AccountId: 011433970860
ContactId: 500596b1-95a4-4c9e-b8bd-a33c8b56be14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 672900 ms
Total Talk Time (AGENT): 165553 ms
Total Talk Time (CUSTOMER): 191990 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/500596b1-95a4-4c9e-b8bd-a33c8b56be14_20250423T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, I'm [PII]. I'm calling on behalf of the provider's office for the verification of eligibility and benefits and the recorded line. Would you please help me with that? And your name is [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm. My callback number is [PII].
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh yes, the policy number I have here is 603996.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I show the policy is effective [PII]. It's currently active.
[AGENT][NEUTRAL] And you needed benefits, is that right?
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, um, I can send you the facts of all of the outline of benefits or if you need to go over them on the phone, we can do that as well.
[CUSTOMER][NEUTRAL] Uh, yeah, uh, if it's OK, shall we do it through the phone?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Um, let me see, get this pulled up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so they have an annual maximum limit of 1000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, preventative, so this is pays so a certain dollar amount for certain codes.
[AGENT][NEUTRAL] Do you need just uh what uh how can I help you?
[CUSTOMER][NEUTRAL] OK. So, uh, you mean like, uh, this plan is uh I mean, co-pay plan?
[AGENT][NEUTRAL] It it just has a list of all of the services and then it'll pay a certain benefit amount per service.
[CUSTOMER][NEUTRAL] Uh, OK, OK, OK, thank you very much for that. So first of all, would you please help me please with the group name, group number please schedule the claiming address for this special plan.
[AGENT][NEUTRAL] Uh group name is.
[AGENT][NEUTRAL] Uh, group number is LA 0225.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the name is LA Department of Education RSD.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what was the other information?
[CUSTOMER][NEUTRAL] Uh-huh. And let me just confirm for the few informations that I have here. I do have here the plan runs in a calendar year and there is the COB is uh standard.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and the patient has a $50 deductible, $250 family deductible as well?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] And the calendar year deductible is 50 and then a max of 150 per family.
[CUSTOMER][NEUTRAL] OK, 1524. Thank you. And is there any useamone from the annal max and the deduct from that or not as well?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEGATIVE] Uh, looks like deductible has not been met and nothing has been used so far this year.
[CUSTOMER][NEGATIVE] OK, thank you very much, and I do have here this plan has no orthodontics coverage, no waiting period, and there is a missing tooth cause.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you very much for that. And um.
[CUSTOMER][NEUTRAL] OK. May I have you please the frequencies for the services and the preventative?
[AGENT][NEUTRAL] Um, let's see, I don't.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sorry, I'm pulling that up. Uh, hold on one moment.
[CUSTOMER][POSITIVE] Mhm. It's OK. Mhm. It's OK, no problem. You can take your time.
[AGENT][NEUTRAL] OK, let me pull up a different form. Hold on one moment.
[CUSTOMER][NEUTRAL] It's OK, it's OK.
[AGENT][NEUTRAL] OK, so oral exams are once every 6 months?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there's not a guarantee of payment basic outline of the policy. Propies and cleanings once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, bite wings once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, full mouth and Pao is once every 3 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, crowns and bridges one every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, partials and dentures once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, periorophy once every 3 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Full mouth the barment once every 12 months.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, fluoride once every 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Feelings are once every 3 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Assailants are limited to children under age [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Fluoride is under age [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Policy does not downgrade.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for Crohn's, is it on the data prote?
[AGENT][NEUTRAL] Uh, prep day.
[CUSTOMER][NEUTRAL] Per day. OK. Thank you. And um OK, policy no downgrades. OK. And for SRPO for quadrants are allowed to do on the same day?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK. Thank you very much for that. And uh [PII], may I have the coinsurances like if there is any I mean of percentage covered for diagnostic, preventative, basic, and major?
[AGENT][NEUTRAL] Um, there's not. This is a fee schedule based, so it pays a certain dollar amount for certain, uh, procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, got you. Thank you very much for that. Meaning like this patients, I mean this policy is a co-pay policy, right?
[AGENT][NEUTRAL] Yes, I mean, yes, it'll pay a certain dollar amount for certain procedure codes, yes.
[CUSTOMER][NEUTRAL] OK, OK, thank you. uh, [PII], would you please help me confirm if there is any history involved with this patient that might affect the frequencies only?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I'm not showing anything that would impact it.
[CUSTOMER][NEUTRAL] OK, then thank you so very much. And I just want to confirm if there is a, if I'm sorry, let me check. If consultation or I'm sorry, consultation, general anesthesia and implants, are they covered?
[AGENT][NEGATIVE] Um, implants are not covered.
[AGENT][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Seizure. You have a code?
[CUSTOMER][NEUTRAL] Uh yes, anesthesia, I have, let me check the code 9223.
[AGENT][NEUTRAL] I'm not pulling up that code.
[CUSTOMER][NEUTRAL] OK, and the last one for consultation is 9310?
[AGENT][NEUTRAL] I'm not pulling up that code.
[CUSTOMER][POSITIVE] OK then thank you so very much, [PII] for all this information really appreciate it. I hope you have a great day ahead. Oh, I'm so sorry. May I have the fees scheduled special plan, please? I'm sorry about that.
[AGENT][NEUTRAL] It's just, it's, so it's a certain dollar amount for, like I said, it's a certain dollar amount for procedure codes.
[CUSTOMER][NEUTRAL] OK, $13 a month. One moment, let me just notate that.
[CUSTOMER][POSITIVE] OK then thank you so very much once again, [PII], bye bye and take care.
[AGENT][POSITIVE] Thanks for calling APL you as well.