AccountId: 011433970860
ContactId: 562746c7-6e3e-4313-8767-f4dbad347b9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252580 ms
Total Talk Time (AGENT): 79918 ms
Total Talk Time (CUSTOMER): 108283 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/562746c7-6e3e-4313-8767-f4dbad347b9a_20250612T15:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I'm calling from Queen City Dentistry. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Doing good. Hey, I'm calling to hopefully get a breakdown of benefits for a patient who's coming into our office tomorrow.
[AGENT][POSITIVE] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what was the policy number for the patient?
[CUSTOMER][NEUTRAL] It is 02608684.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] Um, the patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, um, so the policy is active and effective [PII]. I can send over a fax back that outlines all of the codes that are covered with frequency and duration, um, unless there's something you need to go over on the phone.
[CUSTOMER][NEUTRAL] Um, perfect, yeah, that would be great. Um, I do just have a question, um, so we're not in network with this plan. Does the patient have out of network benefits?
[AGENT][NEUTRAL] Uh, yes, they can go to any dentist they like.
[CUSTOMER][NEUTRAL] OK perfect and it'll and do you guys pay um on UCR?
[AGENT][POSITIVE] We do, yes.
[CUSTOMER][NEUTRAL] You do? OK, perfect. And then while you're on the phone, um, I'm just gonna ask if you don't mind if I ask for um two different codes just to see if there's coverage in case it's not on the on the breakdown.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so the first code, um, is 7230.
[AGENT][NEUTRAL] Uh, yes, it's under oral surgery, um, which is
[AGENT][NEUTRAL] Uh, not a guarantee of payment, basic outline of the policy. Oral surgery pays 40%, um, but there is a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK perfect and then what about um 923-9 um sedation?
[AGENT][NEUTRAL] I'm not showing that code under the policy.
[CUSTOMER][NEUTRAL] OK, so not covered, perfect. So it's, um, so basic you said is at 40%.
[AGENT][NEUTRAL] Um, so they've got preventative pays 100% and then X-rays are actually under basic and then basic restorative, which would be like filling those pay 80% after a $50 deductible and then major endo perio and oral all falls under basically major pays 40% and there's a 12 month waiting period.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, and then, yes, if you don't mind if I could get the fax, um, if you could take the fax number and send me a breakdown of the benefits.
[AGENT][POSITIVE] Yeah, absolutely. What's your facts?
[CUSTOMER][NEUTRAL] OK, it's 704.
[CUSTOMER][NEUTRAL] 544.
[CUSTOMER][NEUTRAL] 8722
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes a few minutes. And is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Um, no, I think on the card it had the group number and payer ID and everything, um, and PO box. Um, is this a calendar year or is it a plan year?
[AGENT][NEUTRAL] Uh, looks like this is a calendar year.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][POSITIVE] OK, I will look out for that fax. Thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.