AccountId: 011433970860
ContactId: 6fd95a65-c8b9-4059-8d2b-5b218cf0be06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379779 ms
Total Talk Time (AGENT): 127250 ms
Total Talk Time (CUSTOMER): 195981 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/6fd95a65-c8b9-4059-8d2b-5b218cf0be06_20250626T12:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning, [PII]. This is [PII] at Third and Smiles. Um, I just talked to somebody there, uh, I don't know, maybe 15 minutes ago, and I got a fax.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the fax isn't clear on some things and I have this patient here for like an emergency visit and I just need clarification on some specific codes please if I could.
[AGENT][NEUTRAL] OK. Well, I'll be able to help you with the codes. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's a direct line. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Um, it's 026242119.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 02624119.
[CUSTOMER][NEUTRAL] Um, no, it's 026242119.
[AGENT][NEUTRAL] The reason I'm asking is because that's coming back that it's not a policy. 0262.
[CUSTOMER][NEUTRAL] Well, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the fax says that there's a 0 in front of it, but just, I guess, take that off. Let me look at his card again. This has been like 2 hours of my life.
[AGENT][NEUTRAL] Yeah, the 0 doesn't matter.
[AGENT][NEUTRAL] What's
[CUSTOMER][NEUTRAL] So his card his card has [PII], but that's not what the fax says, so I don't know.
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, so let's disregard the facts. My apologies. I'll see who sent that to you. The, the number on the card is correct. Can you verify his first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK, so the number on the card is correct.
[CUSTOMER][NEUTRAL] OK, um, his name is [PII], which I think yours ends at [PII] because it doesn't, won't fit.
[AGENT][NEUTRAL] All right. And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, let me see what type of policy. Hold on, and this is medical. That's probably what's going on. Hold on one second.
[CUSTOMER][NEUTRAL] Oh, I bet you the ID is gonna change again. It is. I apologize. I should have told you as well.
[AGENT][POSITIVE] Alright, so the correct it's OK.
[AGENT][NEUTRAL] It's fine. The correct policy number is 264.
[AGENT][NEUTRAL] 2119.
[AGENT][NEUTRAL] So there's too many numbers in the other one.
[CUSTOMER][NEUTRAL] OK, so it is right on the fax, just the 0 does not apply. OK.
[CUSTOMER][NEUTRAL] OK, now that we got all that situated and I know we're in network following Carrington fees.
[AGENT][NEUTRAL] OK, hold on, let me go to the dental policy. Hold on one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, so
[AGENT][NEUTRAL] It's coming up now, my apologies.
[CUSTOMER][POSITIVE] No, that's OK. I've never had to call you guys with or dealt with this insurance, but you guys are are very nice there, so.
[AGENT][NEUTRAL] Well, thank you. OK, so what questions did you have about the fax back?
[CUSTOMER][NEUTRAL] OK, so he's in here for a limited 0140 exam.
[CUSTOMER][NEUTRAL] I know it covers at 80% and the deductible applies, but can he have same day treatment and X-rays?
[AGENT][NEUTRAL] Oh, if it's not specified on the fact that, you can do it.
[CUSTOMER][NEUTRAL] OK, perfect. Um, is a 4355 covered for debridement?
[AGENT][NEUTRAL] 4355 is not on this list of codes. So if it's not on the list of codes, it's not covered by the policy.
[CUSTOMER][POSITIVE] OK perfect and then.
[CUSTOMER][NEGATIVE] Um, I just want to check because it gets very deceiving because the description shows like that it's possibly covered, but then it's not listed in the CDT code. So is a 7210 covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see.
[AGENT][NEGATIVE] No, this, that code is not on the list.
[CUSTOMER][NEUTRAL] Which is a surgical.
[CUSTOMER][NEUTRAL] OK, and so then I'm assuming that I'm correct guessing that a full mouth X-ray or a panel is not covered, 02 10 or 0330.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] No, 0 to 10 is on the list.
[CUSTOMER][NEGATIVE] It's very deceiving looking at the.
[AGENT][NEUTRAL] And 0330 is under it. Um, so full mouth X-rays and panels are under radiograph and FMX which is 80%. It has a limitation limited one X-ray procedure, um, 0210,0277 and 0330 all paired together per 5-year period.
[CUSTOMER][NEGATIVE] I'm such an idiot.
[CUSTOMER][NEGATIVE] I kept looking at this. I'm like, I swear it feels like it's missing a page or something. Literally the page that I, it's the second page, it's just wider spaces than the first page, so it was deceiving. I need to go back to bed.
[AGENT][NEUTRAL] Oh, it looks different. Oh.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Oh my goodness, just, yeah, somebody just feed me and put me back to bed.
[CUSTOMER][NEUTRAL] OK, so I think, gosh.
[CUSTOMER][NEUTRAL] Um, one last thing and then I will let you go. Can you just, and I'm probably gonna answer my own question each.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Can you just confirm if fillings are downgraded?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It says um HNS.
[CUSTOMER][NEUTRAL] 24 months.
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, perfect. You're the best. Thank you. Have a great day. Bye.
[AGENT][POSITIVE] You're very welcome, [PII]. Are you also, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's it. Thanks, bye.
[AGENT][POSITIVE] Alright, thanks for calling A