AccountId: 011433970860
ContactId: 52d891f1-171e-4319-a23d-702904e9f415
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697539 ms
Total Talk Time (AGENT): 279328 ms
Total Talk Time (CUSTOMER): 286200 ms
Interruptions: 7
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/52d891f1-171e-4319-a23d-702904e9f415_20250228T17:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling ATL. speaking. May I help you?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I'm with Plano Smile Center. I just wanna verify some benefits over the phone for a patient of ours.
[AGENT][NEUTRAL] OK, I can verify benefits for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It for you [PII], and
[CUSTOMER][NEUTRAL] I don't have the policy number. I was hoping maybe I could use the Social Security.
[AGENT][NEUTRAL] Is it the social of the policyholders?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, what's that social?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Um, I don't show her social. Uh, you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII] the [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I apologize again. What was her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And if you like, I can give you her policy number with our company.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's 1371798.
[CUSTOMER][NEUTRAL] OK, yeah
[CUSTOMER][NEUTRAL] OK, so you said 1371798.
[AGENT][NEUTRAL] Yes, ma'am. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, and do you have
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and you say you're calling for benefits, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's correct. I first wanna see if our office is in network with this policy.
[AGENT][NEUTRAL] Oh, we don't have a network. Our policies are open.
[CUSTOMER][NEUTRAL] We don't have a network
[CUSTOMER][NEUTRAL] All right, does this patient have dental benefits?
[AGENT][NEUTRAL] They do, yes, ma'am, and the policy pays by UCR.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] UCR OK.
[CUSTOMER][NEUTRAL] And then could I have the
[CUSTOMER][NEUTRAL] The group name and group number.
[AGENT][NEUTRAL] Uh, yes. Group name is Universal Trucking MTP uh MTB Transport.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh MTB
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] And the group number is 19864.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then could I get the payer ID number?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and then what is the effective date?
[AGENT][NEUTRAL] Uh, her effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and then does this run on a calendar year policy?
[AGENT][NEUTRAL] It's calendar year. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is the annual max and what is remaining?
[AGENT][NEUTRAL] Um, not a guarantee of payment, just a verification of coverage. Uh, they have a benefit max up to 1500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They're here
[AGENT][NEUTRAL] And there is a $50 deductible on everything but preventative services.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and then could I get the coinsurances for preventative, basic, and major?
[AGENT][NEUTRAL] Uh, for preventative, it pays 100% of UCR. Basic, basic restorative FMX panoramic pays at 80%, and major pays it at 40%.
[CUSTOMER][NEUTRAL] is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] At 40%
[CUSTOMER][NEUTRAL] OK, and then is there any waiting periods for a missing tooth cloths?
[AGENT][MIXED] Um, there is a 1212 month waiting period for major, but they've already satisfied that and there is a missing tooth claws.
[CUSTOMER][POSITIVE] they've already satisfied OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um for 0120 could I get the percentage and frequency on that?
[AGENT][NEUTRAL] Uh, exams are 2 for 12 month period and all exams share the same frequency, and for that one it's considered preventative, so it pays 100% of UCR.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] period
[CUSTOMER][NEUTRAL] I'm sure the same frequency and for.
[CUSTOMER][NEUTRAL] It considered.
[CUSTOMER][NEUTRAL] OK, and then for 0140, um, could I get that frequency as well?
[AGENT][NEUTRAL] Uh, the same, all exam exams share the same frequency.
[CUSTOMER][NEUTRAL] OK, and then for the 0140 can treatment be done the same day?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes I am
[CUSTOMER][NEUTRAL] OK, and then for 1110 could I get the frequency?
[AGENT][NEUTRAL] Uh, 1110. I said cleaning, uh, once every 6 months.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, and then for 12:08.
[AGENT][NEUTRAL] Uh, once every 12 months under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 1351.
[AGENT][NEUTRAL] Uh, sea lights are under the age of 14, permanent molars only once every 3 years.
[CUSTOMER][NEUTRAL] Once every 3
[CUSTOMER][NEUTRAL] OK, and then for 0274.
[AGENT][NEUTRAL] Uh, by going for 1 to 12 month period.
[CUSTOMER][NEUTRAL] OK, and then 0330.
[AGENT][NEUTRAL] Uh, pen out once every 5 years and it does share its frequency with the full mouth.
[CUSTOMER][NEUTRAL] OK, and that one is covered under 80, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for 0220.
[AGENT][NEUTRAL] Uh, there's no frequency and it falls under basic, so it pays at 80.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, for 4910.
[AGENT][NEUTRAL] Um, that is major, and it's once every 6 months, so it pays at 40%.
[CUSTOMER][NEUTRAL] Pay that 40%.
[CUSTOMER][NEUTRAL] OK, and does it share frequency with the pro fee?
[AGENT][NEGATIVE] It doesn't.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then for 4341.
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][NEUTRAL] Every
[CUSTOMER][NEUTRAL] OK, and that is that covered under major as well?
[AGENT][NEUTRAL] It is, yes, ma'am.
[CUSTOMER][NEUTRAL] And can all 4 quads be done the same day?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK, and then for 4381.
[AGENT][NEUTRAL] Um, there's no frequency, but it is considered as a major.
[CUSTOMER][NEUTRAL] But it is considered as.
[CUSTOMER][NEUTRAL] For 9944.
[AGENT][NEUTRAL] Um, it is once every 7 years and it's major.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Years is OK, and is it for Brookism only?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, for 90 to 30.
[AGENT][NEUTRAL] Uh, it falls on a major and I don't show there's a frequency.
[CUSTOMER][NEUTRAL] And a major and I don't show there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for 2391.
[AGENT][NEUTRAL] 239.
[AGENT][NEUTRAL] Uh, once every 24 months, and it is basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does it have an alternate benefit or downgrade?
[AGENT][POSITIVE] No, ma'am, there's no downgrades for fillings or crowns.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for 2740 could I get the frequency?
[AGENT][NEUTRAL] Uh, once every 7 years.
[CUSTOMER][NEUTRAL] Every 70 years.
[CUSTOMER][NEUTRAL] OK, and then do you guys pay on prep date or Ct date?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for 2950?
[AGENT][NEUTRAL] Uh, once every 7 years and its major.
[CUSTOMER][NEUTRAL] 7 years this major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4 51 10.
[AGENT][NEUTRAL] Uh, once every 5 years.
[CUSTOMER][NEUTRAL] OK, and then for 3330.
[AGENT][NEUTRAL] 333 1 moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there's not a frequency, but it is considered major.
[CUSTOMER][NEUTRAL] But it is considered major. OK. 4 7210.
[AGENT][NEUTRAL] Uh, that is basic.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] For 6, yeah, correct.
[AGENT][NEUTRAL] Oh wait, you said 7210. I'm sorry.
[AGENT][NEUTRAL] Oh, that's also his major, sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then for 6010.
[AGENT][NEUTRAL] Uh, what is that code for?
[CUSTOMER][NEUTRAL] For implants.
[AGENT][NEGATIVE] Uh, implants are not covered.
[CUSTOMER][NEUTRAL] OK, and then is there ortho coverage?
[AGENT][NEUTRAL] Uh, no, ma'am. There's no ortho.
[CUSTOMER][NEUTRAL] OK, and what is the coordination of benefits policy?
[AGENT][NEUTRAL] Uh, standard.
[CUSTOMER][NEUTRAL] OK and then is there any history on file that might affect frequency for this patient?
[AGENT][NEUTRAL] Uh, give me one moment to see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, no, that wouldn't affect that. No, mom.
[AGENT][NEUTRAL] Uh, no, ma'am, not unless she's having a periodontal scaling. I'm showing that was [PII] at [PII], so she wouldn't be eligible until
[CUSTOMER][NEUTRAL] [PII] at [PII].
[CUSTOMER][NEUTRAL] Be eligible until.
[AGENT][NEUTRAL] Next year? Wait, it's [PII]. So she would be eligible, never mind. So I don't see anything in the history that would affect.
[CUSTOMER][NEUTRAL] would be
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, frequency.
[CUSTOMER][NEUTRAL] OK, and then by chance could I get the claims address?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm so sorry, [PII].
[AGENT][NEUTRAL] Uh-huh, [PII].
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][POSITIVE] OK, perfect. Alrighty, I think that should be it if I could just get your name and the reference number for this call.
[AGENT][NEUTRAL] Uh, my name is [PII], and we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, thank you so much. You have a great rest of your day.
[AGENT][POSITIVE] Oh, you too, Ms. [PII], and thank you for calling APL. Have a great day and weekend. Bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm bye bye you too bye bye.