AccountId: 011433970860
ContactId: 56fb2da7-02d0-485d-bf7d-944229e93d4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 938599 ms
Total Talk Time (AGENT): 232603 ms
Total Talk Time (CUSTOMER): 279568 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/56fb2da7-02d0-485d-bf7d-944229e93d4e_20250227T22:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII] from Self Touch Dentistry. I was looking for dental benefits for a patient, please.
[AGENT][POSITIVE] Sure, I can assist you with benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure it is [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Doctor [PII]
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I'm sure, let's take a look here. It is 021.
[CUSTOMER][NEUTRAL] 86378.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Um, sure, it is [PII] and it's [PII].
[AGENT][POSITIVE] Perfect. Thank you. And you need the benefits given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Um, I'm gonna need both actually if you can fax it, I'm just gonna see, can you check if we're in network?
[AGENT][NEUTRAL] This one doesn't have a network, we pay on the usual and customary rates.
[AGENT][NEUTRAL] UCR.
[CUSTOMER][NEUTRAL] OK, let me take
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's a fee it's like a UCR fee schedule type of thing, OK. What is like what is preventative and basic and major covered at?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. Um, preventative cover 100%. Radiograph FMX, including basic and basic restorative, is 80%, and major service is 40% after the 12 month waiting period, which he's already out of the waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He is OK um I need to check a couple um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Codes for me if you can because a lot of times fax backs do not have it.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So one of the codes is D2991.
[AGENT][NEUTRAL] Bear with me just a second, let me pull that schedule.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and that was um code 2111.
[CUSTOMER][NEUTRAL] Uh, D 2991, it's Carreon.
[AGENT][NEGATIVE] The 2991 is not covered.
[CUSTOMER][NEUTRAL] I'm not a cover benefit, OK, um, how about night guards D 9944?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9944 is not covered, you know.
[CUSTOMER][NEUTRAL] Not covered, OK, um, how about SRPs D 4341 D 4342?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, 4341 is going to be under periodontics, which is under major, so it's 40% and it's gonna be um limitation on that one is maximum of 1 in quad for 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can all 4 quadrants be done in one visit?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] It is, you can, OK, perfect. Um, how about implants 60,106,010, it is not covered?
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, implants are not covered.
[CUSTOMER][NEUTRAL] OK, and then also implant crowns and abutments D 6058 and D 6059.
[CUSTOMER][NEUTRAL] And the 6069.
[AGENT][NEUTRAL] 6058 is not covered. And you said the other one is 6069?
[CUSTOMER][NEUTRAL] Right, and the 6059.
[AGENT][NEUTRAL] OK, 69 is not covered.
[AGENT][NEGATIVE] And 159 is not covered.
[CUSTOMER][NEUTRAL] No, OK, um, are crowns, are they.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Downgraded at all?
[AGENT][NEUTRAL] No, there's no downgrades or upgrade.
[AGENT][NEUTRAL] And it's pay day.
[CUSTOMER][POSITIVE] OK, even composite like the composite fillings, there's no downgrades?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] No down
[CUSTOMER][POSITIVE] Great, um, are the crowns, are they paid upon prep or seat date?
[AGENT][NEUTRAL] The dates.
[CUSTOMER][NEUTRAL] Seat OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, let's see here.
[CUSTOMER][NEUTRAL] Um, fluoride, is that covered for adults or just children? D 1206?
[AGENT][NEUTRAL] Under the under the age of [PII].
[CUSTOMER][NEUTRAL] Oh, only each if in [PII] and 100%, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A 19 to downgrade. Let me take a look here. How about um sedation for nitrous D 9230?
[AGENT][NEUTRAL] 9230, that's going to be it looks like on the major, yes, that's major service that's 40% and there's no limitation on that one.
[CUSTOMER][NEUTRAL] OK, so nitric it is covered at 40%. Let me put that in here, 40%.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For D 92,309,230, um, our socket graph D 7953, is that a covered benefit?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 7953 is not covered.
[CUSTOMER][NEGATIVE] Not a cover benefit how about.
[CUSTOMER][NEUTRAL] D 4346.
[AGENT][NEUTRAL] 8346.
[AGENT][NEUTRAL] 4346 is not covered.
[CUSTOMER][NEGATIVE] Oh, it is not OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, um, is there any history on this patient at all?
[AGENT][NEUTRAL] I can check. Let's see.
[CUSTOMER][NEUTRAL] For any of them because I know it's for is the individual for husband and wife.
[AGENT][NEUTRAL] This is a family plan.
[CUSTOMER][NEUTRAL] It is a family plan? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there's no history for [PII].
[CUSTOMER][NEUTRAL] OK, so no history and nothing's been met for either one of them.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what's the maximum benefit per year?
[AGENT][NEUTRAL] And your maximum is $1500 with the $50 deductible.
[CUSTOMER][NEUTRAL] OK, for family or individual?
[AGENT][NEUTRAL] That individual is 150 per family.
[CUSTOMER][NEUTRAL] OK, is there any waiting periods or any missing tooth claws?
[AGENT][NEGATIVE] Um, there was a waiting period, but it's already been met, um, and there is a missing tooth cloth, yes.
[CUSTOMER][NEUTRAL] There is OK, so yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there is waiting periods, but it's met. How long and it's been met. How, how long is it usually for for waiting periods?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a 12 month waiting period, 12 months. Mhm. Yes, and this policy has been effective since [PII]. Let me see what's the exact date.
[CUSTOMER][NEUTRAL] 12 months? OK.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and do you have a payer ID number?
[AGENT][NEUTRAL] Yes, the payer ID number is 60801.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Payer ID OK, and what is the ID number? Is that ID number that I gave you, is that correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Is there a group plan number?
[AGENT][POSITIVE] Yes, let me get that for you.
[AGENT][NEUTRAL] OK. The number, the group number is 24702.
[CUSTOMER][NEUTRAL] 2424 say that one more time.
[AGENT][NEUTRAL] 24702.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK and you said we are in network?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] OK, no net there's no network.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this is based on the calendar year, is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And OK, I think that is it um if you don't mind just sending me a fax back because well that give me like the um.
[CUSTOMER][NEUTRAL] Frequencies like profies and FMX and all of that?
[AGENT][NEUTRAL] Yeah, it's gonna give you a breakdown of all the codes that we cover with their limitations and the percentages.
[CUSTOMER][POSITIVE] Oh perfect yeah if you don't mind sending that to me because I just need a couple more but I think that could be straightforward with the breakdown hopefully.
[AGENT][NEUTRAL] Mhm. Yes, I'm looking at the same thing that I'm sending you. Yeah, that's where I'm checking. All right. uh yeah.
[CUSTOMER][NEUTRAL] Everything
[CUSTOMER][POSITIVE] Oh good perfect yeah.
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, and how do you spell your name?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you right now?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh sure, go ahead.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Miss [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, let's see, what's the reference number in your name again?
[AGENT][NEUTRAL] My name is [PII]. That's S [PII]. Last [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK perfect I appreciate it thank you very much for your help. I'll look out for that uh fax.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.