AccountId: 011433970860
ContactId: 5dcea19d-ae8d-4aeb-8960-4022d8ebb5f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1372689 ms
Total Talk Time (AGENT): 395501 ms
Total Talk Time (CUSTOMER): 218782 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/5dcea19d-ae8d-4aeb-8960-4022d8ebb5f8_20250425T18:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with Complete the North Lake City. I was just seeing if I could ask some individual questions on a patient's policy. It's just a new one we have to add in.
[AGENT][NEUTRAL] Yeah, of course. Do you have their policy number?
[CUSTOMER][POSITIVE] Yes ma'am, it is going are you ready for it?
[AGENT][POSITIVE] Yep, I'm ready.
[CUSTOMER][NEUTRAL] It is going to be 02585622.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, [PII], what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And then the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is going to be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Give me just one second while I pull up his benefits.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, you wanna go ahead and reschedule that now?
[CUSTOMER][NEUTRAL] Can I just place you on a brief hold while I check in this patient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah, go ahead.
[CUSTOMER][NEUTRAL] You needed a couple of days out.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Have you ever missed a dental appointment? Guess what? You're not alone. With a hectic schedule, it's hard to remember everything, and a timely reminder would make a
[CUSTOMER][POSITIVE] Sorry about that wait.
[AGENT][NEUTRAL] Oh, no, that wasn't long at all.
[AGENT][POSITIVE] OK, so I have their benefits pulled up.
[AGENT][NEUTRAL] And what benefits can I provide you with today?
[CUSTOMER][NEUTRAL] Uh, let me, I was just pulling it through. I just had to exit out of but give me one second, sorry.
[AGENT][POSITIVE] OK, no, it's OK. I can also send you this fax back too.
[CUSTOMER][NEGATIVE] Well, I was trying to get a fax back. um, I probably was on the phone with somebody about 2 hours ago and it just still hasn't came through.
[AGENT][NEUTRAL] Oh, no. OK. Um.
[CUSTOMER][NEUTRAL] Are you able to send it through email by chance?
[AGENT][NEUTRAL] No, it has to be fax. What is your fax number and I can do it now and I can also give you benefits on the phone.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Got you. The fax number is gonna be [PII].
[CUSTOMER][POSITIVE] And I appreciate you so much.
[AGENT][POSITIVE] OK, perfect. Yeah, you're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, so let me, I will, I will just get in the process of sending this right now, but I can give you benefits too.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yes ma'am, I'll give you a second to do that.
[AGENT][NEUTRAL] And then I'll address it to you as well.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][MIXED] OK, and it should be going through. Sometimes it takes like 3 to 5 minutes. It's just a little slow, but.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And then I just wanted to check this is an individual policy correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like it's a family plan.
[CUSTOMER][NEUTRAL] Yes ma'am, does it have a group plan name?
[AGENT][POSITIVE] Yes, I can give that to you. It is Universal Trucking.
[CUSTOMER][NEUTRAL] for you
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] P and S.
[CUSTOMER][POSITIVE] You're welcome
[AGENT][NEUTRAL] Transportation.
[CUSTOMER][NEUTRAL] And you said it was PNS Transport?
[AGENT][NEUTRAL] Yes, mhm, the letter P and then and S transport transportation is what it says, yeah.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Got you and then the um mailing address is [PII]?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So our claims address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What was that zip code one more time?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just getting all this in really quick.
[AGENT][NEUTRAL] Oh, you
[CUSTOMER][NEUTRAL] And then what is the group is the group number 19205?
[AGENT][NEUTRAL] See
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Perfect and then the payer ID?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, just a second. I don't see the payer ID on.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, OK, it is 60801.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm just getting in here so I can go into the notes really quick.
[CUSTOMER][NEUTRAL] And then what would be the maximum deductible on this policy?
[AGENT][NEUTRAL] OK, so this is not a guarantee of payment, just a verification of coverage. So it looks like the calendar year max is 1500 per covered insured.
[AGENT][NEUTRAL] And the calendar year deductible is $50 per covered insured up to $150 per family.
[CUSTOMER][POSITIVE] Perfect, because, um, does the deductible apply to the X-rays?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like deductibles do not apply to preventative expenses.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It doesn't say anything about X-rays.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] It's just preventative.
[CUSTOMER][NEUTRAL] Got you. Is there
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any missing two calls or waiting periods for this policy?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[AGENT][NEUTRAL] And it looks like for major services there's a 12 month waiting period.
[CUSTOMER][NEUTRAL] And then 0150.
[CUSTOMER][NEUTRAL] What's the frequency and percentage if you don't mind?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, so 0150 falls under preventative expenses and that's 100% of UCR.
[CUSTOMER][POSITIVE] that's good, OK.
[CUSTOMER][POSITIVE] Alright, Ms. [PII], thank you.
[AGENT][NEUTRAL] And that is limited to 2 oral evaluation procedures in any combination per 12-month period.
[CUSTOMER][NEUTRAL] And then 0140?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Have a good one.
[AGENT][NEUTRAL] OK, 0140 is not listed, so it is not covered.
[CUSTOMER][NEUTRAL] And then 0120?
[AGENT][NEUTRAL] OK, so that falls under under preventative as well.
[AGENT][NEUTRAL] So that would be 100% of UCR.
[AGENT][NEUTRAL] And also limited to 2 oral evaluation procedures.
[AGENT][NEUTRAL] In any combination per 12 month period.
[CUSTOMER][NEUTRAL] And then do the 0150 and 0210 or 0120 do they share frequencies by chance?
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] And then coverage and frequency for 1110.
[AGENT][NEUTRAL] OK, so that falls under preventative as well. So that's 100% of UCR.
[AGENT][NEUTRAL] And maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] And then 0210?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that falls under radiographs, and that is 100% of UCR.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] And that's limited to one X-ray procedure per five-year period.
[CUSTOMER][NEUTRAL] And then 0274.
[AGENT][NEUTRAL] OK, and that falls under major expenses?
[AGENT][NEUTRAL] So that would be 40% of UCR with a waiting period of 12 months.
[AGENT][NEUTRAL] And maximum of 1 procedure, oh, sorry, maximum of 1 per seven year period.
[AGENT][NEUTRAL] And there's another one, hold on.
[AGENT][NEUTRAL] And limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] And I just wanna verify that's for 0274 correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Perfect. And then 0277.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] OK, so this falls under basic expenses and that will be 100% of UCR.
[AGENT][NEUTRAL] Limited to 1 X-ray procedure per 5-year period.
[CUSTOMER][NEUTRAL] And then 12:06 fluoride.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, so fluoride is not on this policy, so it will not be covered.
[CUSTOMER][NEUTRAL] I mean 0431?
[AGENT][NEUTRAL] Let's see, just a second.
[AGENT][NEUTRAL] OK, 0431 is also not on this policy.
[CUSTOMER][NEUTRAL] And then 1351?
[AGENT][NEUTRAL] OK, so 01351, it falls under preventative expenses, and that's a 100% of UCR.
[AGENT][NEUTRAL] Just a minute and I'll tell you.
[AGENT][NEUTRAL] What the limitations are, OK, so.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so not in conjunction with TMJ.
[AGENT][NEUTRAL] Applic applications made to permanent molar teeth only.
[AGENT][NEUTRAL] And limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] And then is there a frequency with it?
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then it says that the, oh sorry, 2991.
[CUSTOMER][NEUTRAL] And then 2991.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and it looks like that fax back went through too.
[CUSTOMER][NEUTRAL] OK, I'm gonna go ahead and check that really quick as well.
[AGENT][NEUTRAL] OK, you can go ahead while I look up this one.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and that procedure code is not listed on these benefits either.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then just before I get you off the phone because I am looking to see if I have that back for 4341, um, can all four quads be done in the same day?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, so it says maximum of 1 each quadrant per 24 months.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then what's the coverage on that one?
[AGENT][NEUTRAL] That is 40% of UCR and the, it does have a waiting period of 12 months.
[CUSTOMER][POSITIVE] Perfect. And then it's the one every 24 months?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] And then only 2 quads can be done on the same day.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So it says maximum maximum of 1 each quadrant per 24 months?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it says for 4341, [PII] scaling and rooting planning, 4 or more contingious teeth or bonded teeth.
[CUSTOMER][NEUTRAL] Yes ma'am, and then I was just gonna check for 4346. Does the deductible apply to this um procedure code?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, so that procedure code is not listed, so.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] It's just not covered, got you.
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] And then are there any age limits with ortho at all or if there is any ortho coverage?
[AGENT][NEUTRAL] Uh, ortho ortho treatment is not covered under this policy.
[CUSTOMER][POSITIVE] Perfect and then can I just get the coordination of benefits?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Are you asking if it's on a fee schedule or not?
[CUSTOMER][NEUTRAL] Just the coordination of benefits like um if they're have a primary secondary.
[AGENT][NEUTRAL] Oh, so this is a secondary insurance company.
[AGENT][NEUTRAL] So, um, I'm not sure you'll have to ask the policyholder.
[CUSTOMER][POSITIVE] I got you, yes ma'am thank you so much and then can I just get a reference number for the call if you don't mind?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, of course. So it's my first name, [PII]
[AGENT][NEUTRAL] Last initial age and then today's date.
[CUSTOMER][POSITIVE] Perfect and then can I just get the effective date of the policy as well and then I'll be done.
[AGENT][NEUTRAL] Yeah, of course. So the effective date is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much thank you for all your help today.
[AGENT][POSITIVE] Yeah, of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No ma'am, that was it thank you so much.
[AGENT][POSITIVE] All right, yeah, thanks for calling APO. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Alright, bye.