AccountId: 011433970860
ContactId: 675546c1-cad7-4496-8359-d0e8331b87d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331880 ms
Total Talk Time (AGENT): 195693 ms
Total Talk Time (CUSTOMER): 100944 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/675546c1-cad7-4496-8359-d0e8331b87d2_20250106T14:29_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. I needed to verify uh dental eligibility and benefits please if you don't mind.
[AGENT][NEUTRAL] I can help with eligibility and benefits. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] This is uh [PII].
[AGENT][NEUTRAL] Thank you, thank you. And what is that policy number we're looking at today?
[CUSTOMER][NEUTRAL] It is 022187887.
[CUSTOMER][NEUTRAL] So 022187887.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you very much. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. I do need a callback number please, ma'am, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Certainly it's [PII].
[AGENT][NEUTRAL] Thank you very much. Um, the, the policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Um, now you mentioned benefits, uh, this policy has $1500 per calendar year as a maximum. That's just the verification of the benefits, not a guarantee of payment. Um, it, uh.
[AGENT][NEUTRAL] Covers basic, basic restorative and preventative services, um, as well as major services. Uh, that $1500 as I mentioned, is just a verification, not a guarantee of payment. Now, I do have a fax back that I can send to you if you are interested, um, if there's anything in particular that we need to look up, I can do that as well.
[CUSTOMER][NEUTRAL] OK, so let's look at, well, yeah, uh, I was gonna say let me get the facts back first, but, uh, do you have a percentage of each uh individual um section is gonna be covered at basic restorative majors preventative or is it upon a fee schedule?
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] Well, what we do is we use a percentage of the UCR and so um of your UCR. So uh for preventative services, that is at 100% of the UCR for basic and basic restorative, it is 80%, and then the major services are at 40%. And when you get this fact, [PII], you're gonna see that there's a waiting period of 12 months that has been met.
[CUSTOMER][NEUTRAL] 87.
[AGENT][NEUTRAL] Uh, so we no longer have that, uh, that problem. So, and it doesn't look like, uh, [PII] has used any of his benefits at all since getting this policy. So it looks like everything is available. And of course it's a calendar year, so it would have started up anyway, um.
[CUSTOMER][NEUTRAL] Oh gosh
[CUSTOMER][NEUTRAL] Oh, that's true.
[AGENT][NEUTRAL] So what is your
[CUSTOMER][NEUTRAL] OK, and
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My fax fax number is 281-353.
[CUSTOMER][NEUTRAL] 979-97 you do take electronic uh payments I mean electronic.
[AGENT][NEUTRAL] Absolutely. It is our payer ID is 60801.
[CUSTOMER][NEUTRAL] Submissions.
[AGENT][NEUTRAL] Um, you will also see, uh, on the, um, fax that we have a PO box address as well as a fax number. Uh, one of the things that that may not be listed on here is that we have a website. It is [PII]. You can submit it that way as well. Um, so I'm gonna have this for you in just a moment. Now, before I send this off.
[AGENT][NEUTRAL] Is there anything in particular, there's nothing at all else that I can tell you, or?
[CUSTOMER][NEUTRAL] So yeah actually he's got a toothache so it would be oral surgery.
[CUSTOMER][NEUTRAL] Uh, I can give you dental codes, but I'm not sure if that would help or what would would be the best thing because it would be oral surgery and it's a [PII] code and the other code is uh [PII].
[AGENT][NEUTRAL] Sure, sure. What's that?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, what was the other code 7210, did you say?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for the um the oral surgery, uh, that is covered at um
[AGENT][NEUTRAL] Uh 40%, um.
[CUSTOMER][NEUTRAL] OK 20431.
[AGENT][NEUTRAL] That uh that covers the, the uh surgical extraction of the tooth, um.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Welcome back.
[AGENT][NEUTRAL] Uh, the, the, um,
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, sedation is also at, at 40%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Now, it does, uh, there are limitations on that, um, uh, and I think he's probably already met them as I mentioned before. Uh, it's a maximum of 1 per 7 year period and the patient's [PII] old and older, so we don't really need to worry about that, but it's gonna be covered at 40%.
[CUSTOMER][NEUTRAL] Mhm, OK, OK, uh, do you have a filing deadline?
[AGENT][NEGATIVE] Uh, no, we do not.
[AGENT][NEUTRAL] You do not. As long as he is active with this with this coverage, um, uh, that's the main thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK, and do you require radiographic images?
[AGENT][NEUTRAL] We do not
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, well just go ahead and send me that fax back if there is additional questions I will definitely give you a call and ask you.
[AGENT][POSITIVE] OK, I'll send it to you right now. [PII], thank you for contacting ATL. You have a very good morning.