AccountId: 011433970860
ContactId: 4e574309-f065-4724-bb1f-51faf8e7ad89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333130 ms
Total Talk Time (AGENT): 154636 ms
Total Talk Time (CUSTOMER): 104919 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/4e574309-f065-4724-bb1f-51faf8e7ad89_20250313T15:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was just trying to see if we are network with this um patients insurance.
[AGENT][NEUTRAL] OK, I can get that policy pulled up and check that network um what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's going to be 02441264.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] It's going to be [PII] and then the last name is going to be [PII]
[CUSTOMER][NEUTRAL] And then the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy, of course it is active, uh, effective date was [PII], and this, uh, policy is not affiliated with any networks. It pays a percentage based off of UCR, and if you'd like I can send you the fax back that shows all of the procedures and benefit information.
[CUSTOMER][NEUTRAL] OK, and then is there a yearly maximum on this?
[AGENT][NEUTRAL] Yes, uh, give me just a moment, let me get that pulled up.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims, so their calendar year maximum is $1500. There is a $50 deductible that does not apply to preventative expenses.
[AGENT][NEUTRAL] If you'll give me one moment, I can check to see if any of that has been used.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] No, OK, and then what about the family deductible?
[AGENT][NEUTRAL] Um, that is up to $150 per family.
[CUSTOMER][NEUTRAL] 150. OK. And then what is the diagnostic percent?
[AGENT][NEUTRAL] So let's see, uh, in short, preventative expenses are 100% of UCR, um, radiographs and basic expenses are at 80% and all major expenses are at 40%.
[CUSTOMER][NEUTRAL] 40? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then how about the X-rays per year?
[AGENT][NEUTRAL] Let's see, that is once every 5 years for full mouth X-rays and panoramics.
[CUSTOMER][POSITIVE] And panoramic.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then what about pro fee?
[AGENT][NEUTRAL] Uh, that is proofies and cleaning. It's, uh, once every 6 months.
[CUSTOMER][NEUTRAL] One every 6 months, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] What about a single crown?
[CUSTOMER][NEUTRAL] And like the crown buildup.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sure, did you have that procedure code by chance?
[CUSTOMER][NEUTRAL] Um, yeah, it's going to be D 2750.
[AGENT][NEUTRAL] OK. Give me just a moment. So that is going to be covered under major.
[AGENT][NEUTRAL] Look at those limitations.
[AGENT][NEUTRAL] So that is a maximum of 1 per 7 year period.
[CUSTOMER][NEUTRAL] For 7 years. And then what about implants?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] I don't believe implants are covered under this no implant placement, removal and all related services are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, and then what about Endodontist?
[AGENT][NEUTRAL] And theontics uh are covered at 40%.
[CUSTOMER][NEUTRAL] 40, and then that goes with oral surgery, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then what about sedation?
[AGENT][NEUTRAL] Um, do you have that code? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, it's going to be
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] 9230.
[AGENT][NEUTRAL] Bear with me just a moment. That is covered under major, so 40%, and there's no limitations.
[CUSTOMER][NEUTRAL] 40%, OK.
[CUSTOMER][NEUTRAL] OK, and then for the SRPs, can we do them like all four quads at once or can it be like half and half?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, all 4 can be done at the same date, yes.
[CUSTOMER][NEUTRAL] You can do all of that? OK.
[CUSTOMER][NEUTRAL] And then what about Perry O'Donnell maintenance?
[AGENT][NEUTRAL] Horizontal, see.
[AGENT][NEUTRAL] Yes, periodontic expenses are at 40%.
[CUSTOMER][NEUTRAL] 40 OK and then do you mind if I just can get a fax back of this?
[AGENT][POSITIVE] Absolutely, yes, what was that fax number for you?
[CUSTOMER][NEUTRAL] It's going to be 682.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 390.
[CUSTOMER][NEUTRAL] 3158.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright, I will get that sent to you. You should get it here within 10 to 15 minutes. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] 10 to 15 days.
[CUSTOMER][POSITIVE] Um, no, that should be it. Thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Yeah.