AccountId: 011433970860
ContactId: 64d90d55-01e4-4a35-9638-0c0081ec04e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 838809 ms
Total Talk Time (AGENT): 314497 ms
Total Talk Time (CUSTOMER): 272040 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/64d90d55-01e4-4a35-9638-0c0081ec04e6_20250303T20:30_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, um, this is [PII] from the claims department and making a transfer. I have a provider on the line name of [PII] Um, he's calling about [PII]. The policy number is 5 consecutive zeros.
[CUSTOMER][NEUTRAL] 1954511.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][NEUTRAL] OK, you say you have a provider on the phone that [PII] and he's wanted to check, what again? I'm sorry.
[CUSTOMER][NEUTRAL] The patient's eligibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you can send them to me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much transferring now.
[AGENT][POSITIVE] You're welcome. Bye.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling for dental office. How are you doing today?
[AGENT][NEUTRAL] Uh, fine, and you were transfer you're needing uh eligibility for the patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Um, and this is for [PII]?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, and [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. I'm showing its effective date is [PII] and I'm showing the policy is active.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And can you please also provide me the group name and group number for this trip?
[AGENT][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] Uh, group number 70055.
[AGENT][NEUTRAL] The group name is TRC Staffing Services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it staffing services?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] TRC Staffing Services.
[CUSTOMER][NEUTRAL] All right. Can you please spell out the second word?
[AGENT][NEUTRAL] Staffing, S T A F F I N G.
[CUSTOMER][NEUTRAL] If I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right and uh.
[CUSTOMER][NEUTRAL] Can you please also verify me the mailing address and the payer ID?
[AGENT][NEUTRAL] Uh, mail address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the payer ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And can you please provide me the direct number for your depart?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the direct phone number for your depart?
[AGENT][NEUTRAL] Well, the [PII] and then follow the prompt.
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Alright, and what is the claim timely filing limit?
[AGENT][NEUTRAL] Uh, there is no time limit to submit.
[CUSTOMER][NEUTRAL] OK, and any coordination of benefits?
[AGENT][NEUTRAL] Uh, standard.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And uh can you please also uh provide me the member ID for this patient?
[AGENT][NEUTRAL] Sure, it is 1954511.
[CUSTOMER][NEUTRAL] 4500
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, can you please confirm the network status of the provider? Is he in network with this time?
[AGENT][NEUTRAL] Uh, we don't have a network with our company. Our policies is open to our patients could go to any provider.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and what's the fees are we going to follow these policies?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, what is the fee schedule? Are we going to follow on these policies? Is it you?
[AGENT][NEUTRAL] Uh, the policy doesn't pay by fee schedule. It pays by UCR.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright, and now I want to confirm, does the, uh, when res in the [PII].
[AGENT][NEUTRAL] I'm sorry, say that again.
[CUSTOMER][NEUTRAL] Is this plan like the year?
[AGENT][NEUTRAL] I'm sorry, say that one more time.
[CUSTOMER][NEUTRAL] Is it a calendar year policy? Like is it run in the calendar year?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is the annual maximum limit for this year?
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification of coverage. The patient has a benefit max of $500 per calendar year.
[CUSTOMER][NEUTRAL] Do right. And does it apply to all covered services?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, any deductibles?
[AGENT][NEUTRAL] There is a $50 deductible that is supplied to everything but preventative.
[CUSTOMER][NEUTRAL] OK. No deductible for family?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] No, it's just an individual policy, so there's not a family deductible.
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] Any coverage for orthodontic services.
[AGENT][NEUTRAL] No, Ortho is not covered nor major services.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And end up paying your annual service is also covered in this bill on the basic services.
[AGENT][NEUTRAL] I'm sorry, say that again.
[CUSTOMER][NEUTRAL] And no patio and oral surgeries. Are they covered under basic services or are they also not covered?
[AGENT][NEUTRAL] No, they're not covered. They're considered major.
[CUSTOMER][NEUTRAL] Oh I do.
[CUSTOMER][NEUTRAL] OK, and what are the coverages for preventative and basic services?
[AGENT][NEUTRAL] Preventative pays 100% of UCR Basic, basic restorative FMX panoramic pays at 80%.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] AZ8T, OK.
[CUSTOMER][NEUTRAL] And uh any waiting period or missing two class?
[AGENT][MIXED] Uh, there is a missing tooth paws, but there is no waiting period.
[CUSTOMER][NEUTRAL] All right. Any history on the file for this patient that may going to affect the patient plan?
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Um, showing the last pano was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And a show last bit Wing was [PII].
[CUSTOMER][NEUTRAL] Alright, yeah, so other than the major services and the major services, I do have some ADA course left. So, uh, can you please provide me the frequency and also the coverage for the.
[AGENT][NEUTRAL] How many cos do you have?
[CUSTOMER][NEUTRAL] Uh, allow me, would I have to go that first, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have 12 cos left.
[AGENT][NEUTRAL] OK, what are those codes?
[CUSTOMER][NEUTRAL] OK. Should I provide you all its?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, the codes are 0120.
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] 0150.
[CUSTOMER][NEUTRAL] 0210.
[CUSTOMER][NEUTRAL] 022002740364.
[CUSTOMER][NEUTRAL] 11101206
[CUSTOMER][NEUTRAL] 1351.
[CUSTOMER][NEUTRAL] 49108.
[CUSTOMER][NEUTRAL] 9230 that's all.
[AGENT][NEUTRAL] OK, well, I'll tell you that 4910 is not covered that falls under or periodontics, which is not covered under the plan. Give me a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And as far as the 9230, what is that code for?
[CUSTOMER][NEUTRAL] Uh, this is for nitrous oxide.
[AGENT][NEUTRAL] Uh, it's not covered, but it's considered major. Uh, the first three codes, the 120, 140, 150 are exams, which are 2 for 12 month period. The first, uh, the 120 and the 150 are considered preventative, the 140 is considered basic. So the 140 pays at 80%, the 120 and the 150 pays 100% of UCR, uh, the 210.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For a full mouth, there is no history and that it's once every 5 years and it shares a frequency with panel, which they did have one on [PII] at [PII].
[AGENT][NEUTRAL] Um, the 220, there's not a frequency, but it is considered basic, so it pays at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The 274 for um Brightwing, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That is once every 12 months and that has already been fulfilled because they have one on [PII], or [PII], so they're not eligible for that. A cleaning is once every 6 months, it does not share frequency with the peril maintenance, which is not covered. The 1206.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] For fluoride, uh, fluoride is under the age of [PII], once every 12 months, and for the 1351 for sealants under the age of [PII], permanent molars only once every 3 years.
[AGENT][NEUTRAL] And those two do consider it preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about the fillings?
[AGENT][NEUTRAL] Fillings. Uh, well, that falls under basic and it's once every 24 months and there are no downgrades.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Just one last thing, uh, can you please confirm that, uh,
[CUSTOMER][NEUTRAL] Oh, this policy, is there a coverage for the occlusal card. The code I do have is [PII].
[AGENT][NEGATIVE] It's not covered. A close guard is considered major, so it is not covered.
[CUSTOMER][NEUTRAL] Dot.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And also for the code 0120, uh, can we do uh 0120 and 0140 on the same day?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And they do not share frequency with each other, right?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, they do not share frequency with each other, right?
[AGENT][NEUTRAL] I'm sorry, you're talking a little too fast. Say it one more time.
[CUSTOMER][NEUTRAL] Uh, they do not share frequency with each other, right?
[AGENT][NEUTRAL] I'm sorry, say what doesn't share frequency?
[CUSTOMER][NEGATIVE] Like, like 00120 and 0140. They do not share frequency with this.
[AGENT][NEUTRAL] They do. As I said at all, as I said earlier, all exams share the same frequency of 2 for 12 months. So the 120, 140, 150 all share the same frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so that will be all for a tech, yeah. How do you, uh, can you please provide the reference of a phone call.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name in today's date.
[CUSTOMER][POSITIVE] All right, that will be all for today. Thank you so much for helping me out. I do appreciate your effort and hope you have a great day ahead. Stay safe and take care.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL. Bye.