AccountId: 011433970860
ContactId: 4dcba152-2b20-4b28-bc57-a596bad54744
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784039 ms
Total Talk Time (AGENT): 307134 ms
Total Talk Time (CUSTOMER): 221384 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/4dcba152-2b20-4b28-bc57-a596bad54744_20250514T18:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I need to get some patient benefit information.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. May I have your name?
[CUSTOMER][NEUTRAL] It's [PII] and what was your name? I'm sorry.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected and the name of the facility for my notes.
[CUSTOMER][NEUTRAL] I'm, I'm sorry, what was that?
[AGENT][NEUTRAL] The callback number just in case we get disconnected and the name of the facility for my note.
[CUSTOMER][NEUTRAL] Oh, OK. It's [PII] and it's [PII] Oral Surgery.
[AGENT][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] [PII] Oral Surgery.
[AGENT][NEUTRAL] [PII]. OK, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said your name is [PII]?
[AGENT][POSITIVE] Yes, mhm, that's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, it is 01972556.
[AGENT][NEUTRAL] Right, thank you. Let me pull this information. One moment.
[CUSTOMER][NEUTRAL] And the insurance company is just called APL.
[AGENT][NEUTRAL] Yes, APR American Public Life Insurance.
[CUSTOMER][NEUTRAL] And there's some dental.
[AGENT][NEUTRAL] We do have dental policies. Um, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][POSITIVE] Perfect, thank you. Do you need the benefit information given to you verbally or faxed over to you, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, if I can get it over the phone.
[AGENT][NEUTRAL] OK. Do you have a specific questions or you need a full breakdown?
[CUSTOMER][NEUTRAL] I have certain codes I need and um.
[CUSTOMER][NEUTRAL] I just have, yeah, just uh just that I can't say it certain questions.
[AGENT][NEUTRAL] A specific question. It's OK. It's all right, no problem. OK, let me pull the just really quick, OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. OK, I'm ready for your questions. Go ahead.
[CUSTOMER][NEUTRAL] Um, so the group name, is it group Voluntary dental?
[AGENT][NEUTRAL] Um, that is, um, the product type. Um, let me go ahead and give you the name of the group and the number of the group.
[AGENT][NEUTRAL] OK. The group name is Universal Trucking.
[AGENT][NEUTRAL] Pitman
[AGENT][NEUTRAL] US press.
[CUSTOMER][NEUTRAL] Ok, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Universal trucking. What was the rest?
[AGENT][NEUTRAL] Pitman
[CUSTOMER][NEUTRAL] How do you spell that?
[AGENT][NEUTRAL] P I E D M O N T.
[CUSTOMER][NEUTRAL] So T I E D M O N T.
[AGENT][NEUTRAL] P as in Peter, P I E D M O N T.
[CUSTOMER][NEUTRAL] Oh, Piedmont, OK. OK, Piedmont.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] USS.
[AGENT][NEUTRAL] So that's like and then X and then P R E S S.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you, and then can I have the group number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The group number is 12155.
[CUSTOMER][NEUTRAL] OK, and can I have the deductible and maximum?
[AGENT][NEUTRAL] Sure, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and we have a calendar year maximum of $1500 with the $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has anything been used or me?
[AGENT][NEUTRAL] OK, let me get that for you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] As of today, she has not used her benefits for [PII]. She still have the full amount available.
[CUSTOMER][NEUTRAL] OK, and then I have certain codes I need to see if she's eligible for. Do you want them all at once or just?
[CUSTOMER][NEUTRAL] Separate.
[AGENT][NEUTRAL] OK, one by one.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] The first code is 9222.
[CUSTOMER][NEUTRAL] And I have, oh, you said one by one. So 9222 9223, they're both the anesthesia codes.
[AGENT][NEGATIVE] OK, 9222 is not covered and 9223 is not covered.
[CUSTOMER][NEUTRAL] OK, what about 7140?
[AGENT][NEUTRAL] 7140, that's gonna be under basic expense which is um 80%. And let me see what's that limitation, maximum of 1 each time per tooth.
[CUSTOMER][NEUTRAL] OK, what about 7210?
[AGENT][NEUTRAL] 7210, that's going to be under oral surgery, which is 40%.
[AGENT][NEUTRAL] Um, and that's, there's no limitation under that one.
[CUSTOMER][NEUTRAL] OK. What about um 7240?
[AGENT][NEUTRAL] 7240.
[AGENT][NEUTRAL] OK, 7240 is also under the oral surgeries. There's no limitation. It's gonna be 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about uh 6010?
[AGENT][NEGATIVE] 6010 is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] What about 0330?
[AGENT][NEUTRAL] OK, so a panel. OK, so that one is limited to one X-ray procedure and any combination of 210, 277, and 330 for 5 year period. Um, let me check this.
[AGENT][NEUTRAL] The history on that one, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so the last um
[AGENT][NEUTRAL] OK, so that one was not that one.
[AGENT][NEGATIVE] OK, it looks like she has no history. The only one I've found was not paid. Let me check why it was not paid. That's weird.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just wanna make sure that she does qualify, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long does [PII] switch Char to oral surgery?
[CUSTOMER][NEUTRAL] Um, it's [PII] was for oral surgery.
[CUSTOMER][NEUTRAL] And um let me know
[AGENT][NEUTRAL] I'm waiting on the system. I'm sorry, it's taking another.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, all the changes.
[AGENT][NEUTRAL] Oh, OK. Yeah, she qualifies for that one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well, what about 0140?
[AGENT][NEUTRAL] 80,130.
[AGENT][NEUTRAL] important
[CUSTOMER][NEUTRAL] Sorry, was that panel covered at 100%?
[AGENT][NEUTRAL] 80%
[CUSTOMER][NEUTRAL] 80.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so 00140, that's on their basic expense which that's gonna be um 80% and the limitation on that one is going to be limited to two oral evaluation procedures and any combination of 120, 140, 150, 160, or 180 per 12 month period.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You all agree.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Second of all, I have.
[CUSTOMER][NEUTRAL] So it's 1 every 12 months?
[AGENT][NEUTRAL] It's 2 for 12 months.
[CUSTOMER][NEUTRAL] Now he wants a new plan so
[CUSTOMER][NEUTRAL] I'm sorry, somebody was talking you said 2 for 12 months, OK, is she eligible, correct? I assume.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] I'm checking, um, I see a 15. Let me see if I can find another one.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And there's 19,170.
[AGENT][NEUTRAL] No 180.
[AGENT][NEUTRAL] Nothing. OK, let me check one more time. 12. There's nothing.
[CUSTOMER][NEUTRAL] Just make sure that
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The only one that was back in [PII] so that's saving account.
[AGENT][NEUTRAL] and
[AGENT][NEUTRAL] Yeah, it looks like she qualifies and the last one she did was the 150 and was back on [PII].
[CUSTOMER][NEUTRAL] OK and then um are we in network with this plan?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] No network. What do you know what fee schedules we use?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We pay under the usual and customer rates, UCR.
[CUSTOMER][NEUTRAL] UCR
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, and then, um, can I have a, is the PO box 248,950?
[CUSTOMER][NEUTRAL] [PII] City.
[AGENT][NEUTRAL] Yes. Mhm. [PII], Oklahoma. The zip code is [PII].
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] OK, and if I can you let me know the eligibility.
[CUSTOMER][NEUTRAL] Like what the patients responsible.
[CUSTOMER][NEUTRAL] And then may I have um.
[CUSTOMER][NEGATIVE] No network. Hold on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] VCR.
[CUSTOMER][NEUTRAL] Um, can I have a reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Mhm. You're welcome and thank you for calling USM, Miss [PII]. Thank you for calling ATL. Bye-bye.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] OK