AccountId: 011433970860
ContactId: 43c54389-8cb8-4bbd-b249-5b7cc5c44e4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449079 ms
Total Talk Time (AGENT): 183707 ms
Total Talk Time (CUSTOMER): 108885 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/43c54389-8cb8-4bbd-b249-5b7cc5c44e4d_20250507T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. I'm calling from a dental provider's office and I was looking to get a benefit breakdown for a patient.
[AGENT][POSITIVE] OK. Happy to help, [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] I do. It is 02594450.
[AGENT][NEUTRAL] OK, let me pull that up.
[AGENT][NEUTRAL] And then if I could get patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] Thank you. All right, so patient is active. Effective date on here is [PII].
[AGENT][POSITIVE] And I'm happy to give you a verbal breakdown on whatever you need. We can also send you a fax back if that would be helpful.
[CUSTOMER][NEUTRAL] OK, um, I'm OK with verbal if you are.
[AGENT][POSITIVE] Yeah, absolutely, let me just pull this up.
[AGENT][NEUTRAL] All right, so it looks like the uh calendar year maximum for this patient is gonna be $500. They do have a $50 deductible. Um, all of that is remaining. They have not met anything for the year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like patient plan is preventative and basic only. Uh, preventative is covered at 100%.
[AGENT][NEUTRAL] And then basic and FMX are at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As far as frequencies go, it looks like uh cleanings are gonna be once every 6 months.
[AGENT][NEUTRAL] Oral evaluations are gonna be 2 for 12 months.
[AGENT][NEUTRAL] Uh, bite wings or once per 12 months.
[AGENT][NEUTRAL] And then FMX and Pano are gonna be once every 5 years.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Uh, policy does have a missing tooth clause.
[CUSTOMER][NEGATIVE] That expire.
[AGENT][NEUTRAL] Does it expire? I'm sorry, is that what you asked?
[CUSTOMER][NEUTRAL] Um, yeah, is it for the whole length of the policy, or does it have an expiration date on that?
[AGENT][NEUTRAL] Yeah, length of the policy, no expiration on that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And then, uh, no ortho treatment on this either.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, then you just need claims mailing address information?
[CUSTOMER][POSITIVE] Um, sure, yeah, I can grab that.
[AGENT][NEUTRAL] OK, we have a payer ID which is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claims mailing address is gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Perfect, OK.
[AGENT][NEUTRAL] Then did you want the fax number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, sure.
[AGENT][NEUTRAL] Fax is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let's see, so as let me get back to like the deductible, does that apply to preventive services as well or just basic?
[AGENT][NEUTRAL] Just basic, uh-huh.
[CUSTOMER][NEUTRAL] Basic, OK, and does preventive count towards the max?
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, any waiting periods on the policy?
[AGENT][NEUTRAL] No waiting period, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Are oral cancer screenings covered?
[AGENT][NEUTRAL] Yes, probably not, but do you have a code for it by chance?
[CUSTOMER][NEUTRAL] Sure, yeah, it is D0431.
[AGENT][NEUTRAL] Yeah, it looks like it's not covered.
[CUSTOMER][NEUTRAL] OK, what about palliative treatment 9110?
[AGENT][NEUTRAL] It looks like that is covered, um, and it looks like under basic, so it'd be at 80%.
[CUSTOMER][NEUTRAL] OK, any frequency to that?
[AGENT][NEUTRAL] There is not, no.
[CUSTOMER][NEUTRAL] Um, OK, are lossal guards covered 9944?
[AGENT][NEGATIVE] I do not see 9944 listed, so it would not be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for per maintenance, is that covered codes 4910.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] Not covered, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, what about simple extractions like oral surgery, 7140.
[AGENT][NEUTRAL] 7140 is covered under basic at 80%. Um, looks like there is.
[AGENT][NEUTRAL] A limitation, a maximum of 1 time per tooth.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What about the periapical X-ray 0220?
[AGENT][NEUTRAL] Yes, those are covered under basic at 80%. I'm not showing any limitation on frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, you did say this runs on a calendar year, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect and are you showing any um X-ray history at all for this year?
[AGENT][NEUTRAL] Oh yeah, let me see what they have on file.
[AGENT][NEUTRAL] Patient does not have any history on file with us.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right, well I think that was everything I needed thank you so much for your help.
[AGENT][POSITIVE] You're welcome. I hope you have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye bye.