AccountId: 011433970860
ContactId: 48e5c3f3-b594-44c8-9ca8-a170bb79ab50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438920 ms
Total Talk Time (AGENT): 208909 ms
Total Talk Time (CUSTOMER): 189007 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/48e5c3f3-b594-44c8-9ca8-a170bb79ab50_20250319T17:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][POSITIVE] Uh yes, my name is [PII] and I'm calling to get eligibility and benefits on a patient.
[AGENT][POSITIVE] So, I'll be glad to help you go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] It is 02574652. Could you spell your first name please?
[AGENT][NEUTRAL] I sure can. It's [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Alrighty, thank you for that and go ahead while I'm pulling this up and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] OK, [PII]. All righty, [PII], thank you for that. Now, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, [PII] looks like [PII] is a dependent spouse on this dental plan to show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want that back back a benefit. Is that correct, [PII]?
[CUSTOMER][NEGATIVE] I already received the fax back, but I'm, I'm confused on the facts so at the top of it it says full mouth and panoramic X-rays are once in 5 years. So when you go down here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And it gives you.
[CUSTOMER][NEUTRAL] The panoramic
[CUSTOMER][NEGATIVE] And it's the limitations it's got the little letters beside it. It's once in 24 months down there on the limitations.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, on the last page, yeah, because I think it is one in in 24 months.
[CUSTOMER][NEGATIVE] But on the on the first page, no, the second page where it says the frequencies for services are as followed and it says full mouth X-ray and panoramics, it says once in 5 years.
[AGENT][NEUTRAL] For mouth and pano.
[AGENT][NEUTRAL] And what, what's the two codes for the full mouth and the pillow? Let's just look at it.
[CUSTOMER][NEUTRAL] The 0330 and the 0210.
[AGENT][NEUTRAL] Alright, so let's see because.
[CUSTOMER][NEGATIVE] I'm confused.
[AGENT][NEUTRAL] Yeah it's not making sense because yeah, I think it's, I think it is on our system set up once every 5 years, but let me go and look.
[AGENT][NEUTRAL] Pretty sure of that, but let's see what it says. Alright, let's see.
[AGENT][NEUTRAL] 330.
[AGENT][NEUTRAL] Alright, so 0330 is, um, let me write this down. I'm not gonna remember it. Uh, let's see FF.
[AGENT][NEUTRAL] Let me go see what FF says. FF down here.
[AGENT][NEUTRAL] Says limited to 1 X-ray, 0210 to 7330 per 5 years.
[AGENT][NEUTRAL] On that last page, you're looking at FF?
[CUSTOMER][NEUTRAL] Oh, you know what I did? I looked at the F.
[AGENT][POSITIVE] Mhm. That's OK. No problem at all because I'm thinking, OK, then that's OK. No problem, [PII].
[CUSTOMER][NEUTRAL] I'm just like, wait a minute.
[CUSTOMER][NEUTRAL] No, I just looked at the single F. Oh my gosh, yeah, that was before I left to go to lunch.
[AGENT][POSITIVE] That's OK, no problem. Hey, that's OK.
[AGENT][NEUTRAL] That is not all I can help you with.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] No, OK, so is this a calendar year or a fiscal year policy?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] And what is y'all timely filing deadline?
[AGENT][NEGATIVE] We don't have a time to find them here at all.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Does the payer ID accept electronic attachments?
[AGENT][NEUTRAL] Yes, and that, that 60801, yes, ma'am, but we don't really need any attachments. We don't need X-rays, we don't need anything like that. All we need is your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then on her deductible has she met the deductible?
[AGENT][NEUTRAL] See if we have any claims.
[AGENT][POSITIVE] No, ma'am, no claims paid as of today I'm [PII].
[AGENT][NEUTRAL] Have no name on that.
[CUSTOMER][NEUTRAL] OK, so that means.
[CUSTOMER][NEUTRAL] OK, so she has no history at all?
[AGENT][NEUTRAL] None.
[CUSTOMER][NEUTRAL] OK, so the exams on this because the 0170 is not on the list for preventative is that covered?
[AGENT][NEUTRAL] No, ma'am. It's not on that, if it's not on that back bag, it's not covered here at all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] And then so the simple extractions not covered? Oh yes it is, never mind, I see it.
[AGENT][NEUTRAL] Yeah, it's on there.
[CUSTOMER][NEUTRAL] Never mind.
[AGENT][NEUTRAL] That's OK. You just said tell somebody to get you through.
[CUSTOMER][POSITIVE] I've never seen one of these. I've never, this is, this is the first one I've ever done of this one.
[AGENT][POSITIVE] Oh, OK, yeah, it's very detailed. It's gonna have every code covered and how it is covered on that fax.
[CUSTOMER][NEUTRAL] OK, so then.
[AGENT][NEUTRAL] Yeah, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so if I.
[CUSTOMER][NEUTRAL] Does preventative get applied to their Mac?
[AGENT][NEUTRAL] Yes, everything.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so there's no history on this patient. Let me just write that on some of these so I'll know.
[AGENT][NEUTRAL] No, ma'am. Not as of today.
[CUSTOMER][NEUTRAL] OK, so on the consultation is treatment allowed to be done same day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that OK, so that con where I see that at.
[CUSTOMER][NEUTRAL] So it says it's so what's the frequency on that one?
[AGENT][NEUTRAL] Every 6 months.
[CUSTOMER][NEUTRAL] Because it just says diagnostic, it's one every 6 months, OK.
[AGENT][NEUTRAL] Mhm. Has to be 6 months apart too.
[CUSTOMER][NEGATIVE] I hate this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh does that share with the other exams?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, there we go.
[CUSTOMER][NEUTRAL] I think I have everything right, we'll just go, is there guidelines for anesthesia?
[AGENT][NEUTRAL] Well, right.
[AGENT][NEUTRAL] Uh, whatever procedure code on that fax is the only thing covered.
[CUSTOMER][NEUTRAL] OK, in conjunction with covered codes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and remember, um, Major has a 12 month waiting period and she just came on [PII].
[CUSTOMER][NEUTRAL] OK yeah I got that on there.
[AGENT][NEUTRAL] OK, yeah, just make sure about that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and basic and major I mean basic and preventative has no waiting period, right? And then there's no missing tooth cloths.
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Thank you. Got it. Yes, ma'am. No problem, [PII]. Is that all I can help you with?
[CUSTOMER][NEUTRAL] And can.
[CUSTOMER][NEUTRAL] I just need a reference number.
[AGENT][NEUTRAL] We do not give reference numbers, but you can use my name in today's date, [PII].
[CUSTOMER][POSITIVE] Thank you so much have a great day.
[AGENT][POSITIVE] Oh, you as well, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh bye bye.