AccountId: 011433970860
ContactId: 5d13d9b6-6548-4379-bf85-5ebf6b7657c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507619 ms
Total Talk Time (AGENT): 151080 ms
Total Talk Time (CUSTOMER): 118949 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/5d13d9b6-6548-4379-bf85-5ebf6b7657c2_20250416T15:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of the dental office to check eligibility and benefits for a patient.
[AGENT][NEUTRAL] And do you have the uh member ID?
[CUSTOMER][NEUTRAL] Yes, it's uh 239-687-3.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] Um, yes, it's like [PII].
[AGENT][NEUTRAL] Oh, OK, um, and then do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, that is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, it's not a guarantee of payment based outline of the policy. So the policy is effective [PII]. Policy is currently active.
[AGENT][POSITIVE] Yeah, cool.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, so it looks like they have a $750 calendar year maximum.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, preventive services pay 100%, no deductible.
[AGENT][NEUTRAL] Uh, radiographs, FMX, basic, basic restorative, those all pay 80% after a $50 calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what, what other benefits do you need? I can also send a fax back that has all the information.
[CUSTOMER][NEUTRAL] All right. So,
[CUSTOMER][NEUTRAL] Uh, yes, what will be the group name and the group number?
[AGENT][NEUTRAL] The group name is.
[AGENT][NEUTRAL] Uh group name is Serge, S U R G E Staffing, S T A F F I N G, and then the group number is 70084.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is it a single or family coverage?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] And um what will be the claim's mailing address?
[AGENT][NEUTRAL] Is mailing address is [PII]. It's [PII].
[CUSTOMER][NEUTRAL] Got it. And [PII], uh, do you accept assignment of benefits to a non-participating provider?
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] And if benefits are exhausted, do in-network provider discounts apply?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We would just deny the claim, so.
[AGENT][NEUTRAL] I get it's up to the provider if they honor discounts.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh if patient is not eligible for service, does the discount apply?
[AGENT][NEUTRAL] Well, we, we don't process discounts when we process the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And do we have any coverage for orthodontics?
[AGENT][NEUTRAL] Um, ortho, let's see.
[AGENT][NEUTRAL] Uh, there's no ortho coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um do we have any waiting period or a missing tooth loss?
[AGENT][NEUTRAL] Uh, no waiting periods. Yes, I'm missing two paws.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And um anything been used or met from the deductible or maximum?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Uh, he's not used anything this year.
[CUSTOMER][NEUTRAL] OK. And you said the uh co-insurance for me is 50%, right?
[AGENT][NEGATIVE] No, there's no major coverage.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] And for 4910, is it covered?
[AGENT][NEUTRAL] I don't see that code listed.
[CUSTOMER][NEUTRAL] OK. Got it. And um
[CUSTOMER][NEUTRAL] Lastly, I do have 5 codes to check. I only need the frequencies. Uh, so do you need all the codes at once or one by one?
[AGENT][NEUTRAL] Uh, one by one.
[CUSTOMER][NEUTRAL] OK. So the first would be 0150.
[AGENT][NEUTRAL] Uh, that is.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, sorry, uh, 2 that is limited to, um, 2 in a 12 month period. Sorry about that.
[CUSTOMER][NEUTRAL] Correct. Next is 11:10.
[AGENT][NEUTRAL] 11:10 is.
[AGENT][NEUTRAL] Max of 1 for 6 months.
[CUSTOMER][NEUTRAL] Next is 0274.
[AGENT][NEUTRAL] Uh, limited to one bite wing X-ray procedure for 12-month period.
[CUSTOMER][NEUTRAL] Next would be 0 to 10.
[AGENT][NEUTRAL] 0210. Let's see.
[AGENT][NEUTRAL] In
[AGENT][NEUTRAL] Limited to 1 per 5 year period.
[CUSTOMER][NEUTRAL] Next would be um
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] 7140.
[AGENT][NEUTRAL] A max of one time per tooth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last is 1208.
[AGENT][NEUTRAL] 1208.
[AGENT][NEUTRAL] Is that for fluoride?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, it's limited 1 per 12 months and for dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And once again, sorry, but uh just to confirm, there is a missing tooth cloth, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And yes, [PII], I'm done with all my questions and you can provide me the reference number to our call.
[AGENT][NEUTRAL] Um, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. And [PII], thank you so much for your assistance and you have a wonderful day ahead.
[AGENT][POSITIVE] Thank you for calling APL you as well.
[CUSTOMER][NEUTRAL] Bye bye.