AccountId: 011433970860
ContactId: 663a0e38-1d08-4651-b01d-338b3d3bd226
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1399949 ms
Total Talk Time (AGENT): 522702 ms
Total Talk Time (CUSTOMER): 563267 ms
Interruptions: 15
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/663a0e38-1d08-4651-b01d-338b3d3bd226_20250429T16:45_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for part office. And how is your day going so far?
[AGENT][NEUTRAL] I'm fine, and yours?
[CUSTOMER][POSITIVE] Mm, so far so fine, thank you for asking.
[AGENT][POSITIVE] Good.
[CUSTOMER][NEUTRAL] All right then.
[AGENT][NEUTRAL] How can I help you? And you said your name is [PII]? Is it [PII]?
[CUSTOMER][POSITIVE] Perfect. Yes, sorry, you got it. You got it. It's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Hi, [PII] and how can I help you today?
[CUSTOMER][NEUTRAL] And your name is [PII]? Is it spelled as [PII]? Oh sorry about that.
[AGENT][NEUTRAL] Just [PII]
[CUSTOMER][NEUTRAL] [PII], sorry about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] OK, the reason of my call is I'm looking for dental benefits.
[AGENT][NEUTRAL] OK, so you're needing dental benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and only actually for our dental policies, we have a fax back of the benefits for the member's plan that I'll be happy to send to you that has everything on there.
[CUSTOMER][NEUTRAL] Uh, mm, actually, [PII], I called, I called you guys before but I haven't received that fax back yet, so that is why I'm calling again.
[AGENT][NEUTRAL] That's covered and if it's not a.
[AGENT][NEUTRAL] OK, well, I can
[AGENT][NEUTRAL] OK, well I can try and send that to you again, um, Ollie, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It's going to be 02408546.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the special name is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is your patient's date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that. And and if you could, uh, please check the uh our provider status, is it in or out of network?
[AGENT][NEUTRAL] Yes, sir, and give.
[AGENT][NEUTRAL] There is no network for this plan. This, the covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And that is stated on the fax back and I'm sorry that you haven't received that. I'm going to um verify something with you in just a moment.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I shared that the fax number that this was sent to.
[AGENT][NEUTRAL] was [PII].
[CUSTOMER][NEUTRAL] Is that fax number and with this.
[CUSTOMER][POSITIVE] Perfect, that's the fax number we have.
[AGENT][NEUTRAL] Uh yes, sir, and that does show that it was faxed just a few minutes ago. That was only faxed like less than 10 minutes ago.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, but I required some codes, uh, frequency limitation as well as history.
[AGENT][NEUTRAL] So it does take a
[CUSTOMER][NEUTRAL] Like I need it urgent.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Just one moment, Ollie, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have any idea about the turnaround time, like when will we receive it?
[AGENT][POSITIVE] I would say you should be receiving it within the next 10 or so minutes and I have also just sent it to you again.
[AGENT][NEUTRAL] To that same fax number, but it does take a few minutes. I mean, you just called and it was just sent to you, so.
[CUSTOMER][NEUTRAL] Mm, I.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. I'm checking the fax system again and again. Nothing is popping up.
[AGENT][NEUTRAL] Yes, sir, but again, I what I just said, it is gonna take a few minutes to come through. I mean, that's not.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][POSITIVE] OK, OK. OK. OK. Uh great.
[AGENT][NEUTRAL] It's not a matter of just seconds. It's gonna take a few minutes.
[AGENT][NEUTRAL] So, what information can I help you with in the interim?
[CUSTOMER][NEUTRAL] Oh, I got your point. Um, but [PII].
[CUSTOMER][NEUTRAL] Yes, I have few calls for preventative services and I need their history as well.
[AGENT][NEUTRAL] OK. What code would you like for me to check? You'll have to provide me the each one code at a time. I'll check one code at a time for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, alright, thank you so much, [PII], and the post code is for exam. It's uh [PII].
[AGENT][NEUTRAL] OK, now you're wanting to know if this is covered or if there's history for that code?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, like I need a frequency limitation and as well as the history.
[AGENT][NEUTRAL] OK, that falls under preventative. Yes, that falls under preventative.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And preventative services are 100% covered.
[AGENT][NEUTRAL] Of UCR, that is correct.
[CUSTOMER][NEUTRAL] OK. And what is the frequency limitation like?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited to 2 oral evaluation procedures in any combination.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] That's 0120140015001600180 for a twelve-month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, it's 2 per calendar year or 1 per calendar year?
[AGENT][NEUTRAL] It is 2 for 12, it's not per calendar year, it's per 12 month period.
[CUSTOMER][NEUTRAL] 2 cleaner
[CUSTOMER][NEUTRAL] 12 months. Alright, sorry about that. 12 months. I got it. And uh what is the history of the exam?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Of this code of 0120?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] is the last service date.
[CUSTOMER][POSITIVE] [PII]. Thank you so much for that. And the next quote I have is uh a prophy the 1110.
[AGENT][NEUTRAL] 1110.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That's also under preventative.
[CUSTOMER][NEUTRAL] What is the frequency limitation?
[AGENT][NEUTRAL] Maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] 1 for 6 months?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the history of property?
[AGENT][NEUTRAL] 1117 [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And what is the frequency limitation for biking T0274?
[AGENT][NEUTRAL] 0274, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] That's also under preventative?
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Limited to one bite wing X-ray procedure, whether that's 0270, 0272, or 0274 per 12 month period.
[CUSTOMER][NEUTRAL] 2 for 12 months or 1 part?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Limited to one bite wing X-ray per twelve-month period.
[CUSTOMER][POSITIVE] One by X-ray for 12 months. All right. Thank you so much for that. And I need the history as well.
[AGENT][NEUTRAL] Yes, last date of service is [PII].
[CUSTOMER][POSITIVE] 25, thank you so much, [PII] for that and the next code I have is for panel D 0330.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] That falls under radiograph and FMX expenses and the frequency, the limitation on that is going to be limited to one X-ray procedure.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Per five-year period, whether that's 0210, 0277, or 0330, and there is no history on file for 0330.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right, thank you so much, uh, [PII] for that and and this one has no history, OK?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The next code I have is for fluoride and sing. The fluoride is 1206. I need frequency limitation and age limitation.
[AGENT][NEUTRAL] 01206 is not covered.
[CUSTOMER][NEUTRAL] Uh, it's uh D 1206.
[AGENT][NEUTRAL] 1206 is not covered.
[CUSTOMER][NEGATIVE] Yes, not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and how about ceiling 1351?
[AGENT][NEUTRAL] 1355. Is that correct?
[CUSTOMER][NEUTRAL] 0 1351.
[CUSTOMER][NEUTRAL] 1351.
[AGENT][NEUTRAL] Also under preventative and the limitations are 1, excuse me, maximum of 1 procedure for 36 months.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only.
[AGENT][NEUTRAL] And limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm, does that include [PII] as well, or uh 0 to 13?
[AGENT][NEUTRAL] Under under age [PII].
[CUSTOMER][NEUTRAL] Right, so it will be 0 to 130.
[CUSTOMER][NEUTRAL] All right. Thank you, [PII], for that. Uh, and how much coverage is for basic services?
[AGENT][NEUTRAL] Basic is 80% of the UCR subject to the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much. And I have 5 more quotes uh mm that I need uh percentage as well as frequency limitation. Like, first one is for SRPD 4341.
[AGENT][NEUTRAL] That falls under periodontic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Is it covered 80%?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And Per services are 40% of UCR with a 12 month waiting period.
[CUSTOMER][NEUTRAL] Hm
[AGENT][POSITIVE] Which that has been satisfied.
[CUSTOMER][NEUTRAL] Uh, it's covered as 40%.
[AGENT][NEUTRAL] 40% of the ECR are subject to deductible.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And the 4342, is it also covered as 40%?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] So, D 4342.
[AGENT][POSITIVE] That is correct.
[AGENT][NEGATIVE] With the same limitations.
[CUSTOMER][NEUTRAL] And frequency limitation is the same. All right, 1 for 24 months, right? And uh can it be performed same, same day as profit perform like shared frequency limitation with prophy or no?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, it does not, it does not state that it cannot be.
[CUSTOMER][NEUTRAL] Alright, thank you so much. And the next quote is I have is uh the 4910 pay your rental maintenance. How much is it covered? Like I mean the percentage and frequency limitation.
[AGENT][NEUTRAL] 4910 falls under periodontic.
[AGENT][NEUTRAL] Again, the periodontic.
[AGENT][NEUTRAL] Is 40% of UCR subject to the 12-month waiting period that has been satisfied.
[CUSTOMER][NEUTRAL] OK. And what is the frequency?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] One procedure for 6 months.
[CUSTOMER][NEUTRAL] 6 months. So I believe this uh 4910 shared frequency with uh prof ED 1110, right?
[AGENT][NEUTRAL] It did not state that.
[CUSTOMER][NEGATIVE] Mm, like the both frequency limitations of the same one for 6 months.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] The limitations are the same.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] But could you see that and they can be covered on the same day or no?
[AGENT][NEUTRAL] Yes, it does not state that they cannot be.
[CUSTOMER][NEUTRAL] OK. And thank you for that. And the next code is D 4355 and the Brightman.
[CUSTOMER][NEUTRAL] How much is it covered like percentage and frequency limitation?
[AGENT][NEUTRAL] That's also at 40% of UCR Its falls into periodontic expenses, and the limitation on it is also maximum of 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you so much, [PII] for that. And the next code is 4346 and then give it is, yeah, and how much is it covered and limitation?
[AGENT][NEUTRAL] 4346 is not covered.
[CUSTOMER][NEUTRAL] It's not covered. Thank you so much for that. And if it is not covered for, it cannot be done with profit.
[CUSTOMER][NEUTRAL] Alright then.
[CUSTOMER][NEUTRAL] OK. Uh, the next code is, uh, for endodontic services, how much percentage is it covered? It's for D 33,303,330.
[AGENT][NEUTRAL] Yes, sir. 3330. OK.
[CUSTOMER][NEUTRAL] Uh, 3330.
[AGENT][NEUTRAL] There is no limitation. That's a molar.
[AGENT][NEUTRAL] Excluding final restoration, is that correct? That falls under indontics. There are no limitations and it's 40% of UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much for that. And there is also 40%. Uh, I need the percentage for oral surgery like the 70 to 10%. How much percentage it covered?
[AGENT][NEUTRAL] Oral surgery is not.
[AGENT][NEUTRAL] How what is the code? No, what is the code?
[CUSTOMER][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] D 7 7210.
[AGENT][NEUTRAL] There is no limitation on that, and that is 40% of the UCR.
[CUSTOMER][NEUTRAL] Thank you so much for that. And how much is the major coverage? Like how much, how much percent is the major coverage? Is it 50%?
[AGENT][NEUTRAL] Major is also for covered Major is covered also at 40% of the ECR of covered services.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Thank you so much. And Crown D 2740 is also covered at 40%.
[AGENT][NEUTRAL] How what was the code?
[CUSTOMER][NEUTRAL] E. 2740.
[AGENT][NEUTRAL] That would also fall under major?
[AGENT][NEUTRAL] And the limitations.
[CUSTOMER][NEUTRAL] OK. It is also covered at 40%.
[CUSTOMER][NEUTRAL] Uh, sure, go ahead.
[AGENT][NEUTRAL] Yes, maximum of 1 per 7-year period and limited to patients age [PII] and over.
[CUSTOMER][NEUTRAL] [PII] old.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] And is there any downgrade for Crown?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK. And I need the percentage for core buildup like D 29 for 50. Is it also covered as 40%?
[AGENT][NEUTRAL] What was the code?
[CUSTOMER][NEUTRAL] D 2950 core buildup.
[AGENT][NEGATIVE] Yes, that also falls under major.
[AGENT][NEUTRAL] With the same limitations. Mhm. Maximum 1 for 7 months and limited to patients age [PII] and over.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] OK thank you so much for that.
[CUSTOMER][NEUTRAL] All right and.
[CUSTOMER][NEUTRAL] I need the percentage and frequency limitation for the nightgu D 9944.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Not covered. Thank you so much for that. And for orthodontic, how much is it covered, like percentage?
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] Uh, how about for the code B 2643?
[AGENT][NEUTRAL] How, what's the code again?
[CUSTOMER][NEUTRAL] And D 2643. D. 2643.
[AGENT][NEUTRAL] All under Major.
[AGENT][NEGATIVE] With the same limitations.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, covered as 40% and
[AGENT][NEUTRAL] Maximum of 1 per 7 year and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] Uh, what is the limitation?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Seeing there
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] And I have 6 more codes that I need percentage.
[CUSTOMER][NEUTRAL] Just only 6 cos after that, we're done.
[AGENT][NEUTRAL] What is the next code?
[CUSTOMER][NEUTRAL] And it's for implant B6010.
[AGENT][NEUTRAL] I'm sorry, what was the code?
[CUSTOMER][NEUTRAL] And D 6010. D 6010.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Mm, alright, thank you so much for this.
[CUSTOMER][NEGATIVE] And for these 6057 is is also not covered?
[AGENT][NEUTRAL] I can tell you anything related to implant placement, removal, and all related services are not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and 60 1060 57, 6058, not covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Anything related to implant placement, removal, and all related services are not covered.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, how about for code D 4267? This is also not covered?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] Thank you. And D 7951 and D 7953.
[AGENT][NEUTRAL] Are these related to implants?
[CUSTOMER][NEUTRAL] Mm, maybe.
[AGENT][NEGATIVE] No, not covered. 51 and 7953 also not covered.
[CUSTOMER][NEUTRAL] Thank you so much for that, [PII], and I think we're done. Uh, OK. Well, one more question. Is it, is there any downgrades for the code D 2643?
[AGENT][POSITIVE] No, there's no downgrades. There's no downgrades.
[CUSTOMER][NEUTRAL] And just hold on, let me write that down no downgrades.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] What where was I done done OK, uh, I need your uh good name. Your name was [PII], and may I have your initial to your last name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name in today's date, [PII], and I'll leave my name in today's date will be your call reference number and lastly if you all do file a claim for this number with us once the claim has been processed, we have a portal in which you should be able to check claim status and our portal website is secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, [PII]. Thank you so much for your kind assistance. I really appreciate it. Have a great rest of the day. That's all from my side.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Yes, and give me, yes, give me your fax number one more time, Ollie, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, yes, I'm checking my fax machine and nothing is still.
[AGENT][NEUTRAL] What is, yes, what is, yes, for some reason it's not going through. What is um what is the fax number again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. It's going to be [PII].
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Does this, do your faxes come to your email?
[CUSTOMER][NEUTRAL] If you can just uh repeat it back to me.
[AGENT][NEUTRAL] Do they come to your email or is it to a fax machine?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, no. It's a fax machine.
[AGENT][NEUTRAL] OK, so again, that's [PII]. Is that correct?
[CUSTOMER][POSITIVE] Perfect, [PII]. Perfect, [PII]. You got it?
[AGENT][NEUTRAL] Yes, sir. So hopefully you will get that because it's now been sent 3 times.
[CUSTOMER][POSITIVE] Hopefully it will. All right. Thank you so much, [PII], for your kind assistance. I really appreciate it. Have a great rest of the day and rest of the weekend as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, well, you're welcome. Yeah.
[AGENT][POSITIVE] I hope you do too, and thank you so much for calling APL and I hope the same thing for you as well.
[CUSTOMER][POSITIVE] OK. Thank you so much. Bye for now.
[AGENT][POSITIVE] Ah, you're welcome. Bye bye.