AccountId: 011433970860
ContactId: 602f5899-c14a-403b-8a4b-58c40428b84b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 988239 ms
Total Talk Time (AGENT): 252388 ms
Total Talk Time (CUSTOMER): 306923 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/602f5899-c14a-403b-8a4b-58c40428b84b_20250109T17:57_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and I'm calling in from Bella Family Dentistry to get the dental benefits of a patient.
[AGENT][NEUTRAL] OK, I can help you with that. Could I get a callback number?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, thank you for that. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] The policy number is 44 sorry.
[CUSTOMER][NEUTRAL] Policy number, let me check, 0257.
[CUSTOMER][NEUTRAL] 6502.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name here is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK. Thank you so much for verifying the, uh, policy and you did say you were calling for benefits. I can send you over a full breakdown of the benefits by fax.
[CUSTOMER][NEUTRAL] Can you take me through uh the call itself?
[AGENT][NEUTRAL] Can I take you through what? I'm sorry?
[CUSTOMER][NEUTRAL] To the benefit over the call?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Please be advise verifying benefits is not guarantee payment and what.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Spell your name for me.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] OK, what benefits are you?
[CUSTOMER][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] So first, is this an active policy and what is the effective date?
[AGENT][NEUTRAL] The policy has been effective since [PII]. It is still active.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, and, uh, the calendar year or a benefit year policy?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh right synonymous [PII] and uh PO Box.
[CUSTOMER][NEUTRAL] 276502 PO box is 248,950. Oklahoma City, Oklahoma 73124 pay ID is 60801. Group name is Management analysis and Utilization. Group number 70056.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] 02576502
[CUSTOMER][NEUTRAL] And uh what is the effective date on the policy? Uh [PII]. It's a calendar year policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is the deductible and max for out of network provider and how much has the patient used?
[AGENT][NEUTRAL] The patient has not used any of their benefits for [PII]. The calendar year maximum is $1250.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 1250 for the annual max right for this year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1250. OK. Nothing has been used. What about the deductible?
[AGENT][NEUTRAL] $50 per person.
[CUSTOMER][NEUTRAL] Family deductible.
[AGENT][NEUTRAL] $150.
[CUSTOMER][NEUTRAL] Anything me from that both individual and family?
[AGENT][NEUTRAL] Nothing has been applied to their benefits for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the co-insurance for preventive basic and major for out of network?
[AGENT][NEUTRAL] For preventive it's paid at 100% for basic it pays up to 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And endo Parian Oral Services.
[AGENT][NEUTRAL] 50%
[CUSTOMER][NEUTRAL] 5050 and do per oral.
[AGENT][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] OK. So major is also covered, it means 50%, is it?
[AGENT][NEUTRAL] 50%, yes.
[CUSTOMER][NEUTRAL] Yeah, 50% for major services also there. Are you sure you're checking the out of network benefits?
[AGENT][NEUTRAL] Uh, there are no, um, that this is a flat benefit, so, um.
[CUSTOMER][NEUTRAL] Because I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, nothing changes in, in and out of network.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So 180 and 50 for preventive basic and major, correct?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 180 and 50 for preventive basic and major.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Endo perio oral, all three are major.
[AGENT][NEUTRAL] At 50%.
[CUSTOMER][NEUTRAL] OK. Any waiting period or missing tooth cloths?
[AGENT][NEUTRAL] Uh, there is no missing tooth cloths. There is a waiting period for major, uh, twelve-month waiting period.
[CUSTOMER][NEUTRAL] Is it already over or is it still going on?
[CUSTOMER][NEUTRAL] Still going on.
[AGENT][NEUTRAL] It's still going on.
[CUSTOMER][NEUTRAL] So wait, so major services are not covered for now, it means, right?
[AGENT][NEUTRAL] The policy was just effective [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One year waiting period.
[CUSTOMER][NEUTRAL] One year for major services only, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so next would be, uh, I have some codes for which I need the coverage and frequency. Can I provide you all the code at once?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I have some codes for which I need the coverage and frequency. Can I provide you all the code at once?
[AGENT][NEUTRAL] OK. Now, I can fax this information over with all the codes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, but, uh, we need to update it over the call itself, so it will not take much time. Can I give you all the code at once?
[AGENT][NEUTRAL] No, you can give them to me one by one. What is the first code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that is under preventive.
[CUSTOMER][NEUTRAL] What is the frequency?
[AGENT][NEUTRAL] Hold one moment.
[AGENT][NEUTRAL] Uh, 2 per year.
[CUSTOMER][NEUTRAL] OK. 0140?
[AGENT][NEUTRAL] 2 per year.
[CUSTOMER][NEUTRAL] 50
[AGENT][NEUTRAL] 2 per year and these are all in combination with each other.
[CUSTOMER][NEUTRAL] OK, 0, OK. 0180.
[AGENT][NEUTRAL] 2 per year.
[CUSTOMER][NEUTRAL] 80 is also the same 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh uh what is the
[CUSTOMER][NEUTRAL] next code is [PII].
[AGENT][NEUTRAL] Uh, 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] OK, and 0272?
[AGENT][NEUTRAL] 0272 is not a covered procedure.
[CUSTOMER][NEGATIVE] Not covered. The bite wings, any of the bite wing code is covered 027477.
[AGENT][NEUTRAL] 0272.
[AGENT][NEUTRAL] And 0, let me see, 0274 1 moment.
[CUSTOMER][NEUTRAL] Check for the bite wings, X-ray any of the coat.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, limited to one bite wing, uh, X-ray procedure per every 12 months. That's 027002720274.
[CUSTOMER][NEUTRAL] One for 12 months, preventive.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 1 for 12 months, right? or calendar year?
[AGENT][NEUTRAL] Are you asking about the bite wings?
[CUSTOMER][NEUTRAL] Yeah, bye wings, is it one per calendar year or 12 months? What?
[AGENT][NEUTRAL] It's 1 per 12-month period.
[CUSTOMER][NEUTRAL] OK, preventive service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next is the FMX and panel.
[CUSTOMER][NEUTRAL] 02100330
[AGENT][NEUTRAL] Hold one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for holding. That would be 1 per every 1 procedure per every 6 months.
[CUSTOMER][NEUTRAL] Oh FMXpano, are you sure? It's 0210 and 0320.
[AGENT][NEUTRAL] What is it called?
[CUSTOMER][NEUTRAL] 02100330.
[AGENT][NEUTRAL] 0210 and 0280.
[CUSTOMER][NEUTRAL] 02100330
[AGENT][NEUTRAL] 033.
[AGENT][NEUTRAL] So 0210.
[AGENT][NEUTRAL] Is.
[AGENT][NEUTRAL] It is OK, let me look.
[AGENT][NEUTRAL] One X spray per five-year period.
[CUSTOMER][NEUTRAL] Basic or preventive?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Please mention the mention the percentage also.
[AGENT][NEUTRAL] I'm sorry, I, I don't understand what you're asking. What's the question?
[CUSTOMER][NEUTRAL] Co-insurance. What is the co-insurance for this?
[CUSTOMER][NEUTRAL] The percentage of coverage, is it 180? What, what is it?
[AGENT][NEUTRAL] That is, let me see.
[AGENT][NEUTRAL] That is going to be.
[AGENT][NEUTRAL] Under the.
[AGENT][NEUTRAL] Mm, it looks like it is under, let me look up here and see. I don't know.
[AGENT][NEUTRAL] 80%
[CUSTOMER][NEUTRAL] They both share frequency?
[CUSTOMER][NEUTRAL] 02100330.
[AGENT][NEUTRAL] They do. Yes, they do.
[CUSTOMER][NEUTRAL] OK. 1208.
[AGENT][NEUTRAL] 1208.
[CUSTOMER][NEUTRAL] Yeah, that's the next code.
[AGENT][NEUTRAL] I do not show 1208.
[AGENT][NEUTRAL] Been a covered procedure.
[CUSTOMER][NEUTRAL] OK. OK, it's not covered then. 1351.
[AGENT][NEUTRAL] OK. 1351 is paid at 800%. Let me look at the limitations.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, that is maximum of 1 per 36 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Age limit
[AGENT][NEUTRAL] It's made to permanent molar teeth only.
[AGENT][NEUTRAL] And limit it to dependent.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] OK, 4341 is paid at 50%.
[AGENT][NEUTRAL] Uh, let me look at the limitation.
[AGENT][NEUTRAL] Maximum 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] 1 for 24 months, 50%. What is?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, how many quads can be done in a day?
[AGENT][NEUTRAL] It does not state.
[CUSTOMER][NEUTRAL] The hardest streets OK.
[CUSTOMER][NEUTRAL] So the, this service will be covered uh right now or not because there's a, there's a waiting period?
[AGENT][NEUTRAL] There is a twelve-month waiting period.
[CUSTOMER][NEUTRAL] So it will not be covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. All the and the perio or services, these will not be covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For one year.
[CUSTOMER][NEUTRAL] OK, so let me just.
[CUSTOMER][NEUTRAL] Should I did it or not.
[CUSTOMER][NEUTRAL] There's a waiting period on you.
[CUSTOMER][NEUTRAL] OK, let me just continue because it's waiting waiting period is still going.