AccountId: 011433970860
ContactId: 5cdd1437-7415-4cdd-9846-a4d81ad0c41b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3025199 ms
Total Talk Time (AGENT): 824163 ms
Total Talk Time (CUSTOMER): 954878 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/2025/03/25/5cdd1437-7415-4cdd-9846-a4d81ad0c41b_20250325T14:03_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from providers and office. Could you please help me with the alternate verification of the patient?
[AGENT][NEUTRAL] Sure, I can assist you with eligibility, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes. Uh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] 154798207.
[AGENT][NEUTRAL] OK, that's too many numbers. Do you have the the copy of the card, the APL card?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Could you please, uh, this is which carrier?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, this is APL American Public Life Insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] American
[CUSTOMER][NEUTRAL] Public.
[CUSTOMER][NEUTRAL] Uh, life insurance company, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. And uh could you please hold for one moment? Is it OK for you?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh hello. Could you please provide the payer ID for this, uh, payer ID for?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For American public life insurance?
[CUSTOMER][NEUTRAL] Yes, payer ID.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just, uh, and so this patient have a plan. Does this patient is have an active plan?
[AGENT][NEUTRAL] With us, do you have a policy number? I, I haven't got a policy number that is our policy number, Miss [PII].
[CUSTOMER][NEUTRAL] Uh, I don't have the new policy number. I have the name and date of birth. Could you please do a name and date of birth, sir?
[AGENT][NEUTRAL] OK, what is the spelling of the last name?
[CUSTOMER][NEUTRAL] Uh, [PII]. One moment, please.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. And the date of birth was [PII].
[AGENT][NEGATIVE] I didn't get the first thing.
[CUSTOMER][NEUTRAL] Uh, sorry, it's [PII].
[CUSTOMER][NEUTRAL] So I.
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[AGENT][NEUTRAL] [PII] [PII] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me try that one moment.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Ah, and could you please, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And you said that the date of birth was [PII], correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I did find a policy on the policy effective date is [PII], and it is active at the moment.
[CUSTOMER][NEUTRAL] OK. Could you please uh provide the uh address for your career?
[AGENT][NEUTRAL] OK, the address is make claims.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, bear with me just a second, let me check on this one. OK, this one goes to IMA before it comes to us. So it will go to IMA [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, sorry. Uh, no, I need your office address, carrier address.
[AGENT][NEUTRAL] Is it to send claims or is it just for verification of where we're located?
[CUSTOMER][NEUTRAL] Uh, for claims also.
[AGENT][NEUTRAL] If it's for claims, it's different. If it's for claim it's IMA it has to go to IMA before it comes to us. It cannot come to us directly. So, um, it goes to IMA and that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, uh.
[CUSTOMER][NEUTRAL] What is the ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And which city?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you please spell?
[CUSTOMER][NEUTRAL] And the address line?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's state, right? OK.
[CUSTOMER][NEUTRAL] Uh, and the phone number?
[AGENT][NEUTRAL] The phone number for us or the phone number for them?
[CUSTOMER][NEUTRAL] Phone number for them.
[AGENT][NEUTRAL] OK, the number for IMA is [PII] option one.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, no. Uh, could you please give your address, uh, could you please give an, uh, phone number, please?
[AGENT][NEUTRAL] Uh, which phone number you need our phone number or their phone number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, your, uh, could you please hold for one moment, please?
[AGENT][NEUTRAL] Sure, yes.
[CUSTOMER][NEUTRAL] Could you please repeat their phone number, the claims, where the claims go. I need the phone number of their.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Option one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. And uh what is the uh name, uh address line?
[AGENT][NEUTRAL] The name of what? I'm sorry?
[CUSTOMER][NEUTRAL] Uh, of that, uh, where the claims go.
[AGENT][NEUTRAL] I am, [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you. Thank you so much for confirming that. One moment, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Could you please confirm the provider participation?
[AGENT][NEUTRAL] We don't have any networks.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That's how you say it's a very, a very
[AGENT][NEGATIVE] There's no network, there's no network.
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the plan name is LARC LLC with the group number 70083?
[AGENT][NEUTRAL] Let me go there one moment.
[CUSTOMER][NEUTRAL] And could you please give me the carrier identifier also?
[AGENT][NEUTRAL] I'm not sure what's that, Miss [PII], but yeah, the group number is 70083 but Lak LAC.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And the effective date is uh [PII].
[AGENT][NEUTRAL] Let me go back
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And the subscriber is the patient itself, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh OK uh.
[CUSTOMER][NEUTRAL] OK. One moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You go.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] You know what I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] You would, you would see.
[CUSTOMER][NEUTRAL] Just a moment. I have a different carrier in my in my system, so I want to add a new carrier. So, so I make you all, is it OK for
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's fine. It's OK.
[CUSTOMER][POSITIVE] Sorry for that. Thank you.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me know let me.
[CUSTOMER][NEUTRAL] My little
[CUSTOMER][NEUTRAL] Uh, so once more confirming the subscriber is the patient itself and the plan name is [PII] with the group number 70083 with the effective date of [PII].
[AGENT][POSITIVE] Mhm, yes, correct.
[CUSTOMER][NEUTRAL] OK. And the plan will reset on a calendar year?
[AGENT][NEUTRAL] I'm sorry, can you repeat that part?
[CUSTOMER][NEUTRAL] Yes, yes. The, the the plan will reset on every calendar year.
[AGENT][POSITIVE] Yes, yeah, calendar year. That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, what is the coordination of benefits for this plan?
[AGENT][NEUTRAL] Um, you said the coordination of innocence?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] You don't coordinate.
[CUSTOMER][NEUTRAL] OK. If there is any missing too close or waiting date for this flight?
[AGENT][NEUTRAL] The what? I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Yes, if there is any missing tooth cloth or waiting paid for this plan?
[AGENT][NEUTRAL] Uh, this is not a dental. You need a dental information or medical information?
[CUSTOMER][NEUTRAL] That I need a dental information.
[AGENT][NEUTRAL] So you're not calling about the medical, you're calling about the dental all this time.
[AGENT][NEUTRAL] Bear with me. I'll have to go back to the dental, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment, OK.
[CUSTOMER][NEUTRAL] OK. And uh so for the dental and the Medicare, does this carrier ID same?
[AGENT][NEUTRAL] No, everything is different.
[CUSTOMER][NEUTRAL] Why, uh, so I need the dental information.
[AGENT][NEUTRAL] Yeah, yeah. Yeah, Miss [PII], you needed to let me know that it was dental because yeah everything is different.
[AGENT][NEUTRAL] And I was giving you medical information.
[AGENT][NEUTRAL] Give me just a minute, OK. I need to pull the dental information now.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so we will have to start all over again, OK, because everything is different. You will have to erase everything you have in the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, uh,
[AGENT][NEUTRAL] The dental, we have a different policy for the dental. So let me give you the correct policy number for the dental and the dental does not go to IMA so IMA is not gonna be for this one at all.
[AGENT][NEUTRAL] Um, let me know when you're ready for the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, uh, first I need to get your information.
[AGENT][NEUTRAL] What carrier information, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, address, ZIP code, state, phone number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], uh, what carrier, what, what information are you trying to get?
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] Where the claims cost.
[AGENT][NEUTRAL] Where the claim goes. OK. So the, for the dental, the claim goes to APL to American Public Life.
[CUSTOMER][NEUTRAL] OK. And uh the ZIP code for them?
[AGENT][NEUTRAL] The address because it's a totally different address and let me give it to you. Let me know when you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, no, wait, wait. I will ask you one by one. Yeah, no. Uh, uh, first, uh, I need the, uh, zip code.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, could you please repeat one more time, sorry. [PII].
[AGENT][NEUTRAL] No, no, no, no, no, no. [PII].
[CUSTOMER][NEUTRAL] OK. And the state and the city?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] And the phone number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And OK.
[CUSTOMER][NEUTRAL] I know. I need the plan name and the group number. So this plan also the subscriber reciation itself, right?
[AGENT][NEUTRAL] Yes, the subscriber is Mr. [PII].
[CUSTOMER][NEUTRAL] OK. And the plan name and the group number?
[AGENT][NEUTRAL] This is a dental basic policy, basic dental policy.
[CUSTOMER][NEUTRAL] OK. So the plan name and the group number.
[AGENT][NEUTRAL] The plan name is the dental basic policy. The group is 70083.
[AGENT][NEUTRAL] And it's still with Lark LLC.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the plan name is Dal Basic LLC.
[AGENT][NEUTRAL] Dental, dental basic.
[CUSTOMER][NEUTRAL] OK. And the group number is 70083.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And, OK. And the plan name is Basic dental with the group number 70083 with the effective date of [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the plan will reset on every calendar year and it is a BPO type plan, right?
[AGENT][NEUTRAL] No, it's not a PPO an HMO it's a commercial plan.
[CUSTOMER][NEUTRAL] Uh, this is H HMO type plan?
[AGENT][NEUTRAL] Commercial.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Commercial, commercial.
[CUSTOMER][NEUTRAL] Commercial plan. Does the commercial plan, uh,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Does it verified as HMO or PPO?
[AGENT][NEUTRAL] It's not an HMO or a PPO.
[AGENT][NEUTRAL] The commercial plan.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. What is the coordination benefits for this plan?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] OK. And there is no network for either, right, for you.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] If there is any missing tooth or waiting period?
[AGENT][NEGATIVE] Not for this one.
[CUSTOMER][NEUTRAL] Sorry? There is no missing tooth cloth or no waiting period?
[AGENT][NEGATIVE] Correct, not for this one. There's no major service under this one. It's just basic, no major.
[AGENT][NEUTRAL] So endodontics, periodontics, prosthetic repair or surgery, they're not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, yeah, we will come to. So that pre-authorization is required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And if there is any maximum for this plan?
[AGENT][POSITIVE] Oh yes, let me get that.
[AGENT][NEUTRAL] To your maximum is $500 with the $50 deductible.
[CUSTOMER][NEUTRAL] Uh 500.
[AGENT][NEUTRAL] Yes, $500 with the $50 deductible.
[CUSTOMER][NEUTRAL] Uh, in your deductible with no family, no family deductible is there, right?
[AGENT][NEUTRAL] It's a $50 deductible for individual $150 per family if it's a family plan.
[CUSTOMER][NEUTRAL] And what is the remaining for or?
[CUSTOMER][NEUTRAL] Is it same or any of them are used?
[AGENT][NEUTRAL] Nothing news as of today.
[CUSTOMER][NEUTRAL] The sort is covered under this plan?
[AGENT][POSITIVE] That's what I'm sorry.
[CUSTOMER][NEUTRAL] Does orthodontic is covered under this plan?
[AGENT][NEUTRAL] No orthodontics are not covered.
[CUSTOMER][NEUTRAL] OK. Does preventive diagnostics are covered under this plan?
[AGENT][NEUTRAL] Yes, preventative cover 100% and radiograph FMX is cover 80%.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Uh, that's, uh.
[CUSTOMER][NEUTRAL] That's, so oral surgery, postonic implants, maxillofacial prosthetics, posteddontic perio end is not covered, right?
[AGENT][NEUTRAL] Correct, it's not covered.
[CUSTOMER][NEUTRAL] Uh, only preventive and basic services are covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And basic is covered at 80%.
[AGENT][POSITIVE] Correct, basic is covered at 80%.
[CUSTOMER][NEUTRAL] And prevent and diagnostics and prevent this covered at 100%.
[AGENT][NEUTRAL] preventative is cover 100% diagnostic, um, it covered 80%.
[CUSTOMER][NEUTRAL] Preventive is covered at 100% and diagnostic is covered at 80%.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And could you please check that? Uh, I have some quotes. Could you please check that if these quotes are covered or not? If covered, give me the coverage percentage only.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you said you needed the percentage only?
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Yes, for these costs, I need the percentage only.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'm gonna put you on a brief hold, OK, one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. All right, what's the first code?
[CUSTOMER][NEUTRAL] Oh did you get?
[CUSTOMER][NEUTRAL] Uh, that is, uh, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh sorry, one moment, please. Postcode was?
[CUSTOMER][NEUTRAL] 2920
[AGENT][NEUTRAL] You said 2920?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Ms. [PII], you said 2920?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] That one is not covered.
[CUSTOMER][NEUTRAL] Uh, this, uh, restorative service was covered under this plan?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 2920 is not covered.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, 20, uh sorry?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, the code, um, can you repeat the code one more time?
[CUSTOMER][NEUTRAL] Yeah, I want to know that the uh restoration costs are covered or not.
[AGENT][NEUTRAL] What are the codes? I need codes, Miss [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, that is starts when 2140. Uh, that is, uh, that starts from 20022999.
[AGENT][NEUTRAL] We have a lot of, OK, Ms. [PII], I cannot tell you, yes, they're all covered. No, uh uh, you give me a code and I tell you if it's covered or not, that's how it works because not all the codes are covered, OK? So, basically the one that you just mentioned, which
[CUSTOMER][NEUTRAL] The codes that come in between.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah I yeah.
[AGENT][NEGATIVE] Is the 2920 was not covered. Now the one that you just gave me, the 2140, that one is covered under the basic, so that's 80%. So you really need to give me each code for me to know if it's covered or not. I can tell you there's a range of numbers covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, yeah. Yes, yes, 1351354.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1354.
[AGENT][NEUTRAL] OK 1354 is not covered.
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] 0220 that's covered at 80%.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 0230
[AGENT][NEUTRAL] 0230, that's covered 80%.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] 66057.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Yes, 6057.
[AGENT][NEUTRAL] 60576057 is not covered.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] 6057 is not covered. 6059.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 59
[AGENT][NEUTRAL] 6059 is not covered.
[CUSTOMER][NEUTRAL] 9995.
[AGENT][NEUTRAL] 9995.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 9995 is not covered.
[CUSTOMER][NEUTRAL] 0180.
[AGENT][NEUTRAL] 0180 is not covered.
[CUSTOMER][NEUTRAL] 4355.
[AGENT][NEGATIVE] Nothing on the 4s. Nothing covered on the 4 starting on 4, 4355 is not covered.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And, uh, does, uh, does, uh, that there is any history for this patient for preventive basic services that may affect the frequency and the eligibility?
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see, the last profi I got for this member.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII] is the last prophy.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The last evaluation, [PII] and the last X-ray, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there is any specific cost for this?
[AGENT][NEUTRAL] You need the codes for each one of them.
[CUSTOMER][NEGATIVE] Service cost.
[AGENT][NEUTRAL] Yes, OK, the first one, which is the pro fee is 1110.
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] The second one, which is the X-ray is 210.
[AGENT][NEUTRAL] And the third one, which is the evaluation is 150.
[CUSTOMER][NEUTRAL] Sorry, one?
[AGENT][NEUTRAL] 150.
[CUSTOMER][NEUTRAL] OK. And I need the frequencies of code. If they are covered codes, I need the frequencies. Can we move on that?
[AGENT][NEUTRAL] Um, you need the ones that I just mentioned, or you have a specific code that you need to check on?
[CUSTOMER][NEUTRAL] I have a specific code that I want to check on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Postcode is [PII].
[CUSTOMER][NEUTRAL] Yeah I don't think so.
[AGENT][NEUTRAL] 0120, which is an oral evaluation that is going to be.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Limited to two oral evaluation procedures and any combination of 120, 140, 150, or 160 per 12 month period.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It was a
[CUSTOMER][NEUTRAL] Well you
[CUSTOMER][NEUTRAL] OK. Uh, so they are shared, right? 0140150 and 160 are shared.
[AGENT][NEUTRAL] Yes, 120, 140, 150, 160, they all share.
[CUSTOMER][NEUTRAL] And 018C is not covered, right?
[AGENT][NEUTRAL] You said 0180?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, it's not covered, right?
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] OK. Uh, uh, by wings, 0270272274.
[AGENT][NEUTRAL] I'm, I'm sorry. Can you repeat that one more time?
[CUSTOMER][NEUTRAL] Yes, 270.
[CUSTOMER][NEUTRAL] 272-274.
[AGENT][NEUTRAL] OK, so uh the bite wings is limited to one X-ray procedure and any combination of 270, 272, and 274 per 12 month period.
[CUSTOMER][NEUTRAL] OK. And uh this is FMX San Pao 0210 and 0330.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, limited to one X-ray procedure and a combination of 210, 277, and 330 per 5 year period.
[CUSTOMER][NEUTRAL] OK. And, uh, profi 1110 and 1120, 1110 9 1120 frequency and if there is any age limit?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, for the 1110 is once every 6 months.
[AGENT][NEUTRAL] For the 11:20 is once every 6 months and that's limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Uh, dependent up, OK.
[CUSTOMER][NEUTRAL] And uh fluoride 1206 and 1208.
[AGENT][NEUTRAL] OK, 1206 is not covered. 08 is the adult, we only cover the adult. So it's gonna be um
[CUSTOMER][POSITIVE] I really like.
[AGENT][NEUTRAL] Maximum of what procedure for 12 months?
[CUSTOMER][NEUTRAL] And uh it's for adult, right? Uh, if there is any age limit?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Over specific age.
[AGENT][NEUTRAL] And this one is limited dependent children aged [PII].
[CUSTOMER][NEUTRAL] Up to this is, uh, adults are not covered or covered.
[AGENT][NEUTRAL] Limited to dependent children aged [PII], that's the limitation, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK. And for adult, it is covered, right?
[AGENT][NEUTRAL] For what? I'm sorry?
[CUSTOMER][NEUTRAL] So you have, you have mentioned something about adult, right, for fluoride 1208.
[AGENT][NEUTRAL] Yes, it's gonna be covered 1208, 1206 is not covered.
[CUSTOMER][NEUTRAL] Uh, so, so 1206 have the limit of up to 19.
[AGENT][NEUTRAL] No, 1206 is not covered. 1208 is covered.
[CUSTOMER][NEUTRAL] OK. So once more, 1208 is covered to the uh to the uh age limit of [PII].
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And seas 135191352.
[AGENT][NEUTRAL] 1351.
[AGENT][NEUTRAL] OK, 1351, 1352 is not covered.
[AGENT][NEUTRAL] 1351 um let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum 1 procedure every 36 months, limited to dependent children age [PII], and application made to the permanent molar teeth only.
[CUSTOMER][NEUTRAL] The, OK. Uh, that's uh 2391.
[CUSTOMER][NEUTRAL] 2392
[AGENT][NEUTRAL] Oh, give me one at a time. 23, no, no, no, no, no, one at a time. 2391 you said?
[CUSTOMER][NEUTRAL] 239
[CUSTOMER][NEGATIVE] It is downgraded to amalgam. Composites are downgraded to amalgam.
[AGENT][NEUTRAL] There's no downgrade or upgrades.
[CUSTOMER][NEUTRAL] Crowns are not uh covered under this plan, right?
[AGENT][NEGATIVE] No, not covered.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9599.
[AGENT][NEUTRAL] 2950 is not covered.
[CUSTOMER][NEUTRAL] 2952
[AGENT][NEGATIVE] 2952 is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 295.
[CUSTOMER][NEUTRAL] 54
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEGATIVE] Nothing on the 4th. No coverage on the 4th. No endodontics, no periodontics.
[CUSTOMER][NEUTRAL] OK. And nothing start with 4 is not covered, right? 4346.
[AGENT][POSITIVE] Correct, no endo.
[AGENT][NEUTRAL] Anything that falls on the endodontics or periodontics are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4910 is also not covered, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And 9110, the city is covered?
[AGENT][NEUTRAL] 9110.
[AGENT][NEUTRAL] 9110 that's gonna be under basic which is 80%, no limitation.
[CUSTOMER][NEUTRAL] Does it record an NIT?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Does it record any narrative? Does the patient want to submit any document?
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Does the patient needs to submit any document. I'm not sure what you're talking about, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is recorded in narrative to do 9110, the patient want to submit any specific documents. If they are specify anything like that.
[AGENT][NEUTRAL] No special documents.
[AGENT][NEUTRAL] No, there's no limitation on this one. It's just on the basics.
[CUSTOMER][NEUTRAL] OK, and 9.
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] 9230. 9230 is not covered.
[CUSTOMER][POSITIVE] You can get it right
[CUSTOMER][NEUTRAL] 994491.
[AGENT][NEUTRAL] 9944. That's not covered.
[CUSTOMER][NEUTRAL] 994 5.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9946.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And whom does the payment goes to, to the provider or to the office?
[AGENT][NEUTRAL] Isn't the provider in the office the same thing?
[CUSTOMER][NEUTRAL] Now, whom does the insurance payment goes to? To the provider or to the office?
[AGENT][NEUTRAL] To the provider of service.
[AGENT][NEUTRAL] I'm not really understanding your question because the Ms. [PII], the provider in the office, what do you mean by the office? What do you mean by that?
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] No, I, sorry, sorry, sorry, that's my mistake. Uh, whom does the insurance payment goes to, to the office or the patient?
[AGENT][NEUTRAL] To the, to the provider of service.
[CUSTOMER][NEUTRAL] Uh, to the office.
[CUSTOMER][NEUTRAL] Could you please send me the fax back for this patient? Yeah, OK.
[AGENT][NEUTRAL] The provider.
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To your attention.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] To what attention, Miss [PII], to who? To what name, to what person, to what attention?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, uh, [PII].
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Would you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold so I can send this fax. One moment.
[CUSTOMER][NEUTRAL] OK. Yeah. 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.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Uh, could you please spell your name?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] And the reference number?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much for helping me today. Have a great day for you. Take care.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.