AccountId: 011433970860
ContactId: 68d27e7a-0b07-49f8-b5eb-e7ed1085b670
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 527510 ms
Total Talk Time (AGENT): 108784 ms
Total Talk Time (CUSTOMER): 221698 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/68d27e7a-0b07-49f8-b5eb-e7ed1085b670_20250429T16:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from office. And how are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm good, thank you for asking. Uh, OK, uh, I'm looking for uh patient dental benefits.
[AGENT][NEUTRAL] OK, I can help you with dental benefits, [PII]. Do you have a good, uh, callback number?
[CUSTOMER][NEUTRAL] Absolutely. It's going to be [PII].
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] And it's going to be 02408546.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I can send you a fax back that has all the codes listed and everything that's covered or do you need to go over something on the phone?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, I can provide you the fax number. It's going to be [PII].
[AGENT][POSITIVE] OK, I can get that covered or faxed over. It just takes about 2 minutes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, and may I have your good name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] How do you spell it? Like [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And initial last name?
[AGENT][NEUTRAL] Uh, it's [PII].
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, I have a few questions like, uh, what is the status of our provider, Doctor [PII]? Is it, uh, is he in-network with you guys?
[AGENT][NEUTRAL] Um there's no network. They can see any dentists they like.
[CUSTOMER][NEUTRAL] Any dentist? OK. What's the schedule do you are you guys follow?
[AGENT][POSITIVE] That's just reasonable and customary.
[AGENT][NEUTRAL] Usual and customary.
[CUSTOMER][POSITIVE] OK thanks
[CUSTOMER][NEGATIVE] Mm, could you please uh slow it down like I'm not getting your point.
[AGENT][NEUTRAL] It's just based on what's reasonable and customary for the region in which you're billing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So no fee schedule?
[AGENT][NEUTRAL] No, it's just based on what's reasonable and customary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I have the group number?
[AGENT][NEUTRAL] Uh, group number is.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] 16068.
[CUSTOMER][POSITIVE] Perfect. And is it uh the group name is Universal Trucking Benefits Association?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Alright, may I have the payer ID for you guys?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][POSITIVE] 0801 thank you so much for that and could you provide me the individual maximum?
[CUSTOMER][NEUTRAL] Like how much is the dental maximum?
[AGENT][NEUTRAL] It's 1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $300. OK. And did this patient use any or nothing has been used?
[AGENT][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sandwiches
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Uh, they've not used anything this year.
[CUSTOMER][POSITIVE] Alright, thank you so much for that and could you also provide me the effective date of this plan?
[AGENT][NEUTRAL] Effective date [PII].
[CUSTOMER][POSITIVE] Thank you so much for that and it's this uh lender euro physical year.
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Is this a calendar year plan or a physical year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. And how much is the individual and family deductible?
[AGENT][NEUTRAL] 50 for individual and 150 for family.
[CUSTOMER][NEUTRAL] Alright, and the deductibles are applied on basic and major services?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] Thank you so much and uh any deductible has been met or no deductible has been used?
[AGENT][NEUTRAL] They've not used anything this year.
[CUSTOMER][POSITIVE] Thank you so much for that and the preventative and diagnostic services are covered as 100%.
[AGENT][NEUTRAL] Preventative services are covered at 100%, and then radiographs, FMX, those are under 80%.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mm, OK. And, uh, I need some frequency limitations and as well as uh frequency, oh sorry, frequency limitation and as, as well as a history of the some codes. Uh, can I provide you all at once or one by one?
[AGENT][POSITIVE] I've sent the fax that includes that information. Um, you should be receiving it in just a few minutes.
[AGENT][NEUTRAL] So it's got all of your frequencies and it has it lists every code that's covered under the policy.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the frequencies with that.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright thank you and could you tell me that is there mm any downgrade for fillings or no downgrades?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] Provider
[CUSTOMER][NEGATIVE] No longer thank you.
[CUSTOMER][NEUTRAL] And can all cards can be done on the same day or no?
[AGENT][POSITIVE] Uh, yes, I can.
[CUSTOMER][NEUTRAL] So I.
[CUSTOMER][NEUTRAL] It can uh.
[CUSTOMER][NEUTRAL] Thank you. OK, that's all. Is there any downgrade for Chrome?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. And the crown is paid on prepate or date?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wrapped
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the for the code for D4267, uh, it can be done with uh conjunction and the extraction or it cannot be.
[AGENT][NEUTRAL] What was the code?
[CUSTOMER][NEUTRAL] It's uh D 4267.
[AGENT][NEUTRAL] I don't show that code listed.
[CUSTOMER][NEUTRAL] Can it be
[CUSTOMER][NEUTRAL] Representative
[CUSTOMER][NEUTRAL] OK, thank you. And is there any missing tooth closs?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, there is. OK, thank you for that. And what is the frequency limitation for the row?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] 1 for 7 years.
[CUSTOMER][POSITIVE] 1 for 7 years. Thank you so much for that. And is there any waiting period?
[AGENT][NEUTRAL] Yes, 12 months for major endopperio and prosedontic and oral surgery.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But he's passed out.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm. So is there any waiting period or no?
[AGENT][NEUTRAL] Not for this patient, he's exceeded the 12 months. His effective date was [PII].
[CUSTOMER][POSITIVE] Alright thank you so much for that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, I think that's all. Uh, I need the reference number for this call.
[AGENT][NEUTRAL] It's my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII], for your kind assistance. Have a great rest of the day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.