AccountId: 011433970860
ContactId: 6e6d4b4d-667c-4499-acae-36cb61f47e42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552520 ms
Total Talk Time (AGENT): 258801 ms
Total Talk Time (CUSTOMER): 187322 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/6e6d4b4d-667c-4499-acae-36cb61f47e42_20250617T20:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get dental benefits for a patient.
[AGENT][POSITIVE] Sure, I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then another
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] What was that? I'm sorry?
[AGENT][NEUTRAL] Patients policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02492089
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. You need this information given to you verbally or faxed over to you, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, verbally, please.
[AGENT][NEUTRAL] OK. Do you have a specific question or you need a full breakdown?
[CUSTOMER][NEUTRAL] Um, I have some specific questions and then some codes if that's OK.
[AGENT][NEUTRAL] OK, um sure. Bear with me just a minute. Let me pull the whole schedule.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'm ready for any questions.
[CUSTOMER][NEUTRAL] Um, first, can I start with the group name and number, please?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, the name is Universal Trucking Transport Design W2.
[CUSTOMER][NEUTRAL] Is there a group number?
[AGENT][NEUTRAL] Yes, the group number is 14481.
[CUSTOMER][POSITIVE] Perfect and can I get the effective date please?
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Effective date is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] And is there any waiting periods they're missing tooth cloths?
[AGENT][NEGATIVE] Um, for this one, there is a waiting period of 12 months for any major service and there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] So then that waiting period will be met on [PII], correct?
[AGENT][NEUTRAL] [PII]. Correct. Mhm.
[CUSTOMER][POSITIVE] Perfect. And did you say there is a a missing tooth cloth? I apologize.
[AGENT][POSITIVE] Yes, for this one, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you tell me this patient's maximum and deductible amounts after that waiting period is met?
[AGENT][NEUTRAL] Sure, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We have a calendar year maximum of $1500 per covered person with a $50 deductible and deductible does not apply to preventative expense.
[AGENT][NEUTRAL] Preventative is cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%, basic expense and basic restorative expense is covered at 80%.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Major service including inonics, periodontics, prostheonic repair, and oral surgery, they're all 40% after the 12 month waiting period.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And I'm sorry, did you say basic was 80 as well?
[AGENT][NEUTRAL] Um, yeah, basic, basic restorative and radiograph FMX080.
[CUSTOMER][NEUTRAL] Alright, perfect, and can you tell me if anything has been met on that maximum or deductible?
[AGENT][NEUTRAL] Mm, sure, I can check. Let's see.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Oh, OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, as of today, Mr. [PII] has not used his benefits, so he still have the 1500 and he has not met his deductible.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect. And can I get your payer ID and claims address please?
[AGENT][NEUTRAL] Payer ID is 60801. Again, that's 60801.
[AGENT][NEUTRAL] And you said the mailing address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Um, the mailing address is [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] O
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And can I give you some codes?
[AGENT][NEUTRAL] OK, bear with me, let me go back to that page.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's gonna be one by one, give me the first one.
[CUSTOMER][NEUTRAL] Yeah, 9310.
[AGENT][NEUTRAL] OK, and you need um percentages or you need limitations?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, both please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Previous date that's fine yeah.
[AGENT][NEUTRAL] So 9310 is gonna be on the basic, which is 80% and there's no limitation on that one.
[CUSTOMER][NEUTRAL] On the [PII], OK, so he wanted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] OK, so panels are gonna be on the radiograph FMX and also so that's 80%.
[CUSTOMER][NEUTRAL] Uh like a follow up and uh.
[AGENT][NEUTRAL] And that one is, let's see, limited to one X-ray procedure in any combination of 210, 277, and 330 per 5 year period.
[CUSTOMER][NEUTRAL] OK, so I didn't, I didn't, yeah, yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and then 9222?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, 9222 is not covered, not listed.
[CUSTOMER][NEUTRAL] OK, on 9223?
[AGENT][NEUTRAL] 9223 it's not it's not listed.
[CUSTOMER][NEUTRAL] OK, 9612.
[AGENT][NEUTRAL] 9612 is not listed.
[CUSTOMER][NEUTRAL] OK, um, 7140.
[AGENT][NEUTRAL] 7140, that's going to be on the basic that's a simple extraction, so that's 80%.
[CUSTOMER][NEUTRAL] Oh yeah
[AGENT][NEUTRAL] And let's see, that is maximum of 1 for 2.
[CUSTOMER][NEUTRAL] OK, 70 to 10.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, 70 to 10, that's gonna be under oral surgery, which is uh 40% after the 12 month waiting period. There's no limitation on that one.
[CUSTOMER][NEUTRAL] Alright, and then 72,407,240?
[AGENT][NEUTRAL] OK, 7240 is also gonna be under oral surgery and that's 40% after the 12 month waiting period and there's no limit, no limitation.
[CUSTOMER][NEUTRAL] Alright, and 6010?
[AGENT][NEGATIVE] 610 is not covered, it's not listed.
[CUSTOMER][NEUTRAL] And 7953?
[CUSTOMER][NEUTRAL] You've never
[AGENT][NEUTRAL] 7953 is not listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is predetermination recommended or required?
[AGENT][NEUTRAL] If not, it's not required or recommended.
[CUSTOMER][NEUTRAL] And um do we have to bill medical first or straight to dental OK?
[AGENT][NEUTRAL] You can buy the albino.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can you, um, the benefits you gave me is that in or out of network or are they the same for both?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] OK, so we would just use UCR correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, um, that is actually I believe all I needed. Let me just make sure, yeah, could I just get um a reference number and then your name one more time please?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII]. That's initial [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] All right thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a good afternoon.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.