AccountId: 011433970860
ContactId: 610e547f-bd50-4675-8ee2-5978179a755f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631669 ms
Total Talk Time (AGENT): 304425 ms
Total Talk Time (CUSTOMER): 182050 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/610e547f-bd50-4675-8ee2-5978179a755f_20250220T19:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. [PII]. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Are we in network?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Hold
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Hey, um, this is [PII] calling from Charlotte Dentistry. How are you today?
[AGENT][NEUTRAL] I'm fine, Ms. [PII], and yourself?
[CUSTOMER][NEUTRAL] I'm good. Um, I have a patient who provided this insurance information. We are a dental office. I was just calling to see if they had, um, dental coverage and to see what our participation is with this plan.
[AGENT][NEUTRAL] OK, I can verify eligibility and benefits for you, Ms. [PII], and what's that policy number, please?
[CUSTOMER][NEUTRAL] I have 02550618.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy. Um, or with this policy, or I should say with our company, we don't have a network of dental providers, so her policy is open to where we will take uh asignment from any dental dental provider.
[CUSTOMER][NEUTRAL] So the plan would pay our office fee?
[AGENT][NEUTRAL] Uh, well, we pay by UCR for services. Preventive pays 100% of UCR, basic, basic restorative, FMX panoramic pays at 80%, and major services pay at 40%. But we can pay the providers office if benefits are assigned, but we don't have a network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, would you mind giving me a verbal breakdown with frequencies and coverages?
[AGENT][NEUTRAL] Sure, um, not a guarantee of payment, just a verification of coverage. The insured has a benefit max up to $1500 per calendar year, and they have a $50 deductible that is applied to everything but preventative.
[AGENT][NEUTRAL] Uh, preventive 100% of UCR, basic, basic restorative FMX panoramic pays at 80%, and for major services which would include endo perio and oral surgery, it pays at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you give me the frequencies for preventative, basic, and major? Do you want specific codes?
[AGENT][NEUTRAL] Um, well, I can give you specifics and then if you have any questions, um, we can go through them, a specific code, but, um, for exams are 2 for 12 month period, all exams share the same frequency.
[AGENT][NEUTRAL] Cleanings are once every 6 months, bite wings 1 per 12-month period.
[AGENT][NEUTRAL] Fluoride is under the age of [PII], once every 12 months, sealants under the age of [PII], once every 3 years, permanent molars only, um, FMX and pans share a frequency of once every 5 years, crowns and bridges every 7, partials, dentures every 5.
[CUSTOMER][NEUTRAL] OK, can I go ahead.
[AGENT][NEUTRAL] Do you have any specific, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, ma'am. So the first, um, preventative codes that you gave me, of course, of course, they are covered under 100, correct? By wings and panel.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, Panna was covered at 80 and then the bite ones at 100.
[AGENT][NEUTRAL] Uh, correct, by ways to preventative, so it pays at 100% of UCR.
[CUSTOMER][NEUTRAL] OK, um, what about PA is the code 0220?
[AGENT][NEUTRAL] Uh, PAs fall on the basics are paid at 80.
[CUSTOMER][NEUTRAL] What's the frequency?
[AGENT][NEUTRAL] Uh, there's no frequencies for PAs.
[CUSTOMER][NEUTRAL] OK, and for panel, what was that frequency?
[AGENT][NEUTRAL] Uh, Pao FMX once every 5 years.
[CUSTOMER][NEUTRAL] OK, the code 0120 and 0140, you said that they share frequency 2 and 12 months covered at 100?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, well, for the 120, the 140 is basic, so it's 80%.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEGATIVE] Uh, 4910 is major, pays at 40% and it's once every 6 months, and it does not share a frequency with a regular cleaning.
[CUSTOMER][NEUTRAL] 4355
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][NEUTRAL] Major?
[AGENT][POSITIVE] Uh, it is major, correct.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEGATIVE] Uh, it's not covered.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEUTRAL] Uh, that's
[AGENT][NEUTRAL] Um, once every 24 months.
[CUSTOMER][NEUTRAL] How many quads are allowed per visit?
[AGENT][NEUTRAL] All 4 could be done on the same day.
[CUSTOMER][NEUTRAL] And it's 40%.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, what is the wait time after SRP for period maintenance?
[AGENT][NEUTRAL] Uh, there's not a wait time.
[CUSTOMER][NEUTRAL] Um, 2394.
[AGENT][NEUTRAL] 23.
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][NEUTRAL] Are posterior composites downgraded?
[AGENT][NEUTRAL] Uh, no downgrades.
[CUSTOMER][NEUTRAL] OK, and then you said um the fillings is under basic.
[AGENT][NEUTRAL] Correct, so they pay at 80.
[CUSTOMER][NEUTRAL] OK, um, 7140 and 7210.
[AGENT][NEUTRAL] 7140 is considered basic, so it pays at um 40 80% and 40, 7 to 10 is major.
[CUSTOMER][NEUTRAL] 80.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and crowns don't downgrade either the 20,740?
[AGENT][POSITIVE] Correct, there's no downgrade.
[CUSTOMER][NEUTRAL] OK, 6010.
[AGENT][NEUTRAL] 6010.
[AGENT][NEUTRAL] 16.
[AGENT][NEUTRAL] Uh, what is that code for, because I'm not showing it.
[CUSTOMER][NEUTRAL] Implant implants.
[AGENT][NEGATIVE] Oh, implants are not covered, nor implant crowns.
[CUSTOMER][NEUTRAL] The 6058 not covered?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 6057 abutment not covered I'm assuming.
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] Um.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] 7880.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] 9944
[AGENT][NEUTRAL] Uh, it's once every 7 years, and it falls on a major.
[CUSTOMER][NEUTRAL] 9947
[AGENT][NEUTRAL] Uh, don't show that's covered. What is that code for?
[CUSTOMER][NEUTRAL] Sleep apnea, sleeping appliance.
[AGENT][NEUTRAL] Oh, no, ma'am. That's not covered.
[CUSTOMER][NEUTRAL] OK, what about work though?
[AGENT][NEGATIVE] Or so it's not covered.
[CUSTOMER][NEUTRAL] OK, does the policy pay on propery date?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] Um, are all services applied to the yearly max?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Are there any waiting periods?
[AGENT][NEUTRAL] Uh, there is a 12-month waiting period for major, so he, uh, I'm sorry, yeah, he wouldn't be eligible till [PII] of this year for major.
[CUSTOMER][NEUTRAL] And there is no family deductible, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, is this a benefit or calendar year plan?
[AGENT][NEUTRAL] Uh, calendar year.
[CUSTOMER][NEUTRAL] Have any benefits been used for deductible met?
[AGENT][NEUTRAL] Uh, no, he doesn't have any history.
[CUSTOMER][NEUTRAL] OK, um, can you give me the group name, group number, the claim's mailing address and payer ID?
[AGENT][NEUTRAL] OK, uh, the group number is 12028.
[AGENT][NEUTRAL] Uh, the group name is Universal Trucking.
[AGENT][NEUTRAL] Intermodel, I gotta spell it. Uh I N T E R M O D A L.
[AGENT][NEUTRAL] Because it's Cartridge, C A R T A G E, Cartridge. Um mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And our pay ID is 60801.
[CUSTOMER][NEUTRAL] OK, you said [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what was your name one more time? I'm sorry.
[AGENT][NEUTRAL] Uh, [PII], and my [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there a dependent age limit or full-time student age limit for this plan?
[AGENT][NEUTRAL] Uh, well, age limit is [PII] [PII], but also any other dependents on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get that reference number. I'm sorry, um, is there a missing two clause and the coordination of benefits? I almost forgot to ask that.
[AGENT][NEUTRAL] Uh, there is a missing tooth clause and coordination benefits are standard.
[CUSTOMER][NEUTRAL] For how long has that been close? Is it um.
[CUSTOMER][NEUTRAL] There's no term, no, um, expiration on that, um, Mr. [PII].
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I'll take that reference number.
[AGENT][NEUTRAL] Um, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Uh, you're welcome. Have a great day and thanks for calling APL Ms. [PII]. Bye.
[CUSTOMER][POSITIVE] Take care, mhm.
[CUSTOMER][NEUTRAL] Bye bye.