AccountId: 011433970860
ContactId: 656cbc06-ea4c-4947-9098-84fb03453f1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514820 ms
Total Talk Time (AGENT): 243367 ms
Total Talk Time (CUSTOMER): 132233 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/656cbc06-ea4c-4947-9098-84fb03453f1f_20250319T17:28_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and I'm calling you on behalf of dental office to check eligibility and benefits for a patient on a recorded line.
[AGENT][NEUTRAL] I can help with eligibility and benefits, [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 187585365.
[AGENT][NEUTRAL] OK. Um, I'm not sure that this is one of our policy numbers, but let's look it up.
[AGENT][NEUTRAL] And uh the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Well, I'm looking that up, if I could have a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much. I'm just checking this now.
[AGENT][NEUTRAL] OK, 187585-365.
[AGENT][NEUTRAL] Well, let's see. Um, maybe we can make, we can find it by their name. And how do you spell their last name, please, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII], that is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] [PII]. OK. Thank you.
[AGENT][NEUTRAL] OK, so the policy number for this is 0149.
[AGENT][NEUTRAL] 8790 and again that's 01498790. This policy went into effect on [PII]. It is active. Uh, these policies have $1500 per calendar year as a maximum. That's just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And it covers basic.
[AGENT][NEUTRAL] Basic restorative and preventative services. Now, um, there's no network with these policies. uh, [PII] can go to uh to any provider that she wants to, and what we do is we pay a percentage of UC of the UCR.
[AGENT][NEUTRAL] So for preventative services, we pay at 100% of UCR and for basic and basic restorative we pay 80%.
[AGENT][NEUTRAL] Major services, we pay 40%. So is there anything in particular or anything specific I can tell you about this dental policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Uh, firstly, uh, the patient itself is a subscriber of the plan.
[AGENT][NEUTRAL] Uh, no, it looks like, uh, her husband is the subscriber. She, she's a participant.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Thank you. And uh can you help me with the group name and number?
[AGENT][NEUTRAL] The group number for the policy is 16927.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I'm just checking here. It's uh.
[AGENT][NEUTRAL] And the group is uh Universal Trucking.
[CUSTOMER][NEUTRAL] Universal tracking.
[AGENT][NEUTRAL] A trekking, trekking like a track.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And some tracking. Thank you for that just a moment and
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Can you please help me with the claim's mailing address?
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you for that. And uh is that a deductible on the plan or there is no deductible?
[AGENT][NEUTRAL] There's a $50 deductible per calendar year that does not provide, uh, does not include preventative services, and it has a family deductible of $150.
[CUSTOMER][NEUTRAL] OK. And orthodontics are covered on the plan or they're not?
[AGENT][NEGATIVE] Uh, no, they are not.
[CUSTOMER][NEUTRAL] OK. And uh you said uh the cover uh implants are covered on the plan or they are not?
[AGENT][NEGATIVE] No, they're not.
[CUSTOMER][NEUTRAL] OK. And uh no waiting period or missing tooth loss, right?
[AGENT][NEGATIVE] Uh, there is a missing tooth cloth. There's no waiting period.
[CUSTOMER][NEUTRAL] OK, that is a passing cloth and no waiting period.
[CUSTOMER][NEUTRAL] Thank you for that. And can you please provide me with the uh frequencies for the diagnostic and preventative services?
[AGENT][NEUTRAL] Yes, the um,
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the uh
[AGENT][NEUTRAL] Uh, exams are 1, excuse me, 2 for 12 month period.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The um bite wings are once for 12 month period.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the uh full mouth and panel are once every 5.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now, for the uh dentures, uh that is uh partials and dentures, that's once every 5, and for crowns and bridges, it's once every 7.
[CUSTOMER][NEUTRAL] Thank you. And uh fluorides are covered or they're not?
[AGENT][NEUTRAL] It is what provided?
[CUSTOMER][NEUTRAL] Uh, fluoride, uh, the code 1208.
[AGENT][NEUTRAL] Uh, the fluoride is provided. Uh, there is an age limit on that, um, so for, um,
[AGENT][NEUTRAL] Let's see, the fluoride for, uh, it's for children [PII] and under or adults [PII] and under.
[AGENT][NEUTRAL] And that's once every 12 months, and then sealants are also covered.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, but, uh, again, that is, uh, there's an age limit on that, and the sealants, uh, are for, um.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] [PII] and under.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what will be the frequency for periodontal maintenance and SRP?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Checking
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is a maximum of 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] And all 4 calls can be done on the same day?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. And uh what's the frequency for period maintenance?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Just checking.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is uh
[AGENT][NEUTRAL] Once per um
[AGENT][NEUTRAL] That's 1 quadrant for 24 months. It's the same thing.
[CUSTOMER][NEUTRAL] OK. And uh can you check if oral cancer screening is covered on the plan or they're not?
[AGENT][NEGATIVE] It is not.
[CUSTOMER][NEUTRAL] OK. And uh is there any downgrades on the plan?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] There are no downgrades. OK. And pre-authorization is required or just recommended?
[AGENT][NEUTRAL] Uh, it's recommended, but it's not required.
[CUSTOMER][NEUTRAL] OK, thank you for that. And for the SRP you said all cards can be done on the same day, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, thank you. And lastly, [PII], can you please provide me with the reference number for this call?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][POSITIVE] Uh, that's all. Thank you.
[AGENT][POSITIVE] OK, well thank you for contacting API have a very good day.