AccountId: 011433970860
ContactId: 4e5b7585-6ec0-4203-8738-d53e44b47d55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 653719 ms
Total Talk Time (AGENT): 235128 ms
Total Talk Time (CUSTOMER): 183170 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/4e5b7585-6ec0-4203-8738-d53e44b47d55_20250109T15:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you very much, [PII]. This is [PII] from For office. How are you?
[AGENT][POSITIVE] I'm good [PII] how are you?
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][POSITIVE] Yeah, fine. Thanks for asking, sir. I have a patient regarding dental benefits.
[AGENT][POSITIVE] All right, I'm happy to check benefits. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes. The policy number is 02408611.
[AGENT][NEUTRAL] All right, [PII], let me pull this up.
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient's name is [PII] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. So patient plan is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a minute please.
[CUSTOMER][NEUTRAL] OK, and for this, what's the group number please?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Group number is 16068.
[CUSTOMER][NEUTRAL] 160.
[AGENT][NEUTRAL] 68.
[CUSTOMER][NEUTRAL] 68 OK and what's the group name?
[AGENT][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] And what are the deductibles and maximums?
[AGENT][NEUTRAL] The calendar year maximum is 1500 per covered insured.
[AGENT][NEUTRAL] The calendar year deductible is $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what are the coinsurance percentages for this?
[AGENT][NEUTRAL] Uh, so it looks like preventative are covered at 100% of UCR radiographs are at 80% of UCR.
[AGENT][NEUTRAL] Basic is covered at 80% and then major is 40%.
[CUSTOMER][NEUTRAL] OK, I have a course. I just need to know the coinsurance percentage frequencies.
[AGENT][NEUTRAL] You have some codes that you need me to check?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I have called.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, the first one is 0120.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] 0120 is covered under preventative, so that would be at 100% limited to two oral evaluation procedures in 12 months.
[CUSTOMER][NEUTRAL] And the next one is 1110.
[AGENT][NEUTRAL] Covered under preventative at 100%. It's a maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] 0274 is covered under preventative at 100% limited to one bite X-ray uh procedure for 12 months.
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] 47.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0210 is covered at, it looks like 80%.
[AGENT][NEUTRAL] It is limited to 1 X-ray procedure for 5 years.
[CUSTOMER][NEUTRAL] And what's the age limitation for fluoride and sealants?
[CUSTOMER][NEUTRAL] Hey good morning this is calling. I'm looking for a.
[AGENT][NEUTRAL] So it looks like for fluoride, one moment.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Fluoride is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then al it would be under the age of [PII].
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Alright, and the next one is 2391.
[AGENT][NEUTRAL] 239-1, 1 moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so 2391 is covered under basic which should be at 80% of the limitation it looks like is.
[AGENT][NEUTRAL] A maximum of 1 each tooth for 24 months and replacement of existing if only in place for 24 months.
[CUSTOMER][NEUTRAL] OK. And it is a downgrade or not?
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] The next one is 4341.
[AGENT][NEUTRAL] 4341.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][POSITIVE] And I'll be able to get on a day with you.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] 4341 is covered at 40% it looks like.
[AGENT][NEUTRAL] Does carry uh looks like a limitation, a maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK. OK. How many calls can be done in one day for us?
[AGENT][NEUTRAL] I don't show a limitation for that.
[CUSTOMER][NEUTRAL] OK, and 4342 can be done on the same day with pro Lexis 1110.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh, and the next one is 4910.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so that's also covered out it looks like 40%. It's a maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] OK, and the next one is 2740.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK thank you
[AGENT][NEUTRAL] 2740 is covered under major, so that would be at 40%. Um, it looks like it's a maximum of 1 per 7 years.
[CUSTOMER][NEUTRAL] OK. And it
[AGENT][NEUTRAL] And limited to patients over the age of [PII].
[CUSTOMER][NEUTRAL] OK, and it is a downgrade or not?
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] And grounds be one is a CD of update.
[AGENT][NEUTRAL] Either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh implants are covered in this plan, not code 6010 and 6058.
[AGENT][NEGATIVE] Implants, um, is not covered.
[CUSTOMER][NEUTRAL] OK. OK. Is there any missing clause or waiting period?
[AGENT][NEUTRAL] Uh, it looks like this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's a 12-month waiting period for major expenses, endodontic, periodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Only for major services.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Orthodontics are covered in this plan or not?
[AGENT][NEGATIVE] They are not.
[CUSTOMER][NEUTRAL] OK, it is a calendar plan or a fiscal year plan?
[AGENT][NEUTRAL] This calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, anything else is, uh, yeah, and what's the pay ID for this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What's the payer ID?
[AGENT][NEUTRAL] Oh, that's 60801.
[CUSTOMER][NEUTRAL] And the claim mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just could you please send me a copy of benefits of tax.
[AGENT][POSITIVE] Yeah, absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Should we mark that attention to anybody?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, fax is on its way, should be there in about 5 minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, thank you. And your name, please?
[AGENT][NEUTRAL] My name is [PII], that is spelled [PII] The last initial to my name is [PII].
[CUSTOMER][NEUTRAL] OK, and the reference number please?
[AGENT][NEUTRAL] Is my name with today's date.
[CUSTOMER][NEUTRAL] OK. Uh, could you please verify for me, uh, the effective date is [PII]. So it means the waiting period is also satisfied for major services. Am I right?
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][POSITIVE] Alright, thank you very much.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII]. Mhm. Bye-bye.
[CUSTOMER][POSITIVE] Thank you, sir.