AccountId: 011433970860
ContactId: 47213e57-1609-46de-9cc1-420705f7da63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 630630 ms
Total Talk Time (AGENT): 128562 ms
Total Talk Time (CUSTOMER): 294434 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/47213e57-1609-46de-9cc1-420705f7da63_20250428T16:07_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling from office. How are you today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm also doing good, thank you for asking. So, uh, I have a patient and I need benefits.
[AGENT][NEUTRAL] OK, you say your name was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, same.
[AGENT][NEUTRAL] OK, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I can help you with benefits. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, it is 412-915-797.
[CUSTOMER][NEUTRAL] Did you
[AGENT][NEUTRAL] Um, that's not one of our policy numbers. Do you have the last name?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII]. Sorry, sorry, Tubs, tubs, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK. Uh, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And the first name was [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], yes.
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not pulling up that name. Um, do you have a group number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] For social?
[CUSTOMER][NEUTRAL] One moment. The group number is 70051.
[CUSTOMER][NEUTRAL] And the group name is Focus Group, No sir.
[AGENT][NEUTRAL] OK, and the last name is.
[CUSTOMER][NEUTRAL] And on.
[CUSTOMER][NEUTRAL] Yeah. I have two names his last name, like it is [PII], uh, and another one is [PII].
[AGENT][NEUTRAL] OK, is that [PII]?
[CUSTOMER][POSITIVE] Yeah, sure. Yeah, that's correct.
[AGENT][NEUTRAL] OK, and then you said the other last name was [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, uh [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, I don't show that name in our system. Oh wait, hold on one moment, let me see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Ma'am, uh, lastly, I have talked to a representative, but I need, uh,
[CUSTOMER][NEUTRAL] I'll be back on call because of some
[CUSTOMER][NEUTRAL] Confirmation.
[AGENT][NEUTRAL] I, I found it. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what were you checking on?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Ma'am, uh, the code for, uh, fluoride 1206. I saw on portal there is a one for 12 months and there is a limit up to 19. But representative tell me, uh,
[CUSTOMER][NEUTRAL] It is not listed, so just to confirm for that code.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] That it was [PII].
[CUSTOMER][NEUTRAL] Yes, fluoride.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] I'm pulling it up, it's not a guarantee of payment, basic outline of the policy. Let me see. Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm not pulling up that code under the policy.
[CUSTOMER][NEUTRAL] Ma'am, but I saw in fax.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I've got
[AGENT][NEUTRAL] Yeah, I've got [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] But 11216.
[AGENT][NEUTRAL] So you wanted to check on one of those too?
[CUSTOMER][NEUTRAL] Yeah, yeah. I want 205.
[AGENT][NEUTRAL] You want to check on 1205?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] It's a maximum of 1 procedure for 12 months, limited to dependent children aged [PII].
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Uh, you said once for 12 months, right?
[AGENT][NEUTRAL] Yes, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. But, ma'am, uh, this is a subscriber. So he's also eligible for it or up to up to [PII]?
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the patient is a subscriber. So this is also not eligible for this code because the, OK, OK, OK, got it, got it. Thank you. Thank you, ma'am, the code 7140. Can you please check for that? The code is 7140.
[AGENT][NEGATIVE] So it's not covered.
[AGENT][NEGATIVE] It's not, yes, correct, it's not.
[AGENT][NEUTRAL] Uh it's covered under basic.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] for.
[AGENT][NEUTRAL] Yeah, it's, did you get that? It's covered under basic.
[CUSTOMER][NEUTRAL] Yes, and what about for frequency?
[AGENT][NEUTRAL] What was it?
[CUSTOMER][POSITIVE] Frequency, frequency.
[AGENT][NEUTRAL] There's no frequency. It's basic.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEGATIVE] No frequency.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, you mean, uh, 7140 is covered at 80% and there is no frequency, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] But ma'am, I saw on portal there is a frequency like once for a lifetime.
[AGENT][NEUTRAL] OK, what are, what are you calling for if you saw it? Is, are you wanting to verify it or what were you checking on?
[CUSTOMER][NEUTRAL] Uh yeah, ma'am. Ma'am, just, I have just 2 to 3 codes uh for verify because the representative tell me that uh 80% no frequency, but I saw on the portal there's a frequency like uh for 7140, there's a frequency of uh once for a lifetime for each uh per coordinate.
[AGENT][NEUTRAL] Right, yeah, correct, it's once per lifetime because you can only extract a tooth one time per lifetime.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][POSITIVE] OK, thank you so much. Now,
[CUSTOMER][NEGATIVE] And uh apart from 7 to 10 to 7 to 83, it is not covered. Is this correct?
[AGENT][POSITIVE] Uh, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. And the fee schedule name is Carrington fee. If it is not done, so we also take UCR, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And in this plan, major services, endodontics, periodontics, and oral surgery are not covered, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And ma'am, uh, this is a non-network plan, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, this is a no network plan, is this correct?
[AGENT][NEUTRAL] A non-network plan, is that what you're saying?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. Like uh the provider is in network or out of network?
[AGENT][NEUTRAL] I, I don't know if the providers in network. They use Carrington, so you'd have to contact Carrington to find out if they're in network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh hm.
[CUSTOMER][NEUTRAL] And annual max is $500 and it applies to all services, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. Ma'am, uh just to confirm the uh group name is focus group, no major, is this correct?
[AGENT][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] And the group number is 70051.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh apart from this,
[CUSTOMER][NEUTRAL] OK, ma'am. Done with this question. May I have your reference number for this, ma'am, ma'am, ma, ma'am. You said uh 1205 is uh once for 12 months and uh up to 19. And for self, it is not covered, but 1206 is not listed covered code, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Ma'am, your reference number for this station?
[AGENT][NEUTRAL] Um, it's my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] [PII] [PII]. OK, thank you so much, [PII], for giving the details. Have a good day. Bye for now. Take care.
[AGENT][POSITIVE] OK, thank you, thanks for calling APL you as well. Bye bye.