AccountId: 011433970860
ContactId: 5968c4f0-fa73-4ffe-9b58-20c8e5db9ac6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471690 ms
Total Talk Time (AGENT): 191121 ms
Total Talk Time (CUSTOMER): 216397 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/5968c4f0-fa73-4ffe-9b58-20c8e5db9ac6_20250225T21:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for a breakdown of benefits.
[AGENT][POSITIVE] OK, sure, I can assist you. And may I have your name?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] [PII] [PII] of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] The policy number is gonna be.
[CUSTOMER][NEUTRAL] 02576415
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] She already has an existing one that has open margins. Hello?
[AGENT][NEUTRAL] Yes, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] The name and date of birth is gonna be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And you need this information given to you verbally or faxed over to you, Miss [PII]?
[CUSTOMER][NEUTRAL] I need it given to me verbally because I was waiting for a fax and the patient is in front of me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just the verification of coverage and that's just a disclaimer. And let me pull his benefits one moment.
[CUSTOMER][POSITIVE] OK she was patient.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][NEUTRAL] What is the plan maximum?
[AGENT][NEUTRAL] OK, so um
[AGENT][NEUTRAL] Yes, the calendar, your maximum is $500 and the $50 is the deductible. Deductible does not apply to, mhm, go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Husband.
[CUSTOMER][NEUTRAL] The 50
[CUSTOMER][NEUTRAL] The plan maximum was.
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] $100?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And have they used anything?
[AGENT][NEUTRAL] Not right now as of today.
[CUSTOMER][NEUTRAL] Alrighty, and there's a $50 deductible, deductible has not been met?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] No, and deductible does not apply to preventative.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Does it provide, does it apply to diagnostic?
[AGENT][NEUTRAL] It does, yes. Radiograph FMXs cover 80%. Basic expense and basic restorative expenses cover 80%.
[CUSTOMER][NEUTRAL] Yeah, I know more than time.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Preventative cover 100%.
[AGENT][NEGATIVE] And this one doesn't have any major service. So endodontics, periodontics, rastoonic, repair, neurosurgeries are not covered.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] So they would be 100% out of pocket.
[AGENT][NEUTRAL] Correct. There's no coverage for the the major service.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And what is the frequency on the radiographs for diagnostics?
[AGENT][NEUTRAL] 80% on the frequency, I'm sorry that is once every 5 years for radiograph FMX panel.
[CUSTOMER][NEUTRAL] And are they shared?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I frequency would.
[CUSTOMER][NEUTRAL] And periodic exam for frequency?
[AGENT][NEUTRAL] OK, one moment, let me get that one pulled up.
[AGENT][NEUTRAL] OK, so for the regular exam, it's going to be limited to two oral evaluation procedures in any combination of 120, 140, 150, or 160 for 12 month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alrighty and bite wing frequency?
[AGENT][NEUTRAL] Once every 12 months.
[CUSTOMER][NEUTRAL] Panel is 21 in 5 years.
[AGENT][NEUTRAL] Yes, FMX radiograph and um panel is once every 5 years.
[CUSTOMER][NEUTRAL] And is there a frequency for profies?
[AGENT][NEUTRAL] For the pro fee it's gonna be once every 6 months.
[CUSTOMER][NEUTRAL] Um, for fluoride.
[CUSTOMER][NEUTRAL] to be.
[AGENT][NEUTRAL] Fluoride, um, it has a limitation on that. Um, it's limited to dependent children age [PII], and that's going to be one moment.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] In.
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And you said major restorative such as inlays online is not covered 100% patient?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Alrighty, endedonicserial removable 100% patient?
[AGENT][MIXED] Correct, it's not covered. The only extraction we cover is the simple extraction, and the 140.
[CUSTOMER][NEUTRAL] And you said it would only be.
[CUSTOMER][NEUTRAL] For all surgery.
[CUSTOMER][NEUTRAL] OK, and what about period on [PII] for 4341, any coverage?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So, no removable prosthodontics, no implant coverage, no bridge coverage.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] So that
[AGENT][NEUTRAL] Hm. Do you have any other questions?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] What about for consults 9310 or any injunctive clusal bar 9944?
[AGENT][NEUTRAL] Let me see, um, you said the first code you gave me, which one was it?
[CUSTOMER][NEUTRAL] It was console for D 9310.
[CUSTOMER][NEUTRAL] The lighter
[CUSTOMER][POSITIVE] Still durable and stronger.
[AGENT][NEUTRAL] United 10 it's gonna be under basic so that one is under basic which is covered and what's the other code you were giving me?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] 9944 is not covered.
[CUSTOMER][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] And is there a frequency on consult?
[CUSTOMER][NEUTRAL] And we're still on this company insurance.
[AGENT][NEUTRAL] OK, let me check on that one.
[CUSTOMER][NEUTRAL] [PII] we're gonna switch our insurance to.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] An advanced
[CUSTOMER][NEUTRAL] Is this pretty normal what insurance would cover, or is there a chance the insurance advantage plan would cover more?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] It's pretty
[AGENT][NEGATIVE] Yeah no.
[CUSTOMER][POSITIVE] The advantage
[AGENT][NEUTRAL] No limitations on that one, no.
[CUSTOMER][NEUTRAL] It doesn't have a frequency?
[CUSTOMER][NEUTRAL] OK, no limitations and no coverage on burial. OK, alrighty, I have what I need from you. Thank you so much. And what about one thing, 4910, is that considered basic for you guys or would it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Major. That's major, and it's not covered. Mhm.
[CUSTOMER][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] And it's not covered, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No ma'am, thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good afternoon.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Lovely.