AccountId: 011433970860
ContactId: 64440da6-2af3-448f-a2ed-acd1f2673b3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572090 ms
Total Talk Time (AGENT): 127420 ms
Total Talk Time (CUSTOMER): 221844 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/64440da6-2af3-448f-a2ed-acd1f2673b3c_20250124T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you?
[CUSTOMER][NEUTRAL] Doing fine. Well, good morning. So, uh, [PII], there's a patient named uh [PII].
[CUSTOMER][NEUTRAL] Need to know the dental breakdown, that's all. Yeah.
[AGENT][NEUTRAL] You're looking for a dental breakdown?
[CUSTOMER][NEUTRAL] Um, yeah, yeah, right.
[AGENT][NEUTRAL] What is the policy number, please?
[CUSTOMER][NEUTRAL] Um, sure, it's 616-8778.
[AGENT][NEUTRAL] Let me try and pull this up, [PII], one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That doesn't come up with an active policy. Do you have their social or can you spell their name?
[CUSTOMER][NEUTRAL] Um, sure. Uh, the name is [PII].
[CUSTOMER][NEUTRAL] [PII], uh, this is the first name, and [PII] is the last name, that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you so much. Let me take a look by name and see what I can find one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. So patient does have an active plan. The effective date on this is [PII]. Would you like the policy number?
[CUSTOMER][NEUTRAL] Um, well, uh, sir, in, in this case, I do have the fax with me. Uh, I have called around, uh, uh, on like 22, but, uh, few of the calls are not on the facts, so I just need to know the information about these codes. That's all, yeah.
[AGENT][NEGATIVE] If the code's not on the fax back, then it's not covered.
[CUSTOMER][NEUTRAL] Uh, well, most of the quotes are not in the fax bag, so that means they're not covered.
[AGENT][NEGATIVE] Yeah, if they're not listed on the fax back then they're not covered.
[CUSTOMER][NEUTRAL] OK, that means.
[CUSTOMER][NEUTRAL] OK. Uh, can you please confirm one thing? Are implants covered under this plan?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm just need to make sure about this one. Yeah, yeah, please.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm not showing that implants are covered. Do you have any codes that you want me to double check?
[CUSTOMER][NEUTRAL] Uh, well, yeah, the code is [PII]. Like I have four codes. Uh, the second one is 60566057 and the last code is [PII].
[AGENT][NEUTRAL] Alright, so I got 605-66065, and what were the other two?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Of course, a lot, a lot of the calls are not in the fax, so I just had to call back once again, yeah, so that's why.
[AGENT][NEUTRAL] OK, yeah, none of those codes are covered under this patient's policy.
[CUSTOMER][NEUTRAL] Uh, OK. And as for the fillings, are composite fillings covered under the plan or not? Uh, cause I'm seeing only amalgam and raising fillings, uh, on the fax. Can you please check this once again?
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so composites are not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And uh under this plan, uh, is there any frequency for?
[AGENT][NEUTRAL] Is there any frequency?
[CUSTOMER][NEUTRAL] Yeah, for 5 peoples.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] What again? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, for code, uh, for the code 0220 and 0230.
[AGENT][NEUTRAL] I'm not showing any frequency limitation under diagnostic.
[CUSTOMER][NEUTRAL] OK, so there's no frequency.
[CUSTOMER][NEUTRAL] OK. And for this plan, uh, the provider is in-network or out of network with the plan?
[AGENT][NEUTRAL] Uh, there's no network required for usage.
[CUSTOMER][NEUTRAL] OK. No network required. And is there any waiting period or any missing tooth clothes?
[AGENT][NEUTRAL] Uh, this policy does have a missing tooth clause.
[AGENT][NEUTRAL] I'm not showing any waiting period.
[CUSTOMER][NEUTRAL] OK. Got it. And apart from this, uh, for the assignments of benefits, uh, does the payment goes to the provider or goes to the payment first or patient first?
[AGENT][NEUTRAL] Uh, it depends on who submits the claim. If the providers submitting the claim, payment would go to the provider.
[CUSTOMER][NEUTRAL] OK. It depends on who submit the claim.
[CUSTOMER][NEUTRAL] OK. Uh, is it going to be billed to the medical first or dental first?
[AGENT][NEUTRAL] Dental.
[AGENT][NEUTRAL] This is just a dental plan.
[CUSTOMER][NEUTRAL] OK. Done, sir.
[CUSTOMER][NEUTRAL] Uh, I'm not seeing any ortho coverage under this plan. Am I correct? Uh, is or not a cover service?
[AGENT][NEUTRAL] Correct, there is no ortho coverage.
[CUSTOMER][NEUTRAL] OK. And for the history, uh, is there any history on file?
[AGENT][NEUTRAL] Uh, let me double check for that. One moment.
[CUSTOMER][NEUTRAL] Yeah, that will affect any frequency for any of the codes.
[AGENT][NEUTRAL] And it's for [PII], correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Last date of service on file is [PII] patient was seen [PII] and [PII].
[CUSTOMER][NEUTRAL] It's [PII] and [PII]. And the date was?
[AGENT][NEUTRAL] This was on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII], [PII] and [PII]. OK, got it.
[CUSTOMER][NEUTRAL] And sir, let me confirm one more thing. Uh, if the code that are not on the fax, that means the services are not covered, right? All the covered services are on the fax, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And there's no network for the patient and there's no downgrade under the plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And all exams shows frequency including the emergency exam, that is 0140, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, got it. And
[CUSTOMER][NEUTRAL] It's only one history that is the profy and pediatrials 11-924.
[CUSTOMER][NEUTRAL] OK, got it. And sir, what about the call reference number, please?
[AGENT][NEUTRAL] Call reference is going to be my name with my last initial than today's date. My name again is [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm. And today's date, right?
[AGENT][NEUTRAL] And today's date. Uh-huh.
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much for your help, sir. Have a great day.
[AGENT][POSITIVE] You're welcome. You too, [PII]. Bye-bye.