AccountId: 011433970860
ContactId: 53ac3fb2-6a8f-437d-bf99-a268b378a597
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1305910 ms
Total Talk Time (AGENT): 310060 ms
Total Talk Time (CUSTOMER): 481765 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/53ac3fb2-6a8f-437d-bf99-a268b378a597_20250123T16:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Angel Touch Dental Office. How are you today?
[AGENT][POSITIVE] I'm doing well. How are you doing today? You said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] [PII]. OK, thank you, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And um how can I help you today, Miss [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, so I have a young lady here that has a dental insurance card that I wanna know if we are in network, which I think we are. I wanna know if there's a PPO plan, and I wanna know what fee schedule we will file if that is the case.
[AGENT][NEUTRAL] OK, I can help you with um eligibility and the benefits and fee schedule. Uh, can you please give me the insured's name?
[CUSTOMER][NEUTRAL] Yeah, her name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's
[AGENT][NEUTRAL] [PII], OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] I do
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is um [PII]'s policy number?
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] 02441731
[AGENT][NEUTRAL] OK, let me pull in that policy.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And and she has, um, the, the dental policy is based on UCR for the fee schedule.
[AGENT][NEUTRAL] And she can use any dentist that she wants to use and if you give me your fax number I can send you a fax back that will have the complete breakdown for you as far as her benefits, what it pays, what the procedure code is, um, how to file the claim it has our uh.
[AGENT][NEUTRAL] Payer ID number on there for you I can send you.
[CUSTOMER][NEUTRAL] Can you email it to me instead?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I might be able to. I can try that, um.
[CUSTOMER][NEUTRAL] Can you try and see just in case I've been having trouble with my fax. I'm not 100% sure it'll go through, but now that I have you on the line, so we participating with this plan?
[AGENT][NEUTRAL] Do you not have a fax number?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, you, you, yes, she can use this plan.
[CUSTOMER][NEUTRAL] And we are, we are following parents and fees.
[AGENT][NEUTRAL] It is, um, the fee schedule is UCR, usual customary reasonable.
[CUSTOMER][NEUTRAL] Right, but I'm in network with Carrington, so that's why I'm trying to figure it out if I'm following [PII]'s fee schedule.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, yes, ma'am. Um, you'll actually follow this fee schedule that's on the fax back. Um, let me look up her information real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me pull in her facts back real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the name of the insurance is American Public Life, that's the name of it?
[AGENT][POSITIVE] Yes, yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Does it have an annual max or no?
[AGENT][POSITIVE] Yes, I'm pulling it in now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a moment while it loads.
[AGENT][POSITIVE] I'm getting it prepared for you now so that I can um.
[AGENT][NEUTRAL] Try to email it to you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright, give me one second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right, tell me.
[CUSTOMER][NEGATIVE] No, no, no, not make it.
[CUSTOMER][NEUTRAL] pan.
[CUSTOMER][NEUTRAL] Be.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well locaso oyega no mamos uh.
[CUSTOMER][NEUTRAL] Total information.
[CUSTOMER][NEUTRAL] See you not to be uh via loladiredalinota so ok one number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It didn't get the info.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I know you get to tell us.
[CUSTOMER][NEUTRAL] Um, are we still on the line, ma'am?
[AGENT][NEUTRAL] Yes, ma'am, we are. I'm gonna go ahead and try to fax it to you because it's having a hard time, um.
[CUSTOMER][NEUTRAL] OK, how many pages? I sure I have enough paper in there.
[AGENT][NEUTRAL] Come to
[AGENT][NEUTRAL] Yes, ma'am. It is 4 pages.
[CUSTOMER][NEUTRAL] it's
[CUSTOMER][NEGATIVE] I see 4 pages. OK, that's fine. You, I think you don't feel like this is estimate delivery errero DS perpoerante.
[AGENT][NEUTRAL] OK, what is your fax number?
[CUSTOMER][NEUTRAL] [PII] um it's [PII].
[AGENT][POSITIVE] Thank you, ma'am. All right, I'm gonna get this right on the way to you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Ah, it's a no, it's a big one. hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK, give me one second
[AGENT][NEUTRAL] I've got that fax back on its way to you.
[CUSTOMER][NEUTRAL] OK, I'm gonna have to go check. Give me a minute, OK?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Thank you. um, this queue.
[CUSTOMER][NEUTRAL] No puente.
[CUSTOMER][NEUTRAL] OK, you don't go away one is so darling ok there you know the same.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, I understand, but.
[CUSTOMER][NEUTRAL] OK I want.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Um, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, well I'm still waiting for the fast. Can you just um give me the deductible? How much is the deductible?
[AGENT][NEUTRAL] Yes ma'am I that to you, let me pull that in.
[CUSTOMER][NEUTRAL] Any.
[AGENT][NEUTRAL] OK, it has a and this is just to verify her coverage. It's not a guarantee of payment. It has a 500.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] dollar per covered insured calendar year maximum and calendar year deductible $500 she has a low and she has a $50 deductible per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] $500?
[CUSTOMER][NEUTRAL] So the annual max is $550 is the deductible.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so for 0150, what, what, what she's responsible for?
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] And also just so you know on the fax back if um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The procedure because not on the fax back then it's not covered.
[CUSTOMER][NEUTRAL] Got you. OK, let me go check and see if it came through. OK, what.
[AGENT][NEUTRAL] 150 is preventative, so her preventative is um 100% of the allowable amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what does she pay nothing?
[AGENT][POSITIVE] Right, it's 100%.
[CUSTOMER][NEUTRAL] OK, and 0 to 10?
[AGENT][NEUTRAL] Uh, let me look for that is that one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What kind of procedure is it?
[CUSTOMER][NEUTRAL] Uh, D 0 to 10 is a full mouth X-ray.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEGATIVE] You have the same, you have the same insurance? You just messed us from last year, December.
[AGENT][NEUTRAL] She gets a full mouth X-ray and pangramics once every 5 years, and let me see you said it was 0210?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But then.
[CUSTOMER][NEUTRAL] Now that 0150 is coming out of her yearly max.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, debating.
[CUSTOMER][NEUTRAL] But I guess I guess.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Uh, [PII] so yeah.
[CUSTOMER][NEUTRAL] I said nothing I can say OK at time.
[CUSTOMER][NEUTRAL] Come on. I'm sorry.
[AGENT][POSITIVE] That's all right.
[AGENT][NEUTRAL] It's 80% the 0 to 10 is 80% of the allowable amount.
[CUSTOMER][NEUTRAL] OK, and does deductible apply?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, does she have any history?
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] OK, I'll be right back when you do that.
[AGENT][NEUTRAL] No ma'am, I do not see that any claims have ever been filed on this policy.
[CUSTOMER][NEUTRAL] OK, good. What about 4341?
[AGENT][NEUTRAL] 4341.
[AGENT][NEUTRAL] And what is 43, 41? What is the description?
[CUSTOMER][NEUTRAL] It's a scanning group planning.
[AGENT][NEUTRAL] OK, and um what is the category?
[CUSTOMER][NEUTRAL] How are you?
[CUSTOMER][NEUTRAL] I think I better check the facts so that way I don't, I don't take too much of your time. You wanna wait one.
[AGENT][NEUTRAL] Right, she has, she only has basic.
[CUSTOMER][NEUTRAL] I would say here.
[CUSTOMER][NEUTRAL] Mhm, she has what?
[AGENT][NEUTRAL] She only has basic, she only has basic um coverage. She doesn't have um.
[CUSTOMER][NEUTRAL] Mayor
[AGENT][NEUTRAL] Yes, she doesn't have major, just basic.
[CUSTOMER][NEUTRAL] But, but
[CUSTOMER][NEUTRAL] Yeah, but 43, 41 is basic, because it's a cleaning, it's a big cleaning.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. It's a cleaning. OK, I'm looking to see.
[CUSTOMER][NEUTRAL] Right, it's a periodontal cleaning.
[CUSTOMER][NEUTRAL] only basico.
[CUSTOMER][NEUTRAL] See, but I'm gonna, I'm gonna find out now. I was gonna go and check the fax so that way I can just hang up and do it from there, but I don't wanna leave her there waiting.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] She gets uh cleaning once every 6 months.
[CUSTOMER][NEUTRAL] Yeah, that's for regular cleaning the D110. I'm asking about the D4341 that's for on the periodontal cleaning.
[CUSTOMER][NEUTRAL] And that should be basic in my understanding.
[AGENT][NEUTRAL] OK. I'm looking, I have not seen it on the fee schedule yet.
[CUSTOMER][NEUTRAL] 4341, no. What about 4355?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 4355.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is not on the fee schedule either.
[CUSTOMER][NEUTRAL] whatever.
[AGENT][NEUTRAL] OK, is there anything else I can help you with before we go?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Give me a second, please.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Give me a second, please.
[CUSTOMER][NEUTRAL] See you later.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am. Are you there?
[CUSTOMER][NEUTRAL] Yeah, I, I was, I was just trying to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I was just trying to give you uh a little break on this one. once say 5 years, so this what you gave me doesn't give me.
[CUSTOMER][NEUTRAL] The history, it only gives me what is covered.
[AGENT][NEUTRAL] Right, she doesn't have a history we checked that already. There were no claims filed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you said whatever is not there is not covered, so.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So she doesn't have that kind of coverage, OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And let me see if I understand this correctly.
[CUSTOMER][NEUTRAL] Um, what is the A and the D stands for?
[AGENT][NEUTRAL] It's down at the bottom.
[AGENT][NEUTRAL] It'll have your codes down at the bottom.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And when you say let me see here you said it gives me the information where I'm supposed to submit this?
[AGENT][NEUTRAL] Yes, that's in the middle. You'll see in the middle claims must may be submitted to our office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Electronically.
[CUSTOMER][NEUTRAL] I see it mhm and this payer ID is 6081 and you said 80% of the allowable.
[AGENT][NEUTRAL] Right, that's up at the top.
[CUSTOMER][NEUTRAL] So I have to go into Carrington um fee schedule and from whatever that price is is 80%.
[CUSTOMER][NEUTRAL] Oh, it's 80% from my fee schedule.
[AGENT][NEUTRAL] It's 80% of the UCR usual customary reasonable.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So preventative, is that OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I see. OK, work with this. Thank you.
[AGENT][POSITIVE] Good.
[AGENT][POSITIVE] You're very welcome. You have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] OK, you too, thank you.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye.