AccountId: 011433970860
ContactId: 6bbe4c3b-0c89-48c4-af81-c100ebbe361d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470399 ms
Total Talk Time (AGENT): 226678 ms
Total Talk Time (CUSTOMER): 81018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/6bbe4c3b-0c89-48c4-af81-c100ebbe361d_20250618T12:38_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I'm trying to get a breakdown of benefits for my patient.
[AGENT][POSITIVE] All right. I'm happy to help with benefits. What's your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's 02594706.
[AGENT][NEUTRAL] Thank you. And then if I can get patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Thank you. So, are we looking for dental benefits or medical?
[CUSTOMER][NEUTRAL] Yes, dental.
[AGENT][NEUTRAL] Dental. OK. Uh, patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we can send you a fax back with a breakdown if that works or give you a verbal breakdown, whatever is best.
[CUSTOMER][NEUTRAL] Um, we can just do it verbally real quick.
[AGENT][NEUTRAL] OK, so it looks like the calendar maximum, let me get that for you.
[AGENT][NEUTRAL] Uh, calendar year maximum is gonna be $500 with the $50 deductible. Patient does have both of those remaining. Deductible does not apply, of course, towards preventative services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, preventative covered at 100%. Patient plan also has basic and FMX covered at 80%.
[AGENT][NEUTRAL] The plan is just for basic and preventative. There is no major and there's no waiting period on those.
[CUSTOMER][NEUTRAL] OK, and what about endo parent oral surgery, is that considered major?
[AGENT][NEGATIVE] Yes, not covered.
[CUSTOMER][NEUTRAL] OK, and what's the claims address?
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and what the schedule do you follow?
[AGENT][NEUTRAL] So it looks like the plan pays by UCR. It does also participate in the Carrington PPO network, however, if you guys are a part of that.
[CUSTOMER][NEUTRAL] Yes ma'am, OK.
[CUSTOMER][NEUTRAL] And then what's the preventive frequencies?
[AGENT][NEUTRAL] Um, so let's see, for cleaning, it looks like once every 6 months, oral evaluations are 2 for 12 months.
[AGENT][NEUTRAL] And then bye wings are once per 12 months and then FMX and pano once every 5 years.
[CUSTOMER][NEUTRAL] SMX andpanos 80% and then the back wings was 100%.
[AGENT][POSITIVE] Uh, eye wings, yes, correct.
[CUSTOMER][NEUTRAL] OK, what about the 0180 and 0140?
[AGENT][NEUTRAL] So I don't see 0140 or 0180 listed. We have 0150 on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and then um is fluoride covered?
[AGENT][NEUTRAL] It is. I do know it's under preventative at 100%. I know it's age restricted. Give me just a second.
[AGENT][NEUTRAL] It is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK, what's the frequency?
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] It's a maximum of 1 per 12 months.
[CUSTOMER][NEGATIVE] The fillings downgrade.
[AGENT][NEGATIVE] No, they do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 4346 would not be covered, correct?
[AGENT][NEUTRAL] Mm, yeah, I don't see it on the fax back 4346 you said?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah, I don't see it so it wouldn't be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about 2940 that one might be covering.
[AGENT][NEUTRAL] Let's see, 2940.
[AGENT][NEUTRAL] Alright, 2940 is actually listed at basic at 80%. It does have a limitation. Let me see what that is.
[AGENT][NEUTRAL] It's a maximum of 1 tooth for 24 months and then it says replace existing only in place for 24 months.
[CUSTOMER][NEUTRAL] OK, and what about 1510?
[AGENT][NEUTRAL] 1550.
[CUSTOMER][NEUTRAL] No 1510.
[AGENT][NEUTRAL] I'm sorry, 1510.
[AGENT][NEUTRAL] Uh, 1510 is listed under preventative, so it looks like at 100%.
[AGENT][NEUTRAL] It looks like limited to dependent children under the age of [PII], it's a maximum of 1 per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then what about PAs?
[AGENT][NEUTRAL] How much
[AGENT][NEUTRAL] Do you have a code for that?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 0220.
[AGENT][NEUTRAL] 220. Where are you at?
[AGENT][NEUTRAL] I don't see it.
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] Yeah, true.
[CUSTOMER][NEUTRAL] 0230.
[AGENT][NEUTRAL] The oh there it is 0220 sorry it's under basic at 80% with no limitation.
[CUSTOMER][NEUTRAL] OK, is there any history on file for her?
[AGENT][NEUTRAL] Uh, let me double check.
[CUSTOMER][NEUTRAL] And the group number.
[AGENT][NEUTRAL] No history on file. Group number 70056. It's management analysis and utilization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then a reference number.
[AGENT][NEUTRAL] Absolutely. Call reference is my name with today's date. My name is [PII], which is [PII] Last initials, my name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, and what's the group name?
[AGENT][NEUTRAL] Uh, the group name is Management analysis and utilization.
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Uh huh bye bye.