAL] The, the crowns are covered at once every 7 years, um, but those are at 40%, but, uh, but they're, but if they're, we're talking about implants, they aren't covered at all.
[CUSTOMER][POSITIVE] But I definitely.
[CUSTOMER][NEUTRAL] The uh crowns for the implants.
[AGENT][NEGATIVE] The, the crowns are covered, but the implants are not.
[CUSTOMER][NEUTRAL] OK, so the crown is for the implants is the same as the regular crowns on the tooth.
[AGENT][POSITIVE] Right, that's right.
[CUSTOMER][NEUTRAL] Yeah, uh, Night guard 9940.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, that is covered at 40%.
[AGENT][NEUTRAL] Um, that is, uh.
[AGENT][NEUTRAL] Limited to age [PII] and up and it's subject to review.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, for for age [PII] and above, OK.
[AGENT][POSITIVE] That's correct. Uh-huh.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] And how about um any limitations?
[AGENT][NEUTRAL] Uh, no, it's, it's just subject to review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, like, uh, nothing like braxism and all that, OK, and, uh, the crown, the implant crown, or, uh, is that downgraded, uh, porcelain crown it.
[AGENT][NEUTRAL] OK, the
[AGENT][NEUTRAL] Yeah, we don't, we don't cover implants, but crowns are not downgraded. Um, and the crowns, yeah, there's once every 7 year per tooth, but they're not downgraded.
[CUSTOMER][NEUTRAL] Not downgraded.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And is there a replacement cloth like for crown bridges missing tooth cloth?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] There is a missing tooth cloth, yes.
[CUSTOMER][NEUTRAL] That that is the same as the replacement clause, right?
[AGENT][POSITIVE] That, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, um, what is the clause?
[AGENT][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] Frequency, what is the frequency to replace the crown bridges and partial ds?
[AGENT][NEUTRAL] OK, so the crowns and the uh bridges are once every 7 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The partials and dentures are once every 5.
[CUSTOMER][NEUTRAL] Once every 5, yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, may I know your name please?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use this in today's date as a reference. Is there anything else that I can help with?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um, uh, your name, can you spell it [PII]?
[AGENT][NEUTRAL] It
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, that's it for now.
[AGENT][POSITIVE] OK. Well, thank you for contacting APL. Have a good day.