AccountId: 011433970860
ContactId: 6ac1c8d1-a230-4d38-bf26-f3a58f028a5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 683049 ms
Total Talk Time (AGENT): 203088 ms
Total Talk Time (CUSTOMER): 326024 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/6ac1c8d1-a230-4d38-bf26-f3a58f028a5f_20250513T17:10_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah, OK, so.
[AGENT][POSITIVE] Good afternoon. Thank you for calling. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I, I have a couple benefit questions on a patient.
[AGENT][POSITIVE] OK, well, I can help you with your benefit questions. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and a good contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] The member's policy number is 1371798.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I believe I will, I might have the last name wrong, but the first is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] So I am showing the
[AGENT][NEUTRAL] And what questions did you have in reference to the policy?
[CUSTOMER][NEUTRAL] Yes, uh,
[CUSTOMER][NEUTRAL] I'm sorry, um, I, I just wanna confirm, is the deductible still 50 and was it, was it met to date or anything?
[AGENT][NEUTRAL] Hold on one moment, let me pull up their benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And you said [PII], correct?
[AGENT][NEUTRAL] So yes, for this policy, the deductible is still $50 per person up to $150 per family, and I'm waiting for their accumulations to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] Her family
[CUSTOMER][NEUTRAL] accumulation
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And if once we're done with this call, is it OK if you can fax over the benefit information to to us.
[AGENT][NEUTRAL] Mhm. Um, sure, so they have not used anything um for [PII], any of the benefits, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] and I still have questions just to confirm.
[AGENT][NEUTRAL] OK. And what are your, what other questions did you have?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So they didn't use the deductible and the annual max is 1500. Did they use any of the in the 1500?
[AGENT][NEGATIVE] No, they haven't used any of their benefits for [PII].
[CUSTOMER][NEUTRAL] OK, and OK, and y'all's fee schedules UCR, is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And um every diagnostics 100% basic is 80 majors 40%.
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEGATIVE] And implants no coverage.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh for D 4910 is there a shared frequency?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, it's not shared with anything. Um, it's just one procedure for 6 months.
[CUSTOMER][NEUTRAL] OK, OK, and um 4341, it's um can you do all quads in one visit?
[AGENT][NEUTRAL] 4341. Hold on one moment.
[AGENT][NEUTRAL] Um, one each quadrant per 24 months.
[CUSTOMER][NEUTRAL] But you can do all 4 in one visit, correct?
[AGENT][NEUTRAL] Yes, you can. There's no specification other than that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, D0 140, is there a shared frequency with D0 120?
[AGENT][NEUTRAL] Um, yes, 120, 50, and 60 and 80.
[CUSTOMER][NEUTRAL] And OK, and can you do treatment the same day?
[AGENT][NEUTRAL] Yes, there's no specification.
[CUSTOMER][NEUTRAL] OK, the 9944, um, does it have to be related to Bruckism?
[AGENT][NEUTRAL] Um, 9944 is not covered on this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so 9944 is not covered, OK.
[CUSTOMER][NEUTRAL] Um, for any waiting periods.
[AGENT][POSITIVE] For a major, they have a 12-month waiting period, but that's been satisfied.
[CUSTOMER][NEUTRAL] 12 month waiting period.
[CUSTOMER][POSITIVE] OK, so they're already satisfied, um, any missing tooth cloths?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK, um, let's see, any posterior composite alternate benefit?
[AGENT][NEUTRAL] As in like downgrades?
[CUSTOMER][NEUTRAL] Yeah, any downgrades for crowns and fillings.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, there's no downgrades.
[CUSTOMER][NEUTRAL] OK, um, are, do you pay for crowns on prep or seat date?
[AGENT][NEUTRAL] Um, either or.
[CUSTOMER][NEUTRAL] Either or, OK, and you can do build up the same day as Crown.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, and what the pay ID is 60801.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Alright, um, yeah, so you can fax over the rest of the benefits that would be great and can I get a good reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], and I am sending the, um, well, I've already faxed it over to you, so you should be receiving it shortly.
[CUSTOMER][NEUTRAL] He's the name and
[CUSTOMER][NEUTRAL] OK perfect and it's [PII] with [PII] or [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, alright, [PII], thank you so much for the help.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] 00 wait sorry sorry I'm so sorry. Yes, is there any history that could affect the frequency like any history of FMX or any treatment that could affect the history? I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have codes for that?
[CUSTOMER][NEUTRAL] Um, FMX probably like D 0330.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so there's no, hold on, let me go to one.
[AGENT][NEUTRAL] For [PII], last day of service for 0330 is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] of.
[CUSTOMER][NEUTRAL] [PII] and that was uh what code D 0330?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah how about D0210.
[CUSTOMER][NEUTRAL] I assume that's similar.
[AGENT][NEUTRAL] Um, the same, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and um let me see, any other history on there that could affect the frequency like any dental work that the patient got done?
[AGENT][NEUTRAL] So the reason for the call is because we'll have to go through each claim. I don't have like a way to just see what was done.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, um, how about, um, D1110?
[AGENT][NEUTRAL] Um, there's no history for that for that code.
[CUSTOMER][NEUTRAL] There's no
[CUSTOMER][NEUTRAL] OK, how about D0140?
[AGENT][NEUTRAL] 0140.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of [PII] that's for uh D0274.
[AGENT][NEUTRAL] I'm sorry, I thought you said 0140 you said 0.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] 0 0140 OK I'm so sorry yeah D 0140 OK.
[AGENT][NEUTRAL] And then what was the other code you want me, I can look up the other code for you.
[CUSTOMER][NEUTRAL] Um, let's try any D 2740.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII] and what tooth number was that?
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] 14, so it was there on that data service. How about any other ones on 2740, just 14?
[AGENT][NEUTRAL] Oh, just 14, yes.
[CUSTOMER][NEUTRAL] OK, how about 2950.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And also 214. Mhm.
[CUSTOMER][NEUTRAL] And it's for number 14 as well, right? Yeah.
[CUSTOMER][NEUTRAL] Um, how about any D 5213?
[AGENT][NEUTRAL] 52 130.
[AGENT][NEUTRAL] Um, nothing on file for that, um, code.
[CUSTOMER][NEUTRAL] OK, how about D 4341?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 127 and 2019 and that's for all all quads or it was just for like certain parts like upper right lower right?
[AGENT][NEUTRAL] Um, it just says per quad. I can tell you the tooth number.
[CUSTOMER][NEUTRAL] Sure, what's the tube number?
[AGENT][NEUTRAL] It's 40.
[CUSTOMER][NEUTRAL] 40. OK, so probably 4, OK, and um I wanna say that's all the codes I would need that would affect the frequency any of 2331 or 23, yeah 2331.
[AGENT][NEUTRAL] Um, nothing for 2331, and then what was the other one?
[CUSTOMER][NEUTRAL] Um, 23, let's do 91.
[AGENT][NEUTRAL] 2390 and nothing for 2391 either.
[CUSTOMER][POSITIVE] OK perfect um and um I think that would be it. OK, yeah that would be it.
[AGENT][POSITIVE] All right, [PII], well, thank you. Go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And you faxed it to [PII]?
[AGENT][NEUTRAL] Mhm. Attention, [PII].
[CUSTOMER][POSITIVE] OK OK perfect I'll look out for it, but yes, that's all I need the help from you. Thank you, [PII] for the help.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.