AccountId: 011433970860
ContactId: 6a326729-257d-445a-9ebf-674d3e5740f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1286550 ms
Total Talk Time (AGENT): 425358 ms
Total Talk Time (CUSTOMER): 314552 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/6a326729-257d-445a-9ebf-674d3e5740f5_20250124T16:57_UTC.wav
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[AGENT][POSITIVE] Hi, good afternoon, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. Uh, my name is [PII] from Para's office. By the way, good morning.
[AGENT][POSITIVE] Oh yes, I'm having a great morning. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing fine as well. Uh, how about you?
[AGENT][POSITIVE] Thanks, I'm doing great thank you for asking and how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] So, there's a patient named [PII]. I need to know some dental benefits. Just need to confirm a few questions about the plan. That's all.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that. um, do you mind really quick if I get a good call back number?
[CUSTOMER][NEUTRAL] Um, yeah, sure. Of course, it's going to be uh [PII].
[AGENT][NEUTRAL] Thank you. And then the policy number for your patient?
[CUSTOMER][NEUTRAL] Uh, of course, the policy number is 006168778.
[AGENT][POSITIVE] Alright, give me a moment to get that pulled up for you.
[CUSTOMER][NEUTRAL] Yup, sure.
[AGENT][NEUTRAL] And you said 006186878?
[CUSTOMER][NEUTRAL] Uh, no, oh, that is 006168778.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And would you be able to verify for me your patients, uh, and I know you already said it, but I'm sorry if you could say it again, their first and last name and date of birth.
[CUSTOMER][NEUTRAL] Sure, patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] All right, so I have that number pull up a dental policy, but it's just not pulling up one with that um insured's name. Do you mind if I try searching under their first and last name?
[CUSTOMER][NEUTRAL] Yeah, sure. The first name is [PII], that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Last name is [PII], that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you I appreciate that.
[AGENT][POSITIVE] All right, thank you so much for your patience on that. I just, I guess I typed in the number wrong twice and I'm sorry, so I was able to pull it up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] well known shoes, yeah.
[AGENT][NEUTRAL] Um, [PII] is current and active with us, and her effective date is [PII], and you said you had just a couple questions about her benefits, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right. That's right. Yeah.
[AGENT][POSITIVE] OK perfect let me pull up her benefit document for you so I can give you what you're needing.
[AGENT][POSITIVE] Alright perfect and what questions can I help you out with today?
[CUSTOMER][NEUTRAL] So, the first thing I want to confirm, is there any group name or group number for the plan?
[AGENT][NEUTRAL] Oh yes, so there should be both a group name and a group number. Oh no, I'm sorry I spoke too soon. No, um, this is.
[AGENT][NEUTRAL] Um, an individual plan, not through a group.
[CUSTOMER][NEUTRAL] So there is no group name and there's no group number, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, got it. And apart from this, uh, the patient has annual max of $1000. Anything is from the annual max for deductibles?
[AGENT][NEUTRAL] OK, yeah, I'll take a look at that calendar year balance for you.
[CUSTOMER][POSITIVE] Yup, thank you.
[AGENT][NEUTRAL] Uh, it looks like as of.
[AGENT][NEUTRAL] This year we have not used anything.
[CUSTOMER][NEUTRAL] So, everything is still 100%, right? Including the deductibles as well?
[AGENT][POSITIVE] Um, correct, yes.
[CUSTOMER][NEUTRAL] Uh, OK. So, am I correct the family deductible is $150?
[AGENT][NEUTRAL] And I'm so sorry, can you repeat that question? I just had a loud car go by me.
[CUSTOMER][NEUTRAL] Um, sure, sure. Uh, uh, am I correct the annual, uh, family deductible is $150 right?
[AGENT][NEUTRAL] Yes, that is correct, but this is just an individual plan so it doesn't seem like they'll need to use the family deductible, but it is 150.
[CUSTOMER][NEUTRAL] And nothing is used, right? OK, got it.
[CUSTOMER][NEUTRAL] OK. And apart from this, uh, under this plan,
[CUSTOMER][NEUTRAL] Uh, there are a few quotes that I need to check if the codes are covered or not, and
[CUSTOMER][NEUTRAL] So, can I give you all code at once or one by one?
[AGENT][NEUTRAL] Um, yeah, I can take all of them for you and then I'll report them back to you one by one. How does that sound?
[CUSTOMER][POSITIVE] Yeah, that's great. That's great. Because most of the codes I have gone through the facts, so most of them are not on the facts, so starting with the first code.
[AGENT][NEUTRAL] OK. Whenever you're ready.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then the code is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then the code is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] 6
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the code is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then the code is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then the code is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last code is 9944.
[AGENT][NEUTRAL] Perfect and then you said uh when you had checked you didn't see any of these codes on the fax back, is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, right. If there's any code is covered, then you can just tell me. Yeah.
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Alright, so it looks like code 9110 is covered under adjunctive services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At what percentage or at what dollar amount?
[AGENT][NEUTRAL] Um, it is covered at a $15 amount.
[CUSTOMER][NEUTRAL] Uh, $15.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and that is the only one I see um as a covered service. The rest of them I don't show is covered and then I do just wanna let you know that any benefit information I give you over the phone is always just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. And apart from this, 999,110 on call, calls are not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what the code 2950. Can you please check this code once again? I think this is under ground. Can you please, in, in this case.
[AGENT][NEUTRAL] You said 2950?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Oh yeah, no, that one is covered now I feel like I need to go back and double check them all, um.
[CUSTOMER][NEUTRAL] Yeah, please, in this case.
[AGENT][NEUTRAL] Yes, that one is covered as it shows at a $45 benefit.
[CUSTOMER][NEUTRAL] And is there any frequency for this call?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It says crowns and bridges are once every 5 years.
[CUSTOMER][NEUTRAL] So the 2950 is $175 year, right, at $45.
[AGENT][NEUTRAL] Yes, and.
[AGENT][NEUTRAL] Let me just.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So I want to check something else for you.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It looks like um procedure code 02920 I'm sorry 02392 and 02393.
[CUSTOMER][NEUTRAL] Uh, well, these are not the codes. I think that is 02, what was that?
[AGENT][NEUTRAL] You gave me 2392 and 2393 to check?
[CUSTOMER][NEUTRAL] Uh, yeah, right, right, and 2394, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so those codes, well, um, number, OK, I'm sorry.
[AGENT][NEUTRAL] 2392 is covered under a different code. It's 2386 on this policy.
[AGENT][NEUTRAL] Um, resin to surface, posterior permanent.
[AGENT][NEUTRAL] And then 2393 is covered under the code 2387 resin three or more surfaces posterior permanent. So they um.
[AGENT][NEUTRAL] Through the same procedure but they're they're covered under a different code.
[CUSTOMER][NEUTRAL] OK. And for these two quotes, is there any different amount or anything like this?
[AGENT][NEUTRAL] Yeah, so for those two codes, the 2392, which is covered under 2386, that benefit amount is $64 and then for the $2393 which is covered under code 2387, that benefit amount is $85.
[CUSTOMER][NEUTRAL] $85. And what's about 2394?
[AGENT][NEUTRAL] Um, that one is not covered on this policy.
[CUSTOMER][NEGATIVE] Again, not covered. That is under the code 2386 and the second one is 2387.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK. And any other services that is covered under the plan?
[AGENT][NEUTRAL] Um, yeah, so I also noticed that the 9944, um.
[AGENT][POSITIVE] It's covered under 9940 instead of 44, the code is 4440 for the acousal guard, and it has a $30 benefit.
[CUSTOMER][NEUTRAL] OK. Also covered under 9940, that is $30.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And those are the only ones I have that were covered under different codes. The rest of them I don't show.
[CUSTOMER][NEUTRAL] OK. And all the costs are not covered, right? OK. Got it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the code that is 4910, shows frequency with 1110.
[AGENT][NEUTRAL] You said 49, 10 and 1110, is that correct?
[CUSTOMER][NEUTRAL] Yeah, do the share frequency.
[AGENT][POSITIVE] That's a wonderful question. Let me look at that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do not show that they
[AGENT][NEUTRAL] Share frequency now.
[CUSTOMER][NEUTRAL] OK, got it. And uh how many quotes allowed on the same visit for the SRP?
[AGENT][NEUTRAL] It doesn't mention um a maximum number of quads done in a day.
[CUSTOMER][NEUTRAL] OK, so it depends upon like the necessity of the patient, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, got it.
[CUSTOMER][NEGATIVE] No guidelines.
[CUSTOMER][NEUTRAL] Uh, OK. And, uh, apart from this, uh, for this patient, is there any history on file that will affect any frequency?
[AGENT][POSITIVE] OK, that's a great question. Let me pull up their history for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so their proies are every 6 months and so are their oral examinations. The last ones were on [PII], so it hasn't quite been 6 months since then.
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] The bite wings, let's see, every 6 months. They have gone 6 months since their last bite wings, so those are good.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Look for any.
[AGENT][NEUTRAL] FMX or Pianos.
[AGENT][NEUTRAL] Do you know off the top of your head um the code for the FMX?
[CUSTOMER][NEUTRAL] Uh, sure. That is [PII].
[AGENT][POSITIVE] 0210 thank you.
[AGENT][NEUTRAL] OK, I don't have history on that and it does not look like I have history on the panels the 00330, um, in the last.
[AGENT][NEUTRAL] 5 years.
[CUSTOMER][NEUTRAL] Mm, OK. Um.
[AGENT][NEUTRAL] Oh, they're every years anyway, so it looks like your bite wings and your FMX and panos um are
[AGENT][NEUTRAL] You don't have any history that's gonna impact you, but your prophy and your exam, um.
[AGENT][NEUTRAL] The last one was in November, so it hasn't been 6 months yet.
[CUSTOMER][NEUTRAL] OK. And for the exam, which is the specific code that is done on the [PII]?
[AGENT][POSITIVE] Oh, that's an excellent question. Let me pull that back up for you. Um, the exam, it was 0120.
[CUSTOMER][NEUTRAL] 0120. And for the profit that is 1110. And any history of tes?
[AGENT][NEUTRAL] Any, I'm so sorry, what was that question?
[CUSTOMER][NEUTRAL] Uh, and that is for periodicals. The code is 0220 and 0230. Any history?
[AGENT][NEUTRAL] Yes, 0220 was done on [PII] as well.
[AGENT][NEUTRAL] And it looks like 0230 was done [PII].
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] [PII]. Got it. And [PII], uh for this plan, uh, do all exams show frequency including the emergency exam, that is 0140?
[AGENT][NEUTRAL] So under their exams it just says oral exam once every 6 months, but it doesn't have on this policy where it says that they share frequencies so.
[CUSTOMER][NEUTRAL] OK, understood. Got it.
[CUSTOMER][POSITIVE] Well, no issues. Uh, that's all I want to confirm.
[CUSTOMER][NEUTRAL] Yeah, so, uh, [PII], uh, what about the call reference number?
[AGENT][NEUTRAL] Oh, the call reference number is my name, [PII] last name, B like [PII], in today's date.
[CUSTOMER][NEUTRAL] OK, that is.
[CUSTOMER][POSITIVE] Mhm. OK. Got it. And today's date. Yeah. Thank you so much for your help by the value. Have a great day.
[AGENT][POSITIVE] Hey, my pleasure you have a great day too. Thank you for calling APL.
[CUSTOMER][POSITIVE] Yeah. Thank you.
[AGENT][NEUTRAL] Bye bye.