AccountId: 011433970860
ContactId: 5e3beb4a-69bc-4936-aa32-af9efe846fa7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 481660 ms
Total Talk Time (AGENT): 171230 ms
Total Talk Time (CUSTOMER): 144459 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/5e3beb4a-69bc-4936-aa32-af9efe846fa7_20250404T15:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, ma'am. I was calling to do a dental breakdown for a patient.
[AGENT][NEUTRAL] OK, I can help you and may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Thank you [PII]. What is the policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I have 02277434.
[AGENT][POSITIVE] OK, I have that as 02277434. Thank you.
[AGENT][NEUTRAL] Verify the patient, excuse me, verify the patient's name and date of birth.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right then [PII], [PII].
[AGENT][POSITIVE] OK, one moment, thank you.
[AGENT][NEUTRAL] OK, the member shows effective as of [PII] and it shows active for the member.
[AGENT][NEUTRAL] And once I'm done with giving you a verbal breakdown, I can also send over a fax back if you like as well for the member.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, ma'am, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment, get that breakdown started for you.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. The member has a $1500 calendar year max with a $50 deductible.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And currently the member has not used anything or met anything towards the deductible.
[AGENT][NEGATIVE] The member has no history at all on file.
[AGENT][NEUTRAL] Um, the plan pays preventative at 100% of UCR. Basic services are covered at 80% and major services are covered at 40%.
[CUSTOMER][NEUTRAL] OK, do they have any group name?
[AGENT][NEUTRAL] Uh, yes, the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Um, just like you one quick second.
[CUSTOMER][NEUTRAL] I'm sorry, what was that group name one more time?
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Universal checking?
[AGENT][NEUTRAL] Universal trucking, yes.
[CUSTOMER][NEUTRAL] OK. Um, and then.
[CUSTOMER][NEUTRAL] OK, and then is there any group um group number?
[AGENT][NEUTRAL] Yes, the group number is 21769.
[CUSTOMER][NEUTRAL] OK, and then, um, I do see there's a waiting period for major services for 12 months, but that has already been met, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, um, and then any coordination of benefits?
[AGENT][NEUTRAL] We do not coordinate benefits.
[CUSTOMER][NEUTRAL] OK, is there any downgrade for billings on code 2391?
[AGENT][NEUTRAL] I'm sorry, are you asking our downgrades or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, there are no downgrades at all on the plan, no downgrades at all.
[CUSTOMER][NEUTRAL] OK. And then, uh, for SRP can all four quads be done the same day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then our cross pay on birthday date.
[AGENT][NEUTRAL] Either or
[CUSTOMER][NEUTRAL] OK, and then I did have some codes that I wanted to know the percentage and frequency in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you want the one by one or all at once?
[AGENT][NEUTRAL] Um, probably one by one.
[CUSTOMER][NEUTRAL] OK. Um, the first one is gonna be 90.
[AGENT][NEUTRAL] I'm sorry, your voice broke up. If you could repeat that code.
[CUSTOMER][NEUTRAL] Yes, 9230.
[AGENT][NEUTRAL] OK, thank you. 9230 that is covered under major at 40%.
[CUSTOMER][NEUTRAL] OK. Oh OK.
[CUSTOMER][NEUTRAL] Code 7956.
[AGENT][NEUTRAL] OK, 7956. I do not believe that it's covered. Give me one moment just to verify that. Again, that's 7956. Is that correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, that is not a covered benefit.
[CUSTOMER][NEUTRAL] OK. 7210.
[AGENT][NEUTRAL] OK, 7210. That is covered under major at 40%.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, 7953.
[CUSTOMER][NEUTRAL] No
[AGENT][NEGATIVE] Is not covered.
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Back door open. 9944.
[AGENT][NEUTRAL] That falls under major at 40%.
[CUSTOMER][NEUTRAL] And there's no frequency?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, that is a max of 17-year period limited to those aged [PII] plus.
[CUSTOMER][NEUTRAL] OK, and then code 1208. That door open.
[AGENT][NEUTRAL] That is covered under preventative at 100% and that's 1 per 12 month period.
[CUSTOMER][NEUTRAL] Code 1351.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's covered under preventative, that's 1 per 36 months. Permanent molarity is only limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK, and then you said um this is based on UCR fee so we can put like our office fee and we're not like because it's not like in network or out of network type of insurance, correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That is correct, it's UCR.
[CUSTOMER][NEUTRAL] OK, but I can bill electronically through our cleaning house, correct?
[AGENT][NEUTRAL] Yes, would you like our payer ID?
[CUSTOMER][NEUTRAL] Um, is it the 60801?
[AGENT][NEUTRAL] It is, yes.
[CUSTOMER][NEUTRAL] OK, um, and then the insurance company is called APL.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Um, OK, what was your name again, ma'am?
[AGENT][NEUTRAL] My name is [PII]. My last initial is [PII]. Uh, would you need that faxed back or do you have one already?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, ma'am, can I just get a reference number for this call?
[AGENT][NEUTRAL] I'm sorry, did you, I'm sorry, your, your voice broke up again. Do you need the fax back sent over?
[CUSTOMER][NEUTRAL] Um, no, ma'am, I already have one. If I can just get a reference number for the call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can hear you so much better now. The reference number would be my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, ma'am. You have a good day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Take care. Bye.
[CUSTOMER][POSITIVE] Thank you, yes, you too, bye.