AccountId: 011433970860
ContactId: 60c25833-4100-49d7-b680-5c82f37d8bac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331869 ms
Total Talk Time (AGENT): 128751 ms
Total Talk Time (CUSTOMER): 125550 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/60c25833-4100-49d7-b680-5c82f37d8bac_20250625T20:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, hello, my name is [PII]. I'm calling from A Plus Center Group trying to verify benefits for a member.
[AGENT][NEUTRAL] OK, I can verify benefits for you and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, it's gonna be one second um 02441693.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's gonna be [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And are you need a general breakdown of benefits or I can send you a fax back?
[CUSTOMER][NEGATIVE] Um, if I can get both, the only thing I requested a fax, but it didn't come in complete. It was cut off halfway.
[AGENT][NEUTRAL] There second one said that um.
[AGENT][NEUTRAL] Wonder what's going on, uh, but yes, ma'am, I can verify verbally over the phone for you, um.
[AGENT][NEUTRAL] OK, not a guarantee of payment, just a verification coverage. Uh, the insured has a benefit max up to 500 per calendar year.
[AGENT][NEUTRAL] And she has a $50 deductible, uh, that is applied to everything but preventative services.
[AGENT][NEUTRAL] Preventative pays 100% of UCR.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays 80 and under this plan, major services are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you said what was considered basic?
[AGENT][NEUTRAL] Um, FMR of Lord words, um.
[AGENT][NEUTRAL] FMX panel, filling, simple extractions, PAs, those are all considered basic.
[CUSTOMER][NEUTRAL] And that's 80%? Got it OK and then simple extractions, is there a specific code?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, the 7140.
[CUSTOMER][NEUTRAL] 7140 OK.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] Perio, um, surgical extractions and endo dentures, crowns, those are not covered.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] Got it. OK, is, um, is there a frequency for any exams?
[AGENT][NEUTRAL] Uh, exams are a 2 for 12 month period and all exams share the same frequency.
[CUSTOMER][NEUTRAL] I got it. OK, um, is, uh, the 4910 covered?
[AGENT][NEUTRAL] No, ma'am, it's considered uh.
[AGENT][NEUTRAL] Perio, so it's not covered under the plan.
[CUSTOMER][NEUTRAL] Got it. And then for the uh regular prophylaxis, the 1110, is it covered?
[AGENT][NEUTRAL] Yes, ma'am. It's preventive and it's once every.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Lord, I forgot. Once every 6 months. I'm sorry.
[CUSTOMER][NEUTRAL] No worries and then for Flori?
[AGENT][NEUTRAL] Fluoride is under the age of [PII].
[AGENT][NEUTRAL] Once every 12 months.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got it. OK, and then bite wings?
[AGENT][NEUTRAL] Uh, bite wings are preventive and they're once every 12 months.
[CUSTOMER][NEUTRAL] OK, thank you and then for PAs, are they covered under preventative or basic?
[AGENT][NEUTRAL] Uh, basic.
[CUSTOMER][NEUTRAL] Is there a frequency?
[AGENT][NEUTRAL] Uh, for PA, no, ma'am.
[CUSTOMER][NEUTRAL] Got it. OK, thank you. And then is this a calendar or fiscal plan?
[AGENT][NEUTRAL] Uh, calendar year.
[CUSTOMER][NEUTRAL] Got it OK and then the coordination of benefits?
[AGENT][NEUTRAL] Uh, standard
[CUSTOMER][NEUTRAL] And then just to verify this plan doesn't require pre-op?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] I want to verify is the payer ID I have is 60801?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Got it. And then claim address I have [PII] and then the zip code [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] And then just to verify, is there any history on file?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, no, ma'am. There's no history.
[CUSTOMER][NEUTRAL] And then for fillings, do they get downgraded?
[AGENT][NEUTRAL] Uh, no, ma'am. There are no downgrades.
[CUSTOMER][NEUTRAL] The downgrades got it. OK. And then if I can get a fax uh if possible.
[AGENT][NEUTRAL] Yes ma'am, what's their fax number?
[CUSTOMER][NEUTRAL] Yeah it's gonna be [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] Mhm that's correct.
[AGENT][POSITIVE] OK, I will send this off to you in a few moments. Um, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that was everything thank you.
[AGENT][POSITIVE] OK, yes, ma'am. You're welcome. Thanks for calling ATL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.