AccountId: 011433970860
ContactId: 4cccbbdf-c294-4539-b4f8-900b9d7fe9aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502179 ms
Total Talk Time (AGENT): 188962 ms
Total Talk Time (CUSTOMER): 112976 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/4cccbbdf-c294-4539-b4f8-900b9d7fe9aa_20250506T12:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, my name is [PII] and I'm calling from Mid America Professional Group. I was wondering if you could help me with the patients benefits and eligibility.
[AGENT][NEUTRAL] Yeah, absolutely, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Um, I have 02488477.
[AGENT][NEUTRAL] All right, thank you. Let me pull this up here.
[AGENT][NEUTRAL] And if I could get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, it's, well, I'll spell it [PII] and then last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then just date of birth.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, [PII].
[AGENT][POSITIVE] No, no worries. Thanks, [PII]. All right, so patient is active. We're looking for dental coverage or medical?
[CUSTOMER][NEUTRAL] Uh, dental, please.
[AGENT][NEUTRAL] OK, so this is a dental plan and the effective date on here is [PII].
[AGENT][NEUTRAL] And if you need us to we can also send you a fax back with a breakdown.
[CUSTOMER][NEUTRAL] No, that's OK as long as you can um answer um the questions I have, that'll be fine. Is this on a calendar year?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, and then what's the maximum deductible?
[AGENT][NEUTRAL] Let me pull it up here. One moment.
[AGENT][NEUTRAL] Alright, so it looks like their calendar year max is gonna be $500 and then the deductible for the year is $50 up to $150 per family.
[CUSTOMER][NEUTRAL] OK, and have they met any of that yet?
[AGENT][NEUTRAL] So it looks like they've used 14,160, which means the remaining balance is 35,840 and they have uh met their deductible.
[CUSTOMER][NEUTRAL] They have.
[AGENT][NEUTRAL] Yes, they have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any waiting periods?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right, can I just get the, uh, percentages for preventative, basic, and major?
[AGENT][POSITIVE] Yeah, absolutely. So patients plan has preventative at 100% of allowable. FMX and basics are at 80%.
[AGENT][NEGATIVE] That's all the patients plan covers. There is no major coverage on here.
[CUSTOMER][NEUTRAL] OK, um, what about the code D 1354, is that a cover benefit?
[AGENT][NEUTRAL] 1354.
[AGENT][NEGATIVE] I do not see it listed, so it would not be covered.
[CUSTOMER][NEUTRAL] OK, and how about um the 2930?
[AGENT][NEUTRAL] No, 29:30.
[CUSTOMER][NEUTRAL] OK, um, for free, uh, the, the, for the frequencies for, um, preventative, can I get the, um, prophy exam bye wings, fluoride and sealants?
[AGENT][NEUTRAL] Yeah, absolutely. So profy is gonna be once every 6 months. Oral evaluation is 2 for 12 months.
[AGENT][NEUTRAL] Fight wing is once per 12 months.
[AGENT][NEUTRAL] And then full mouth X-rays and panels are once every 5 years.
[AGENT][NEUTRAL] And then for fluoride.
[AGENT][NEUTRAL] Fluoride is a maximum of 1 procedure per 12 months. It is limited to children under the age of [PII].
[AGENT][NEUTRAL] And did you say sealants also?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes ma'am.
[AGENT][NEUTRAL] So that's a maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] It is also limited to dependent children under the age of [PII].
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] And you said it was 1 time per 2 for 36 months?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And permanent mullers only.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, OK, now do they have any history for these, um, procedures that we just talked about?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] It looks like they did have some X-rays on [PII].
[CUSTOMER][NEUTRAL] It was this uh uh by wings.
[AGENT][NEGATIVE] Uh, it's code 230, so it was not bite wings. It does not want, yeah.
[CUSTOMER][NEUTRAL] Oh PAs.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Research
[AGENT][NEUTRAL] I don't see anything for bite wings or
[AGENT][NEUTRAL] It looks like their last exam was on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What I'm showing in my system is we got some sealants.
[CUSTOMER][NEUTRAL] And by wings on [PII].
[CUSTOMER][NEUTRAL] An exam on [PII].
[CUSTOMER][NEUTRAL] I don't know why um we wouldn't have it in there though.
[AGENT][NEUTRAL] I do see the [PII], yes, where there were sealants and X-rays. I do see that, yes.
[CUSTOMER][NEUTRAL] OK, so I'll go ahead and put those in there.
[AGENT][NEUTRAL] Did you need me to check on anything else, [PII]?
[CUSTOMER][NEUTRAL] Um, do they have any fillings on file by chance that you see?
[AGENT][NEUTRAL] No, I don't see anything.
[CUSTOMER][NEUTRAL] OK, can I just get a call reference number?
[AGENT][NEUTRAL] Absolutely, that's my name with my last initial and then today's date, my name again is [PII], which is [PII] Last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much, Ms. [PII]. I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good day.