AccountId: 011433970860
ContactId: 6b4567d9-a679-4fa3-b516-5ab5610cd5ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382359 ms
Total Talk Time (AGENT): 198816 ms
Total Talk Time (CUSTOMER): 108925 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/6b4567d9-a679-4fa3-b516-5ab5610cd5ca_20250220T18:08_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning or good afternoon. Thank you for calling APL. This is. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from Chandler Dental Arts, and I was calling to get a breakdown of dental benefits for a patient.
[AGENT][NEUTRAL] OK, I can verify benefits for you and you say your name is [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Mhm I have.
[CUSTOMER][NEUTRAL] Individual oh here uh 02560071.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah it's [PII] no extension.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you say you're calling to verify eligibility and benefits, correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm shown his effective date is [PII]. He is active on the policy and for benefits you need general or I can send you a fax back.
[CUSTOMER][NEUTRAL] Uh, yeah, just a general breakdown. Are we gonna be in or out of network?
[AGENT][NEUTRAL] Well, we don't have a network. Uh, the insurance policy is open to where we do take assignment from any dental provider, um, not a guarantee of payment, just a verification coverage. The patient has a benefit max up to $500 per calendar year.
[AGENT][NEUTRAL] Oh, I
[CUSTOMER][NEUTRAL] You said 2500 or 500?
[AGENT][NEUTRAL] Uh, 500, but let me double check. I think, uh, this one is different. Give me one moment.
[CUSTOMER][NEUTRAL] Is this gonna be a discount policy or this is just like a a regular you pay the general dentist and they pay a percentage as well?
[AGENT][NEUTRAL] Well, this policy is just, I guess you can say a limited group dental plan, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited as far as benefits and I know the policy doesn't cover any major services like crowns, bridges, partials, dentures, endo perio or oral, only preventive and basic, and I apologize, insurance benefit maxes up to $1000 per calendar year, and they do have a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] OK, and then your frequencies for preventative?
[AGENT][NEUTRAL] Um, preventive, well, exams are 2 for 12-month period. All exams share the same frequency. Cleanings are once every 6 months, bit wings 1 for 12-month period.
[AGENT][NEUTRAL] Uh, fluoride under the age [PII], once every 12 months, sealants under the age of [PII], once every 3 years, permanent molars online.
[CUSTOMER][NEUTRAL] And then your piano and FMX.
[AGENT][NEUTRAL] Uh, they fall under 80% of UCR and it's once every 5 years.
[CUSTOMER][NEUTRAL] And do you guys cover 0140 for a limited emergency exam?
[AGENT][NEUTRAL] Uh, yes. Oh, and I apologize, it's not a benefit of 1000 it's up to 750 per calendar year. I apologize.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, and is there a 140, what's your frequency and percentage?
[AGENT][NEUTRAL] Uh, as I say, all exams share the same frequency, so it's 2 for 12 month period, and for the 140 that falls within basic, so it pays at 80% of UCR.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Do you guys allow treatment same day?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] And preventative was 100% you said?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] And what was basic percentage?
[AGENT][NEUTRAL] Uh, basic, basic restorative FMX panoramic is 80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Sounds good and.
[CUSTOMER][NEUTRAL] What's the group name group number?
[AGENT][NEUTRAL] Uh, wait.
[AGENT][NEUTRAL] Uh, group number 70084. Group name is Serge Staffing LLC.
[CUSTOMER][NEUTRAL] SERG.
[AGENT][NEUTRAL] S U R G E Surge Staffing.
[CUSTOMER][NEUTRAL] S for Sam, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry, you said S U R G E.
[AGENT][NEUTRAL] Serge, S as in Sam, U R G E, Staffing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] LLC, OK, and what's your guys' dental claims mailing address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And you said the fee we're using is UCR?
[AGENT][NEUTRAL] Uh, what, how we pay is UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you have my patient as the subscriber under this policy?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] And do you have any history on file?
[AGENT][NEUTRAL] Uh, let me double check. I don't believe so. Uh, no, ma'am, we don't have any history.
[CUSTOMER][POSITIVE] OK, sounds good.
[CUSTOMER][NEUTRAL] Uh, that's then.
[CUSTOMER][NEUTRAL] Uh, if I could just get the spelling of your name and our reference number.
[AGENT][NEUTRAL] Uh, it's [PII] last initial [PII], and we don't give reference numbers, but if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK, sounds good thank you I appreciate it.
[AGENT][POSITIVE] Oh, you're welcome, [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.