AccountId: 011433970860
ContactId: 52969432-a652-42bc-99af-9ce0927538e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 797239 ms
Total Talk Time (AGENT): 229109 ms
Total Talk Time (CUSTOMER): 250403 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/52969432-a652-42bc-99af-9ce0927538e2_20250224T19:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Excuse me. Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Dental Depot. I was trying to verify eligibility for a patient and see if we're in network.
[AGENT][NEUTRAL] OK, I can verify eligibility for you and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is the policy number?
[CUSTOMER][NEUTRAL] It is let's see, so I have their member ID it's 02595679.
[AGENT][POSITIVE] OK, thank you. Give me one moment, please.
[AGENT][NEUTRAL] OK. And do you have a callback number, Ms. [PII], in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. The date of birth is let's see.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And this is for dental, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII], and he is active on the policy.
[CUSTOMER][NEUTRAL] OK and um is our office in network with them with your uh with the policy?
[AGENT][NEUTRAL] Uh, we don't have a network.
[AGENT][NEUTRAL] So our policies are open to where insurance can go to any dental provider and we do take assignment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is the group number?
[AGENT][NEUTRAL] 0033.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Excuse me, and Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, I will just need to ask a few more questions just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is the group name?
[AGENT][NEUTRAL] Uh, it's actually APLANH Group.
[CUSTOMER][NEUTRAL] APL A and H group.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the deductible on the plan?
[AGENT][NEUTRAL] Uh, there's a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] OK, and then the maximum.
[AGENT][NEUTRAL] Uh, Be max, uh, not a guarantee of payment, just a verification coverage is up to $1250 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is the PO box?
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and that was a calendar year correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it is a standard or non duplicating plan?
[AGENT][NEUTRAL] Uh, standard.
[CUSTOMER][NEUTRAL] OK, and the deductible applies to basic and major?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it does not apply to X-rays or preventative?
[AGENT][NEUTRAL] But it doesn't it apply to preventative.
[CUSTOMER][NEUTRAL] OK, it applies to X-rays?
[AGENT][NEUTRAL] Unless it's a preventative, like a bite wing that's considered preventative, but an FMX panel that's considered basic, so it does apply.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then let's see, preventative, what is it covered at?
[AGENT][NEUTRAL] Uh, preventive pays 100% of UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then do exams and pro fees apply to the maximum?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then X-rays.
[AGENT][NEUTRAL] All charges apply to the max.
[CUSTOMER][NEUTRAL] OK, and then what is the frequency on panos?
[AGENT][NEUTRAL] Uh, panos are once.
[AGENT][NEUTRAL] Oh, I'm sorry, once every 5 years and they do share a frequency with an FMX.
[CUSTOMER][NEUTRAL] OK, and what is the frequency on bye wings?
[AGENT][NEUTRAL] Uh, bike wings are one for 12 month period.
[CUSTOMER][NEUTRAL] OK and then what about exams?
[AGENT][NEUTRAL] Exams are 2 for 12-month period. All exams share the same frequency.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] OK and then for cleanings.
[AGENT][NEUTRAL] Queens are once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then uh for I'm assuming sealants, what age are they covered up to? Probably not on his plan.
[AGENT][NEUTRAL] Uh, seas under the age of [PII], once every 3 years, permanent owners only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is basic covered up?
[AGENT][NEUTRAL] Uh, basic is paid at 8%.
[CUSTOMER][NEUTRAL] OK and then what about D 9944?
[AGENT][NEUTRAL] Uh, it's considered major, and there is a 12-month waiting period for major services, so he wouldn't be eligible until [PII] of next year.
[CUSTOMER][NEUTRAL] OK, and what is that covered up?
[AGENT][NEUTRAL] 50% VCR.
[CUSTOMER][NEUTRAL] OK, and then there's, is there a downgrade to a magum benefit?
[AGENT][POSITIVE] Uh, there are no downgrades.
[CUSTOMER][POSITIVE] No downgrades, OK.
[CUSTOMER][NEUTRAL] And then and uh what is that covered up?
[AGENT][NEUTRAL] Uh, endo is considered major, so it pays at 50%.
[CUSTOMER][NEUTRAL] OK, and then for Perrio.
[AGENT][NEUTRAL] Uh, periodontics the same, considered a major, so it pays at 50.
[CUSTOMER][NEUTRAL] 50%.
[CUSTOMER][NEUTRAL] OK, is that the same for SRPs 4341?
[AGENT][NEUTRAL] Uh, yes. Endoerio oral surgery, crowns, uh, crowns, bridges, partial dentures are all considered major.
[CUSTOMER][NEUTRAL] OK, and then what is the frequency on SRPs?
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][NEUTRAL] OK, and then how many quads per visit?
[AGENT][NEUTRAL] All 4 quads can be done on the same day.
[CUSTOMER][NEUTRAL] OK, what is the frequency on Pao maintenance?
[AGENT][NEGATIVE] Uh, once every 6 months, and it does not share a frequency with a cleaning.
[CUSTOMER][NEUTRAL] OK, and the one about 4249, what does it covered up?
[AGENT][NEUTRAL] 424-9. What is that code?
[CUSTOMER][NEUTRAL] It is crown lengthening 4249.
[CUSTOMER][NEUTRAL] Billing OK
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] I do not show that it's covered.
[CUSTOMER][NEUTRAL] OK, and then what about 4240?
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] That does fall on a major, but let me see if there's a frequency. 42, what was that again? 42.
[CUSTOMER][NEUTRAL] 4240.
[CUSTOMER][NEUTRAL] Let's schedule your appointment real quick.
[CUSTOMER][NEUTRAL] I can go ahead
[AGENT][NEUTRAL] Uh, once
[AGENT][NEUTRAL] Every 24 months.
[CUSTOMER][NEUTRAL] OK, and it's at 50%?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then 7140.
[AGENT][NEUTRAL] Uh, that falls on the basic, so it pays at 80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 7210.
[AGENT][NEUTRAL] Uh, that falls under major.
[CUSTOMER][NEUTRAL] OK, 7220.
[AGENT][NEUTRAL] Uh, oral surgery falls on a major.
[CUSTOMER][NEUTRAL] OK, 7230.
[AGENT][NEUTRAL] The same
[CUSTOMER][NEUTRAL] And 7240.
[AGENT][NEUTRAL] The same.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then what is the replacement period on crowns?
[AGENT][NEUTRAL] Uh, crowns and bridges every 7 years.
[CUSTOMER][NEUTRAL] OK, and then dentures, that's considered a major paid 50%.
[AGENT][NEUTRAL] Uh, dentures and partials once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it pay on proper seat?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] OK and then are porcelain crowns covered on posterior teeth?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's see and then implants, are they covered?
[AGENT][NEGATIVE] Uh, implants are not covered, nor they're, uh, implant crowns.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and then or so is that covered at anything?
[AGENT][NEGATIVE] Or though it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, let me just make sure I got everything on here.
[CUSTOMER][NEUTRAL] Alright, and what is your name, ma'am?
[AGENT][NEUTRAL] Uh, it's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Thank you. All right, that's all I needed thank you so much.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Oh, actually there are a couple of questions I have sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK, is there a missing tooth clause or any waiting periods?
[AGENT][NEUTRAL] There's a missing tooth cloth and there's a 12-month waiting period for major services.
[CUSTOMER][NEUTRAL] OK, nothing for basic or major?
[AGENT][NEUTRAL] For major services, there is a 12-month waiting period, not for basic or preventative.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I apologize, OK, and then the deductible has not been met yet?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and nothing has been used on the maximum?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no that's all I needed thank you so much.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.