AccountId: 011433970860
ContactId: 50e3c116-9551-400a-8272-510031581bb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1457319 ms
Total Talk Time (AGENT): 521237 ms
Total Talk Time (CUSTOMER): 439009 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/50e3c116-9551-400a-8272-510031581bb3_20250203T14:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII], good morning and happy Monday. My name is [PII] and I am looking for the eligibility and benefits for dental.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the eligibility and benefits. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, please. That will be [PII]. Again, it's [PII]. Do you need the extension number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, the extension number that will be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] That will be 597-017981. That is the SSN number.
[AGENT][NEUTRAL] Do you have the member's American Public Life policy number?
[CUSTOMER][NEUTRAL] Let me see, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The only number I have apart from that one, that will be 246-456-0.
[AGENT][NEUTRAL] 246-456-0
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. Give me a moment here. The name I have on file, that will be [PII] with the date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII]. And hold on one moment, let me see what type of policy they have.
[CUSTOMER][NEUTRAL] OK, I need a PPO uh dental policy, OK?
[AGENT][NEUTRAL] I'm looking for the type of policy they have. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Yes, sure, please. Go ahead.
[AGENT][NEUTRAL] So this particular policy is not on a network, PPO or HMO. Um, did you need a copy of the fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] Um, then what type of policy may I know?
[AGENT][NEUTRAL] This is a um standard.
[AGENT][NEUTRAL] See schedule, it uses um UCR percentages.
[AGENT][NEUTRAL] It's not like on a network like PPO or HMO. We use Carrington though.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But that's
[CUSTOMER][NEUTRAL] But does it have any uh dental benefits though?
[AGENT][NEUTRAL] Yes, this is a dental policy. It's just not on a PPO or HMO network.
[CUSTOMER][NEUTRAL] Dental
[CUSTOMER][NEUTRAL] OK, so I'm confused. Is it like a discount policy or uh?
[AGENT][NEUTRAL] So this is not major insurance.
[CUSTOMER][NEUTRAL] The indemnity policy.
[AGENT][NEUTRAL] This is not major insurance. APL provide it could be considered secondary if they have other insurance.
[CUSTOMER][NEUTRAL] Is it an EPO or?
[AGENT][NEUTRAL] This could be considered a second insurance if they have other dental insurance. There's this is not a network. It's not EPO, PPO, HMO. It's, it's a standard secondary policy or it could be their primary.
[CUSTOMER][NEUTRAL] 10 days
[AGENT][NEUTRAL] If they have other insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I'm very confused now. Hold on a moment, OK, let me see.
[AGENT][NEUTRAL] So if the insured has another type of insurance policy, sometimes medical policies offer dental benefits, sometimes they have other dental benefit policies. This can be
[AGENT][NEUTRAL] There's no coordination of benefits. If you bill us 1st, 2nd, 3rd, we will process the claim as we receive it. It's on no other network except for [PII].
[AGENT][NEUTRAL] It's not PPO.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and just one more thing, does it have any like frequencies or any percentage categories?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you double check what about the provider?
[AGENT][NEUTRAL] As in if the providers in network?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Again, so this policy doesn't have a network, so there's no list of providers.
[CUSTOMER][NEUTRAL] What type of, hold on a moment here.
[CUSTOMER][NEUTRAL] Let me double check something regarding that one American public life.
[CUSTOMER][NEUTRAL] Do you have any code number so I can double check?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] The group number is 17626.
[CUSTOMER][NEUTRAL] 17626. 1 moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do you guys have any web portal or not?
[AGENT][NEUTRAL] For dental coverage or like their, their portal to like bill for claims?
[CUSTOMER][NEUTRAL] Um, the web portal to check the benefits, yes, dental coverage.
[AGENT][NEUTRAL] Yes, you can use our online service center as a provider and um access the coverage.
[CUSTOMER][NEUTRAL] Can I have the link?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][POSITIVE] So it's secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII]. OK, thank you very much for that. OK, so just in case they want us to um take the benefits, we'll just go ahead with the benefits then.
[AGENT][NEUTRAL] OK, and did you have particular questions? OK.
[CUSTOMER][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yes please one moment OK? Let me save this one first so it won't disappear one moment APL.
[CUSTOMER][NEUTRAL] APL
[CUSTOMER][NEUTRAL] So you said this is just.
[CUSTOMER][NEUTRAL] This is not a PPO or EPO or HMO or discount.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what did you say about the plan? This is just a standard plan?
[AGENT][NEUTRAL] Yes, on the Carrington network, it's just a standard policy.
[CUSTOMER][NEUTRAL] Let's just a standard. OK, I'll mention that one, OK.
[CUSTOMER][NEUTRAL] Mhm and the Carrington.
[CUSTOMER][NEUTRAL] Carrington.
[CUSTOMER][NEUTRAL] But we use you said that we will be using UCLee.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Got it. Thank you. Thank you very much. So no network for the provider.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this the calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Got it. Thank you very much. Now, can I have the good name?
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] OK, Universal Trade.
[AGENT][NEUTRAL] Stevens.
[CUSTOMER][NEUTRAL] Stevens, OK.
[CUSTOMER][NEUTRAL] OK, you can go ahead with the benefits. Sorry for the delay. I'm actually trying to save all of this info that you provide to me. So yes, you can go ahead with the maximum deductible, the one that you have like the general benefits.
[AGENT][NEUTRAL] So the calendar year maximum is $1500 per covered insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a $50 deductible per person up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The deductible doesn't apply to preventative expenses?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative expenses are covered at 100% of UCR.
[AGENT][NEUTRAL] Radiographs, um, basic expenses and basic restorative are all at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Major expenses, which includes endodontic, periodontic, prosodontic, and oral surgery, are all at 40%.
[AGENT][NEUTRAL] With a twelve-month waiting period?
[AGENT][NEUTRAL] The waiting period for this policy would be over on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Trophies and cleanings are once every 6 months?
[AGENT][NEUTRAL] Exams are 2.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Hold on, so this is on the provided, the one that you provide to me just now.
[AGENT][NEUTRAL] Trophies and cleanings are under preventative, yes.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Exams are the frequency for exams is 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bite wings are once per 12 month period.
[AGENT][NEUTRAL] Full mouth X-rays and panels are once every 5 years.
[AGENT][NEUTRAL] Crowns and bridges are once every 7 years per tooth.
[AGENT][NEUTRAL] And partials and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The policy does have a missing too.
[CUSTOMER][NEUTRAL] Hold on, I'm well.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] I'm really sorry, my.
[CUSTOMER][POSITIVE] OK, go ahead. I'm having some problem with my system. I'm really sorry.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh, you're fine. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] All right, thank you so much for holding. Did you need more time?
[CUSTOMER][POSITIVE] Uh, no, no, I'm OK now. Thank you.
[AGENT][NEUTRAL] OK. You're welcome. Um, so the policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Orthodontic treatment is not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] TMJ services are not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Implants, placement removal and all related services are not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so there's 3 ways to file a claim. You can send it electronically.
[AGENT][NEUTRAL] Using our payer ID which is 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oklahoma.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And our fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's attention claims department?
[CUSTOMER][NEUTRAL] OK, so you don't have any other general info apart from those, right? Can I go ahead with my question now?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. So when you said that X-rays are on the basic, that means FMX and panel is on the basic as well at 80 with deductible, right?
[AGENT][NEUTRAL] Right, FMX and panels are under 80, yes.
[CUSTOMER][NEUTRAL] OK, what about PA pre-optical X-ray, do you have any frequency?
[AGENT][NEUTRAL] What's the code? It's most likely 80 if it's not preventative or major.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] Mhm. 0220 is under basic at 80%.
[CUSTOMER][NEUTRAL] Got it. Is there any 1206 coverage?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] Is it because of the age limit?
[AGENT][NEUTRAL] Um, no, 1206 is just not a covered code on this list.
[CUSTOMER][NEUTRAL] And what about 1351?
[AGENT][NEUTRAL] 1351 is on this list. It does have limitations. Did you need those as well?
[CUSTOMER][POSITIVE] Yes, please go ahead.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So maximum of 1 procedure per 36 months?
[CUSTOMER][NEUTRAL] OK. And the H?
[AGENT][NEUTRAL] Application
[AGENT][NEUTRAL] Applications made, hold on one moment.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only.
[AGENT][NEUTRAL] And it's limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Got it. That is preventative, right? 100?
[AGENT][NEUTRAL] Oh, you said 1351. Hold on one moment. Let me go back up.
[AGENT][NEUTRAL] Yes, that's under preventative at 100%.
[CUSTOMER][NEUTRAL] Got it, thank you. Now, fluoride for child 1208, is there any coverage?
[AGENT][NEUTRAL] Um, no, that code is not on this list either.
[CUSTOMER][NEUTRAL] OK, got it. Thank you. Um, can you go ahead with the fillings or basic restoration frequency?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Basic restoration is a whole category. Do you have a particular code you'd like me to look for or would you like a copy of the fax back?
[CUSTOMER][NEUTRAL] Um, you can use 2391. That's OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so 2391 is under, hold on one second, let me go back up.
[AGENT][NEUTRAL] It's under basic restorative at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Replacement of existing only is in place for 24 months?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And do you downgrade?
[AGENT][NEUTRAL] Did you need the other limitation?
[CUSTOMER][NEUTRAL] Oh, just a downgrade if there's any downgrade or not.
[AGENT][POSITIVE] There's no downgrade.
[CUSTOMER][NEUTRAL] So you do not downgrade any um.
[CUSTOMER][NEUTRAL] What do you say, any crown or fillings, right? You do not downgrade on the plan itself?
[AGENT][POSITIVE] Correct, there are no downgrades.
[CUSTOMER][NEUTRAL] OK, thank you. Now, what about the um
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Frequency. Do you have any frequency for payroll services like those SRP pay maintenance and formal department?
[AGENT][NEUTRAL] Do you have particular codes other than the general information, there's only a list of codes on the fax back and then the limitation, so it goes by codes.
[CUSTOMER][NEUTRAL] Oh, OK. Hold on a moment. You can fax me, um.
[CUSTOMER][NEUTRAL] I'm trying to create an account on this uh web portal, you know, using the tax ID and then it asks for the patient account number. So which account number shall I use?
[AGENT][NEUTRAL] So once there's a claim process, the account number comes from the provider. So when we process the claim, it's under the account number that you provide to us. So that most likely will come up after billing.
[CUSTOMER][NEUTRAL] OK. And any patient account number will be OK?
[AGENT][NEUTRAL] No, it's particular to the patient that you're looking um for.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, then, uh, in that case, I don't have any account number for this one. I mean.
[AGENT][NEUTRAL] Right, you will have to, because you're a provider, so you have to file a claim first so we can have your information to put in the system.
[CUSTOMER][NEUTRAL] Oh, can you check for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. The patient have any claim or not? Any history or not?
[AGENT][NEUTRAL] Um, hold on one second. So you asked for the fax back. Would you like me to fax that to you?
[CUSTOMER][NEUTRAL] Sure, please go ahead. OK, I'll go.
[AGENT][NEUTRAL] May I have your fax number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][POSITIVE] OK, that will be great. Thank you.
[AGENT][NEUTRAL] You're welcome. And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what questions did you, you, you wanted to check history?
[CUSTOMER][NEUTRAL] Yes, that may affect the frequency only for preventative diagnostic and period, OK?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] I understand what history is, ma'am.
[AGENT][NEUTRAL] There's only one claim on file?
[AGENT][NEUTRAL] For date of service, um, [PII].
[AGENT][NEUTRAL] Would you use this code 011101206 and 00180?
[AGENT][NEUTRAL] 1206 is no longer a covered code.
[AGENT][NEUTRAL] Um, 00180. Hold on one moment.
[AGENT][NEUTRAL] 1110 is once every 6 months, April, May.
[AGENT][POSITIVE] So they're almost at a year for their cleaning. So yes, the cleaning, they're eligible for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there is no FMX or buying, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. And there is no pay at all.
[AGENT][NEUTRAL] No, only the 3 codes that were mentioned.
[AGENT][NEUTRAL] are on the claim.
[CUSTOMER][POSITIVE] OK, thank you. mhm OK got it thank you.
[CUSTOMER][NEUTRAL] OK, so just a guideline, do you allow all 4 parts for the SOP on the same day?
[AGENT][NEUTRAL] Um, there's no specification.
[CUSTOMER][NEUTRAL] OK, no specification. And what about co build up and crown? Do you allow on the same day?
[AGENT][NEUTRAL] Yes, there is no specification for the dates.
[CUSTOMER][POSITIVE] OK, got it, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you know, like, uh, we have a new code which uh are listed. Can I just go ahead and provide you those uh new code? I'm not sure if it will be on the site or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. So around 4 or 5, I have 0367.
[AGENT][POSITIVE] You can give them to me all at once.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Oh, sure. 0431.
[CUSTOMER][NEUTRAL] 0470.
[CUSTOMER][NEUTRAL] 0801.
[CUSTOMER][NEUTRAL] And the last one is 1330.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I look through the claim um sorry, the codes?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] You don't have enough numbers.
[AGENT][NEUTRAL] 123
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] All right, thank you so much for holding. I do apologize for that wait. So I didn't see those codes on the um fax back, and I did fax it over to you as well, so you should be receiving it within the hour.
[CUSTOMER][NEUTRAL] OK, thank you. So if, if the, if a specific code is not listed on text, will that be considered as non-covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK. Do you have any reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. So again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][POSITIVE] Thank you very much. I got it and thank you so much. I'm actually done with my questions for today. I really hope you have a great day and stay safe. Happy Monday.
[AGENT][POSITIVE] Wow.
[AGENT][POSITIVE] Thanks, [PII] and thanks for calling APR. Have a good day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK, you too. Bye bye.