AccountId: 011433970860
ContactId: 34e2a573-a9e0-4d7c-ab3b-854aa0d05782
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 813580 ms
Total Talk Time (AGENT): 315019 ms
Total Talk Time (CUSTOMER): 310827 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/34e2a573-a9e0-4d7c-ab3b-854aa0d05782_20250318T13:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and I'm calling on behalf of the dental office, and I'm looking for patients to handle benefits. How are you doing today?
[AGENT][NEUTRAL] I'm doing just fine, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, [PII], go and give me a good policy number.
[CUSTOMER][NEUTRAL] My policy number is 2335604.
[AGENT][NEUTRAL] What [PII]?
[CUSTOMER][NEUTRAL] It's actually 023-35604.
[AGENT][POSITIVE] All right, [PII], thank you so much for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] What was the last 4 numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. All right, thank you so much for that, [PII]. Now what's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Alright, patient name I have is uh.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Alrighty, thanks for that [PII]. Looks like he is the patient, I mean the uh insured on this dental plan. They show the original effective date is [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want the fax back a benefit or just eligibility.
[CUSTOMER][NEUTRAL] I have some specific questions to check for this patient, like first of all, uh, policy that is active and uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you tell me that, uh,
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] OK. Is there a single or a family coverage?
[AGENT][NEUTRAL] Single?
[CUSTOMER][NEUTRAL] Single coverage policy. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the effective date of this policy would be [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Single coverage, and is there any, uh, sorry, what is the coordination of benefits?
[AGENT][NEUTRAL] There is none. He's our insured. We don't coordinate with anybody for any reason.
[CUSTOMER][NEUTRAL] OK. And uh this one runs on a calendar year, right?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK. How much is the annual maximum deductible and how much they have been used on me?
[AGENT][NEUTRAL] $1500 per calendar year maximum, $50 deductible. Let's see if they've used any for this year.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] No claims for [PII] at all.
[CUSTOMER][NEUTRAL] OK. And uh any waiting period or missing tooth cloths?
[AGENT][NEUTRAL] He's already surpassed the twelve-month waiting period for major, so he has nothing now that would hold him back, no waiting periods.
[CUSTOMER][NEUTRAL] And missing tooth loss?
[AGENT][NEUTRAL] Oh, let's see. Missing 2 clouds, yes.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] What is the replacement period for crowns, bridges, and dentures?
[AGENT][NEUTRAL] Let's see, got to go to the facts back, so let's see.
[AGENT][NEUTRAL] I think it's once every 5 years, but let me make sure, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, once every 7 years.
[CUSTOMER][NEUTRAL] And this is for crowns and bridges and dentures also once in every 7 years.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK. Because last year, one of your rep told us that for dentist, it is once in every 5 years.
[AGENT][NEUTRAL] Oh, let me double check that code then. I'm seeing 7, but hang on, let me get back up.
[AGENT][NEUTRAL] What's procedure code for dentures? I can look it up like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is 5110.
[AGENT][NEUTRAL] Uh, let's see. 5110.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] 5110.
[AGENT][NEUTRAL] 5, let's see.
[AGENT][NEGATIVE] Not even seeing 5110 on my tax back of benefits. I'm showing 5, a different code, but 5510.
[AGENT][NEUTRAL] I'm not even showing 5110.
[CUSTOMER][NEUTRAL] And it.
[CUSTOMER][NEUTRAL] Anything in the 5000 code series like for dentures, any codes if you can see.
[AGENT][NEUTRAL] Yes, yeah, and if you want this faxed back a benefit, it's gonna tell you every code that's covered.
[AGENT][NEUTRAL] But yeah, there the dentures are covered under the, but it is very detailed and coded, but I can't tell you what codes are covered, but I can send you the fact bag of benefits.
[CUSTOMER][NEUTRAL] But for dents on your side, it is showing as 1 in every 7 years, right?
[AGENT][NEUTRAL] 516, let me see.
[AGENT][NEUTRAL] I'm gonna look up just another code, another denture code, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bear with me, my computer is moving slow, OK?
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][POSITIVE] Here we go, finally moving.
[AGENT][POSITIVE] Yeah, it is 5. You are correct.
[CUSTOMER][NEUTRAL] Oh, great. And uh the replacement period is
[AGENT][NEUTRAL] Yeah, 5 on 7 on crowns.
[CUSTOMER][NEUTRAL] OK. The replacement here is same as uh the frequency, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. So now, can you tell me that uh arrest in the code 4381 is covered in this policy or not?
[AGENT][NEUTRAL] Say that one more time.
[CUSTOMER][NEUTRAL] Um, the code 4381, that is for arresting, it is covered or not?
[AGENT][NEUTRAL] 4381.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, sir, not a covered benefit.
[CUSTOMER][POSITIVE] Great. And pay maintenance and profit shares frequency?
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][NEUTRAL] They do. OK. And how many calls of SRP can be done on the same day?
[AGENT][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] 4, all 4. OK. And how much time we have to wait for uh pay your maintenance after we have done SRP?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm, 12 months.
[CUSTOMER][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] Pay maintenance between SRP and pay maintenance, it is 12 months.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, I'm, I'm, I'm looking at this fact bag and like I said, my computer is slow. What's that? What's that procedure code I can find it easier by that.
[CUSTOMER][NEUTRAL] 4341 and 4910, how much gap should be there between these two codes?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] You mean how, how much is the frequency? Is that what you're asking?
[CUSTOMER][NEUTRAL] No, no, no. No, no. Uh, if we have done SRP, right? And if we want to do the periodontal cleaning that is 4910, then how much, how much days we have to wait to this, uh, to do this 4910, that's what I'm asking.
[AGENT][NEUTRAL] OK, let me see if 4910 is even covered, so let me find that. Let's see.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah, it is covered a lot. Let's see, the 4910.
[AGENT][NEUTRAL] The only stipulation is 1 maximum 1 procedure per 6 months.
[AGENT][NEUTRAL] It's the only stipulation they have.
[CUSTOMER][NEUTRAL] So we can do uh scaling and cleaning uh both on the same day, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And of course this is not a guarantee of payment anyway, but yeah, your fax back would definitely explain all this.
[CUSTOMER][NEUTRAL] No, that I, I have the fax pack with me, but this information is not available on the fax pack. That's why I'm asking.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] If you, if you look on each of the procedure codes on the very last column which says limitations, that's gonna, yeah, that's gonna tell you on that last page any limitations if they have any, it's on that back back.
[CUSTOMER][NEUTRAL] That's enough.
[CUSTOMER][NEUTRAL] The letter, yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Only the frequency is given, no limitation is given for this thing. No problem. So what we have to do, so we have to submit the PD or uh should I update that there is no guidelines?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can do it either way, whatever you want to do either way.
[CUSTOMER][NEGATIVE] 3D and no guidelines. I'll write both.
[AGENT][NEUTRAL] That's your decision, yeah.
[CUSTOMER][NEUTRAL] G.
[CUSTOMER][NEUTRAL] Alright, so.
[CUSTOMER][NEUTRAL] OK. And for space maintainers 1510.
[CUSTOMER][NEUTRAL] Uh, let me see if I have the age limit and other things with me E and BB.
[CUSTOMER][NEUTRAL] And 1575 is not covered.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, it's not covered.
[CUSTOMER][NEUTRAL] E as in echo under 14, and then BB maximum once in a lifetime.
[CUSTOMER][NEUTRAL] All right. Uh.
[CUSTOMER][NEUTRAL] Uh, and what is the fee schedule we will follow?
[AGENT][NEUTRAL] This is paid on UCR and your zip code. They are not in the network.
[CUSTOMER][NEUTRAL] So, we are out of network.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, of network.
[CUSTOMER][NEUTRAL] OK. And uh is there any history on file for this patient? Oh, before that, the uh co-insurance or preventive basic measure would be 180, 40, right?
[AGENT][NEUTRAL] Preventative is $100 basic is $80 major is 40, after that $50 deductible, yes.
[AGENT][POSITIVE] You're right.
[CUSTOMER][NEUTRAL] OK. And is there any history on file for this patient that could affect any of the frequency like anything?
[AGENT][NEUTRAL] Uh, looks like he had an office visit and appropriate on [PII].
[AGENT][NEUTRAL] That might affect and he had a bite wing done on that day as well.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that looks like probably would be it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Anything for exams?
[AGENT][NEUTRAL] Uh, same date, [PII].
[CUSTOMER][NEUTRAL] And anything, any larger service for FMX or pano?
[AGENT][NEUTRAL] Give me those codes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 0330 or 0210.
[AGENT][NEUTRAL] Let's put in, let's see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He's not had, uh, well, he had a pano on 8-28-2023.
[CUSTOMER][NEUTRAL] OK. Any last service for SRP like 4341 or 4342?
[AGENT][NEUTRAL] What was your question?
[CUSTOMER][NEUTRAL] Any history for SRP 4341 or 4342?
[AGENT][POSITIVE] Oh, I got you.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No? OK. And the payer ID would be 60801, right?
[AGENT][POSITIVE] Correct, [PII].
[CUSTOMER][NEUTRAL] OK. And you said your name is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I was
[CUSTOMER][NEUTRAL] All right. uh, can you give me the reference number for this call, please?
[AGENT][NEUTRAL] We do not give reference number, [PII], but you can use my name in today's date if you need to do so.
[CUSTOMER][NEUTRAL] Oh, we can do so.
[AGENT][NEUTRAL] And is that
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All I can help answer for you today, [PII].
[CUSTOMER][POSITIVE] All right. So this is the all information I needed from your side and that's all for today and thank you, thank you, thank you so much for your assistance today.
[AGENT][POSITIVE] You're welcome, [PII], and I hope you have a great rest of your day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Same to you bye.
[AGENT][NEUTRAL] Bye bye.