AccountId: 011433970860
ContactId: 2f94b2a4-15e9-4c95-ad29-1ff0c0cb5a66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 856770 ms
Total Talk Time (AGENT): 303492 ms
Total Talk Time (CUSTOMER): 225788 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/2f94b2a4-15e9-4c95-ad29-1ff0c0cb5a66_20250603T15:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I'm calling from Ballard Family Dentistry, and I'm needing to get some information on a patient please.
[AGENT][NEUTRAL] OK, and what's your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what's the patient's policy number?
[CUSTOMER][NEUTRAL] OK, I got 205-797-58.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] OK, I'm not showing that policy number.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have their social security number or their card with with you?
[CUSTOMER][NEUTRAL] Um, let
[CUSTOMER][NEUTRAL] The this is what she's emailed me um I have got.
[AGENT][NEUTRAL] Oh, she emailed you? OK.
[CUSTOMER][NEUTRAL] I've got [PII]'s um social I think he's the subscriber I believe [PII] um it is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me look that up real quick.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, I'm calling about his wife. It's [PII]. Her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what questions did you have?
[CUSTOMER][NEUTRAL] Um, I called earlier, but they said that the plan didn't have any dental coverage, so we're trying, she's got an appointment today, her as well as her daughter, so I was trying to make sure that they do have active coverage.
[AGENT][NEUTRAL] OK, for me, so let me give you the correct policy number. I think she just flipped the the numbers around and that's why I couldn't find it. It's 02579758 or maybe I flipped it. I don't know.
[CUSTOMER][NEUTRAL] OK, I was gonna say that's what's on her card, yeah, in here.
[AGENT][NEUTRAL] OK, I, I, I must have slipped it then. I apologize. I, I put in 205. OK, so you do have the correct policy number. Um, I am showing that this policy is active with an effective date of [PII]. Um, did you want me to send you a fax back?
[CUSTOMER][NEUTRAL] That's OK, no, that's OK.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Did we are not in network with this so does she have out of network coverage?
[AGENT][NEUTRAL] So this plan will go through UCR.
[CUSTOMER][NEUTRAL] OK, what is that?
[AGENT][NEUTRAL] Let me find there.
[AGENT][NEUTRAL] Let me just pull up their policy real quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So they don't go in network they go based off of a percentage of UCR.
[AGENT][NEUTRAL] Um, and what that is, I can't remember what it stands for, but it goes by zip code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and it gives specific amounts based off of that zip code and we give the percentage amount. Um, I had it pulled up so they do have preventative expenses, um, at 100% of UCR.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, was there a specific code you were wanting to know about or just wanting about just seeing if they have coverage?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, just uh I need a breakdown. She, her and her daughter [PII] are coming in for their cleanings, so I, and we don't have, she's just now presented us with this new card.
[AGENT][NEUTRAL] OK, um, so would you like me to send you a fax back and it should be the same for everyone on there so if you have a fax back for [PII], um, unless the other one, they don't do orthodontics, so it should be the same for all of them.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, that sounds that sounds good. Will it have like a group number and everything like that in there?
[CUSTOMER][NEUTRAL] And the address, all of that.
[AGENT][NEUTRAL] It does have the claim how to submit a claim um I can give you the group number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go ahead and fill this out real quick.
[CUSTOMER][POSITIVE] Alright, I'm I'm ready, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 26107.
[CUSTOMER][NEUTRAL] OK, is there a group name?
[AGENT][NEUTRAL] It'll be universal Trucking, usher Transport.
[CUSTOMER][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] Support, is that what you said?
[AGENT][NEUTRAL] Usher Transport, so US H ER and then transport.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] So who would the carrier be?
[AGENT][NEUTRAL] So it's through APL um they don't they we don't go in network we're not we don't use networks.
[AGENT][NEUTRAL] So the carrier would still be uh APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the, is the address the [PII], is that correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then our claims sent electronically.
[AGENT][NEUTRAL] And can I
[AGENT][NEUTRAL] Uh, you can submit claims through, uh, electronically, mail or fax them.
[AGENT][NEUTRAL] Uh, our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And then his their subscriber ID does it go by his social?
[AGENT][NEUTRAL] Um, I don't know for subscriber ID. Let me look on here.
[AGENT][NEUTRAL] Yes we just do the policy number.
[AGENT][NEUTRAL] And we don't have a subscriber except for APL.
[CUSTOMER][NEUTRAL] So so his subscriber ID is his policy number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so like if they when they come in today they're having an exam, they're having prophy X-rays, um, how do you all is that covered for them?
[CUSTOMER][NEUTRAL] Since we are not in network.
[AGENT][NEUTRAL] So they are allowed uh cleaning once every 6 months, exam 2 for every 12 month period. Um, and what else did you say?
[CUSTOMER][NEUTRAL] X-rays.
[AGENT][NEUTRAL] X-rays, that's once every 5 years.
[AGENT][NEUTRAL] And then real quick while I've got you on the phone, can I get your fax number?
[CUSTOMER][NEUTRAL] Mhm yeah it's [PII].
[CUSTOMER][NEUTRAL] And then do they have an annual max and a deductible?
[AGENT][NEUTRAL] Yes, it looks like they have a calendar year maximum of $1500 and a calendar year deductible of $50 up to $150 per family, and this is a family plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is fluoride covered or sealant for a certain age?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] What would the code be for uh fluoride?
[CUSTOMER][NEUTRAL] Um, let's see, we've got mal, OK.
[AGENT][NEUTRAL] Oh, here we go. I see it.
[AGENT][NEUTRAL] I, I'm sorry, I do see it, um.
[AGENT][NEUTRAL] With the cleaning, yes, it is allowed for a child and adult, and then you wanted a sealant, those are also covered.
[CUSTOMER][NEUTRAL] So no matter the age, fluoride is covered?
[AGENT][NEUTRAL] Yes, it has child and adult.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so you had said um.
[CUSTOMER][NEUTRAL] Because we go off of like percentages um and you said that they are eligible for cleaning and everything so do you pay 100% of their cleaning like their exam? What are your fees?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For for an exam and cleaning.
[AGENT][NEUTRAL] So it goes
[CUSTOMER][NEUTRAL] That you're paying 100% for.
[AGENT][NEUTRAL] So that's preventative expenses, um, which includes the cleaning and the fluoride.
[AGENT][NEUTRAL] Let me see, it also covers.
[AGENT][NEUTRAL] An oral eva evaluation, bite wings.
[CUSTOMER][NEUTRAL] um
[AGENT][NEUTRAL] Seal it would be considered under the preventative expenses.
[AGENT][NEUTRAL] And then um a space maintainer.
[CUSTOMER][NEUTRAL] OK, and I know our fees are gonna be different than than your fees, so are you able to tell me like if you pay 100%.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Are you able to tell me what your fee is so I know so I can adjust that in here for them.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Let me check on that for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] say that.
[AGENT][NEUTRAL] And I'm also sending you the um.
[AGENT][NEUTRAL] Backs back just in case.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have 2706659559.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I did just send that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] There's been an hour and then we.
[AGENT][NEUTRAL] And I'm, I don't know where the site is for the UCR, um.
[AGENT][NEUTRAL] dental provider should have that somewhere, but I am trying to double check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] We got a patience kiddos up here.
[AGENT][NEUTRAL] I'm assuming talking to their sibling.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm on the phone with insurance and she, she can be here.
[AGENT][NEUTRAL] OK, it stands for usual and customary rate, so it's based on their location and the zip code, but I'm still not able to find the website, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, I'm not able to find it. So if you have a billing department, um, see if they would be able to find it, um, but I do, I did send over the fax back to at least show what is covered.
[CUSTOMER][NEUTRAL] OK, OK, alrighty, that's all I need.
[AGENT][NEUTRAL] Um, but I, yeah, I wasn't able to find that. I think it's a software system, not necessarily a.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK, alrighty, that's all I need to know then I appreciate your help.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Alright, well thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] OK.