AccountId: 011433970860
ContactId: 5d7b1211-27fa-4eaf-aba0-792c00f7c356
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1146439 ms
Total Talk Time (AGENT): 104438 ms
Total Talk Time (CUSTOMER): 240307 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/5d7b1211-27fa-4eaf-aba0-792c00f7c356_20250306T14:51_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII]. Um, I'm sorry, can you repeat your name for me?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, perfect. My name is [PII] um I'm calling from a dental provider's office and I got a fax back on a member yesterday, but I have a couple of additional questions that I did not see on the fax back.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, 02585607.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK. And one moment, her benefits are coming up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. And how can I help you?
[CUSTOMER][NEUTRAL] Um, is there a group name for the policy?
[AGENT][POSITIVE] Um, yes, let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the group name is Universal Trucking United Road.
[CUSTOMER][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] United Road, like, like what you drive on road.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK perfect um and do the benefits run on a calendar year or do they renew [PII] when the the family opted in?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I see they have a $1500 annual maximum. Has [PII] used any of that this year?
[AGENT][NEUTRAL] OK, let's see, one moment.
[AGENT][NEUTRAL] Um, no, she hasn't used any of our benefits yet this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Is it a standard coordination of benefits or non duplicative?
[AGENT][NEUTRAL] I'm standard.
[CUSTOMER][NEUTRAL] Thank you. Um, I did see where it said that diagnostic services are not applied to the deductible. Are the diagnostic and preventive services applied, excuse me, to that $1500 annual maximum?
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Most things had a frequency on that fax back. Can you tell me if code 4346 is a covered benefit and it's frequency?
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I'm showing that it's not covered.
[CUSTOMER][NEUTRAL] OK, perfect. um, do the adult profi and aerial maintenance limit with one another?
[AGENT][NEUTRAL] Yes, ma'am, they do.
[CUSTOMER][NEUTRAL] OK. Is an oral cancer screening covered? It's code 0431?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] No, ma'am. I'm showing that that's not covered.
[CUSTOMER][POSITIVE] OK perfect um.
[CUSTOMER][NEUTRAL] Let's see, are there any downgrades on posterior composites?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. I'm not showing that there are any.
[CUSTOMER][NEUTRAL] OK, and then, um, porcelain crowns, do those get downgraded to the, the metal?
[AGENT][NEUTRAL] OK, one moment, please. I'm still waiting on my system.
[CUSTOMER][POSITIVE] Sure, not a problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, ma'am. Thanks for your patience. I'm showing that it does not.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, perfect. And those crowns, do those pay on the prep date or the seat date?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] Um, it doesn't pay on either.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So how does that work? Does it just pay when we bill it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, are there any quadrant restrictions on an SRP or can all four quadrants be done in the same visit?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] That can be done on the same visit.
[CUSTOMER][NEUTRAL] OK, perfect. Um, any coverage on an occlusal guard, um, on the fax back it showed that there was coverage for a 9940, um, but we bill out a 9944.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Yes, ma'am. It's covered.
[CUSTOMER][NEUTRAL] Um, is it covered under basic or major?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] Is there a frequency on it?
[AGENT][NEUTRAL] Um, no, ma'am. I'm not showing any frequencies on it.
[CUSTOMER][NEUTRAL] OK, perfect. And then, um, my last question about the policy, uh, I did see there was a missing tooth clause. Is that for the duration of the policy or does it expire at some point?
[AGENT][NEUTRAL] It's for the duration of the policy.
[CUSTOMER][POSITIVE] OK perfect and then.
[CUSTOMER][NEUTRAL] I know this policy just became active on [PII] and we're 5 days later on [PII]. Does this patient have any history on file?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Um, no, ma'am. I'm not showing any history. This is a brand new policy.
[CUSTOMER][NEUTRAL] OK perfect and I am so sorry I, I lied um.
[CUSTOMER][NEUTRAL] On the fax back it says radiographs dash FMX expenses are at 80% of the UCR. Is that all X-rays are covered at 80% or just the full mouth?
[CUSTOMER][NEUTRAL] By wings and um the periaapicals, are those 100% of the UCR or um the 80% as well?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Um, no, ma'am. Bite wings are covered at 100%.
[CUSTOMER][POSITIVE] OK, perfect. OK, so that is all the information that I need. I truly appreciate your time today um if I could just get a reference number from you.
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name in today's date. My name is [PII], um it's spelled [PII] My last initial is [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That is it. Thank you so much. I appreciate it.
[AGENT][POSITIVE] No problem. I thank you again, [PII], for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye