AccountId: 011433970860
ContactId: 3d9ce85b-cb15-4b81-985d-54081c91e785
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574700 ms
Total Talk Time (AGENT): 251408 ms
Total Talk Time (CUSTOMER): 147605 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/3d9ce85b-cb15-4b81-985d-54081c91e785_20250508T19:58_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hello. My name is [PII]. I'm calling regarding the dental benefit for the patients. So could you please help me out?
[AGENT][NEUTRAL] Sure, I can verify benefits for you and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It's 1080673.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And this is for dental?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, showing his effective date is [PII]. He is active on the policy, and are you needing general benefits or I can send you a fax back.
[CUSTOMER][NEUTRAL] Yeah, the general benefits. So could you please confirm me the group name and the group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] OK, showing a group number 50011.
[AGENT][NEUTRAL] Group name is U R W A Shepherd Lightning Lighting.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the annual max and the deductible?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1250 per calendar year, and they have a $50 deductible that applies to everything but preventative services.
[CUSTOMER][NEUTRAL] OK, and could you please repeat the annual match. Sorry, I missed it. It's
[AGENT][NEUTRAL] Up to $1250 per calendar year.
[CUSTOMER][NEUTRAL] OK, and the deductible is 50 and 150 for family, right?
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] And anything has been utilized from the annual max and the deductible?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, it shows he.
[AGENT][NEGATIVE] has not used or she has not used any benefits and she has not met her deductible.
[CUSTOMER][NEUTRAL] OK. And what about the lifetime or maximum? Is it covered or not?
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][NEUTRAL] OK. And what are the co-insurance or preventive BC can measure?
[AGENT][NEUTRAL] It's not a coinsurance. They have a UCR for preventative, is 100% of UCR. Basic, basic restorative FMX panoramic is 60% and for major services is 40% of UCR.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Is there any history for the patient that can affect the frequency?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Uh, well.
[AGENT][NEUTRAL] No, they don't have anything that would break their frequency.
[CUSTOMER][NEUTRAL] OK. And is there any healing or waiting period between SRP and 4910?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And is there any downgrade for fillings and rows?
[AGENT][POSITIVE] No, there are no downgrades.
[CUSTOMER][NEUTRAL] And how many calls can be done on the same day?
[AGENT][NEUTRAL] All 4
[CUSTOMER][NEUTRAL] OK, and the patient is a subscriber or the dependent?
[AGENT][NEUTRAL] Uh, they are the policy holder, so they are the subscriber.
[CUSTOMER][NEUTRAL] And it is a calendar year policy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and I do have some quotes and I need the frequency and coverage for them. So could you please provide me?
[AGENT][NEUTRAL] How many cos do you have?
[CUSTOMER][NEUTRAL] It's around 15 to 20.
[AGENT][NEUTRAL] You said 50
[CUSTOMER][NEUTRAL] It's 15:15 to 20.
[AGENT][NEUTRAL] OK, what are the codes?
[CUSTOMER][NEUTRAL] All at once?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] 1351 911043554341.
[CUSTOMER][NEUTRAL] 4346.
[CUSTOMER][NEUTRAL] 60 10 9944 1208.
[CUSTOMER][NEUTRAL] 9243.
[CUSTOMER][NEUTRAL] 923-056-70
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] 0274. Yeah, that's it.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, for the exam, uh, it falls under. Give me a moment.
[AGENT][NEUTRAL] Uh, it falls under preventative, so it pays 100% of UCR and exams are 2 for 12 month period. All exams share the same frequency. The 210 is once every 5 years, falls on a basic. The 1351 is preventative.
[AGENT][NEUTRAL] And it is once every 3 years under the age of 14 permanent molars only, 9110 that falls under basic.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it pays at 60, 4355 is major and it's once every 24 months.
[AGENT][NEUTRAL] 4341 also falls on a major once every 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4346.
[AGENT][NEGATIVE] Uh, not covered.
[AGENT][NEUTRAL] The 6010 not covered, 9944.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, once every 7 years and it falls in a major. The 1208, uh, fluoride is under the age of 19, once every 12 months and it's preventative.
[AGENT][NEUTRAL] 9243. 1 moment.
[AGENT][NEUTRAL] Uh, what is that code for 9243?
[CUSTOMER][NEUTRAL] Yeah, it's after that 9230.
[AGENT][NEUTRAL] I'm asking, what is the 9243 for?
[CUSTOMER][NEUTRAL] OK, it's for IV.
[AGENT][NEUTRAL] Sedation
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it falls under a major.
[AGENT][NEUTRAL] 9230.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Falls on major 5670.
[AGENT][NEUTRAL] That is once every 5 years, falls on a major.
[AGENT][NEUTRAL] 4910 is once every 6 months, falls on a major.
[AGENT][NEUTRAL] 7210, it's major.
[AGENT][NEUTRAL] And the what was the other 1 70 0274.
[AGENT][NEUTRAL] Um, bit wings are one for 12 month period falls under is uh preventative.
[CUSTOMER][NEUTRAL] OK, and I just want to confirm the age limit for 1208. It's under age [PII] or [PII]?
[AGENT][NEUTRAL] [PII], under the age of [PII], once every 12 months. Seal the 1351 is under the age of [PII], once every 3 years.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and yeah, yeah, could you please tell me your name and the reference number for this call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name and today's date and it's [PII], last initial [PII]. And is there anything else, Miss [PII], I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, thank you. Have a great day.
[AGENT][POSITIVE] You too. Thank you for calling APL. Bye.