AccountId: 011433970860
ContactId: 369bd413-8eef-47a6-a15f-43a44eab5e56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1682699 ms
Total Talk Time (AGENT): 436371 ms
Total Talk Time (CUSTOMER): 287482 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/369bd413-8eef-47a6-a15f-43a44eab5e56_20250508T20:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and I'm looking for the dental benefits.
[AGENT][NEUTRAL] OK, well, I can help you with the dental benefits, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Uh, OK. So the policy number is 02607170.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] Yeah, before the fax copy, I would like to know, uh, the doctor showing is in network or not, so that we can get the verification.
[AGENT][NEUTRAL] Um, this policy is not on a network, so there's no list of providers.
[CUSTOMER][NEUTRAL] Mm, sorry, I didn't get that.
[AGENT][NEUTRAL] This policy is not on a network, so it doesn't have a list of providers.
[CUSTOMER][NEUTRAL] OK. And uh does patient uh has the out of network benefits?
[AGENT][NEUTRAL] There's no network. So, so there's no list of providers. These benefits are the same wherever they go. There's no PPO or HMO, there's no network.
[CUSTOMER][NEUTRAL] Then how it will be considered, uh, like which one it is?
[AGENT][NEUTRAL] It's a standard fee schedule. We use um UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like the percentages?
[CUSTOMER][NEUTRAL] Yeah, yeah. Just a moment.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Here, uh,
[CUSTOMER][NEUTRAL] The group uh name will be Group Voluntary Dental, right?
[AGENT][NEUTRAL] Um, no, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] C like cat, B like boy, S like Sam, L like Larry, Transportation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. And what will be the group number?
[AGENT][NEUTRAL] 12,470.
[CUSTOMER][NEUTRAL] Uh huh, just a moment.
[CUSTOMER][NEUTRAL] And uh what is the annual max for this patient?
[AGENT][NEUTRAL] $1500?
[CUSTOMER][NEUTRAL] Mhm. And anything has been used?
[AGENT][NEUTRAL] Um, hold on one moment, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, so for this year, none of the benefits have been used on the max has not or the deductible has not been met either.
[CUSTOMER][NEUTRAL] I, uh, what are the deductibles for this plan?
[AGENT][NEUTRAL] $50 per covered insured up to $150 per family. The deductible does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any waiting period?
[AGENT][NEUTRAL] Um, there is a 12-month waiting period for major expenses. Major includes endodontic, perdontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK. For major 12 months, right?
[AGENT][NEUTRAL] 12 months, yes.
[CUSTOMER][NEUTRAL] OK. And uh what about the missing tooth cloth?
[AGENT][NEUTRAL] There is a missing tooth cloth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh payment on proceed for crowns.
[AGENT][NEUTRAL] Um, it could be either or.
[CUSTOMER][POSITIVE] Oh, OK, perfect.
[CUSTOMER][NEUTRAL] And uh is there any downgrade for crowns or uh fillings?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any history for this patient? Any major which can affect the frequency like panel or FMX?
[AGENT][NEUTRAL] Um, there's no history on file for the patient yet.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yes, and uh
[CUSTOMER][NEUTRAL] So, I have a procedure code for preventative, basic and major and I need the frequency and the percentage. So could you help me with that?
[AGENT][NEUTRAL] Sure, um, can you provide your list of codes?
[CUSTOMER][NEUTRAL] Yeah. So it's 0120.
[CUSTOMER][NEUTRAL] 1110
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] 1351
[AGENT][NEUTRAL] 1251.
[CUSTOMER][NEUTRAL] 1208
[AGENT][NEUTRAL] Hold on. 1251.
[CUSTOMER][NEUTRAL] 1313, no, no, no. It's 1351.
[AGENT][POSITIVE] OK. Thank you for confirming. And the next one?
[CUSTOMER][NEUTRAL] 1208
[CUSTOMER][NEUTRAL] 010
[CUSTOMER][NEUTRAL] 0220
[CUSTOMER][NEUTRAL] 0274
[CUSTOMER][NEUTRAL] 1510
[CUSTOMER][NEUTRAL] 3310.
[CUSTOMER][NEUTRAL] 4341
[CUSTOMER][NEUTRAL] 4346
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 4355
[CUSTOMER][NEUTRAL] 2391.
[CUSTOMER][NEUTRAL] 7220
[CUSTOMER][NEUTRAL] 7210
[CUSTOMER][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 7250
[CUSTOMER][NEUTRAL] 7952.
[CUSTOMER][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] 2750
[CUSTOMER][NEUTRAL] 624 5
[CUSTOMER][NEUTRAL] 5110.
[CUSTOMER][NEUTRAL] 5213.
[CUSTOMER][NEUTRAL] 2950
[CUSTOMER][NEUTRAL] 2930.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] 4266
[CUSTOMER][NEUTRAL] 4381.
[CUSTOMER][NEUTRAL] 2920
[CUSTOMER][NEUTRAL] 994 4
[CUSTOMER][NEUTRAL] 9110
[CUSTOMER][NEUTRAL] 9230
[CUSTOMER][NEUTRAL] And the last one is 9243.
[AGENT][NEUTRAL] 9243.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. Is it all right if I place you on a brief hold while I go through your, your codes?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][POSITIVE] Thank you so much for the, for holding. I apologize for the wait. Um, so for code 0120, that's preventative at 100%.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 1110 is preventative at 100%, max 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0140 is basic at 80%.
[AGENT][NEUTRAL] Limited to 2 oral evaluation procedures, um, it can be
[AGENT][NEUTRAL] Per 12 months paired with 120, 40, 50, 60, or 80.
[CUSTOMER][NEUTRAL] Does it share with other exam?
[AGENT][NEUTRAL] Yes, it shares with the codes I just gave 120, 40, 50, 60, and 80.
[CUSTOMER][NEUTRAL] And treatment can be done on the same day?
[AGENT][NEUTRAL] Can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Treatment can be done on the same day?
[AGENT][NEUTRAL] Can they be done on the same day?
[CUSTOMER][NEUTRAL] Treatment
[AGENT][NEUTRAL] Can treatment be done on the same day as the evaluation? Yes.
[CUSTOMER][NEUTRAL] OK. Yeah. And basically will be covered under uh 80, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] 1351 is preventative at 100%.
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only?
[AGENT][NEUTRAL] Unlimited to dependent children under age [PII]?
[AGENT][NEUTRAL] 1208 is not covered?
[AGENT][NEUTRAL] 210 is 80%.
[AGENT][NEUTRAL] Limited to 1 X-ray procedure per five-year period.
[AGENT][NEUTRAL] It is paired with 2773 and 330.
[AGENT][NEUTRAL] 0220 is basic at 80%.
[AGENT][NEUTRAL] 0274 is preventative at 100%.
[AGENT][NEUTRAL] Limited to 1 bite wing procedure per 12 months.
[AGENT][NEUTRAL] This code is paired with 272 and 270.
[AGENT][NEUTRAL] 1510 is preventative at 100%.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[AGENT][NEUTRAL] And maximum of one per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3310 is major at 40%.
[AGENT][NEUTRAL] 4341 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[AGENT][NEUTRAL] 4346 is not covered?
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK, just a moment. For 3310, uh, what will, what will be the frequency?
[AGENT][NEUTRAL] Uh, there's no frequency unless I stated, so there's no frequency for that one.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] So for 4341, it was major at 40%, um, yeah, 40%.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[AGENT][NEUTRAL] 4346 is not covered?
[AGENT][NEUTRAL] 4355 is 40% major.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[AGENT][NEUTRAL] 23.91 is basic 80%.
[AGENT][NEUTRAL] Replacement of existing only if in place for 24 months?
[AGENT][NEUTRAL] A maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You missed 4910.
[AGENT][NEUTRAL] 4910 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Does it share the profit?
[AGENT][NEUTRAL] It's the same frequency, yes, but the codes are not paired.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so 7220 is major at 40%.
[AGENT][NEUTRAL] 70 to 10 is major at 40%.
[AGENT][NEUTRAL] 7140 is basic at 80%.
[AGENT][NEUTRAL] Maximum of one time per tooth.
[AGENT][NEUTRAL] 7250 is major at 40%.
[AGENT][NEUTRAL] 7952, and 53 are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2750 is 40%.
[AGENT][NEUTRAL] Major, maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to patients age [PII] and over?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6245 is the same, 40%?
[AGENT][NEUTRAL] Max of 1 per seven-year period.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Limited to patients age [PII] and over?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5110 is 40% major.
[AGENT][NEUTRAL] Maximum of 1 procedure per 12 months.
[AGENT][NEUTRAL] And 6 months must have.
[CUSTOMER][NEUTRAL] 01 procedure for 12 months for.
[CUSTOMER][NEUTRAL] Yeah, just, just a moment. What was the code for this?
[AGENT][NEUTRAL] Maximum of 1 procedure per 12 months.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] For which code?
[AGENT][NEUTRAL] We're going over code 5110.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, next.
[AGENT][NEUTRAL] This code also has a limitation of 6 months, must have passed since initial placement.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5213 is 40% major?
[AGENT][NEUTRAL] 2950 is 40% major?
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to patients age [PII] and over?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2930 is 40% major, maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to dependent children under age [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6010 and 4266 are not covered.
[AGENT][NEUTRAL] 4381 is major at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2920 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9944 is not covered?
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] 9110 is 80%.
[AGENT][NEUTRAL] 90 to 30 is 40%.
[AGENT][NEGATIVE] And 9243 is not covered.
[CUSTOMER][NEUTRAL] And the code 9248.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that or the cover benefit?
[AGENT][NEUTRAL] Can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Uh, or is the cover benefit?
[AGENT][NEGATIVE] Orthodontics is not covered on this policy.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Um, yeah, got it. Thank you so much for this information. And can I get your name and the reference number?
[AGENT][NEUTRAL] Yes, again, my name is [PII], first initial to my last name is [PII], and there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] And today's date, just a moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes, got it. And [PII], for this uh plan, the, uh, the Pamela is a dependent, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The patient name is dependent, right, for this plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the subscriber is uh [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. So, uh, the subscriber also has a coverage for this plan?
[AGENT][NEUTRAL] Yes, this the coverage is the same for everyone on the policy.
[CUSTOMER][NEUTRAL] OK, so he's active, right?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, the policyholder is active.
[CUSTOMER][NEUTRAL] OK. Uh, can you just confirm the, uh, date of birth for the, uh, subscriber? I just wanted to, uh, double check.
[AGENT][NEUTRAL] Um, you can let me know what you have and I'll confirm it for you.
[CUSTOMER][NEUTRAL] Um, actually, on the card, uh, the date of birth is not mentioned. So that's why I got confused.
[CUSTOMER][NEUTRAL] Only name is mentioned in the card.
[AGENT][NEUTRAL] The date of birth that we have on file.
[AGENT][NEUTRAL] The date of birth that we have on file is [PII].
[CUSTOMER][POSITIVE] [PII]. OK, perfect. Thank you so much, [PII], for your help. Have a nice day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great.