AccountId: 011433970860
ContactId: 74f31f71-ee11-4470-be56-ecd9c8f95f28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 762989 ms
Total Talk Time (AGENT): 217923 ms
Total Talk Time (CUSTOMER): 211163 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/74f31f71-ee11-4470-be56-ecd9c8f95f28_20241230T14:57_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I was just to get an update on um dental benefits for a patient we have coming in today.
[AGENT][NEUTRAL] OK, I can help you with that. May I have your name and a callback number?
[CUSTOMER][NEUTRAL] It's [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 6,138,500
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for verifying her account.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you're calling to get an update on the benefits?
[CUSTOMER][NEUTRAL] Yeah, I have a um like a fax back or something that was sent to us.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's been about a year and a half ago, so, um, if nothing has changed, I can get some things off of it, you know, so we don't have to go through everything, but for sure, um, like what she used on her benefits this year just that would affect today's visit.
[AGENT][NEUTRAL] OK, let's see, and you said it's been a year and a half?
[CUSTOMER][NEUTRAL] Yeah, it looks like, let's see. Well, [PII], so a little over a year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and would you like uh the updated fax back or you want accumulation?
[CUSTOMER][NEUTRAL] Um, and another day like back would be fine, but I, unless it has, you know, patients specific information, I do need to know those as well, but verbally it's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold one moment.
[AGENT][NEUTRAL] OK. And what is the information that is needed? What, what would you like to verify? Uh, I can go ahead and have the fax back sent.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I have the the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So that the annual max is $1000 and deductible is $50 so I just need to know if the deductibles been met and how much of the max has been used this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look at the benefits.
[AGENT][NEUTRAL] So I do show a calendar year maximum of 1000 and deductible 50 and hold one moment, let me pull up.
[AGENT][NEUTRAL] Uh, to see what his acc accumulations are right now.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And please be advised verifying benefits is not guaranteed payment.
[AGENT][NEUTRAL] OK, uh, so I show.
[AGENT][NEUTRAL] I'll wait, let me see
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] 50
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, it looks like for [PII], the deductible has been met. Uh, it looks like of the $1000 calendar year maximum, she has $228 remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see, it's the calendar year plan.
[AGENT][NEUTRAL] Yes, it is calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you guys accept assignment of benefits to pay the providers since we're out of network?
[AGENT][NEUTRAL] I'm sorry, if you could repeat that.
[CUSTOMER][NEUTRAL] Um, assignment benefits to pay the provider directly since we are out of network.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Do you still pay the provider? OK.
[AGENT][NEUTRAL] We do still pay the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there a group name for this plan?
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] Group name is Trust Mark National Bank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and I've got this frequency, um, as far as history for exams and cleanings and X-rays, could you give me the most recent history for those?
[AGENT][NEUTRAL] What particular benefit are you looking for?
[CUSTOMER][NEUTRAL] Um, like exams, like [PII], the, um, periodic exam.
[CUSTOMER][NEUTRAL] And cleaning.
[CUSTOMER][NEUTRAL] Um, bot Wings and FMX or pano.
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] But I can give you codes.
[AGENT][NEUTRAL] OK, what are the codes?
[CUSTOMER][NEUTRAL] Um, the exam 0120.
[AGENT][NEUTRAL] OK 0120.
[AGENT][NEUTRAL] OK, looks like she has uh had two for 2024. I'm sorry, it looks like she had um
[AGENT][NEUTRAL] The procedure, we pay for the procedure for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and a cleaning, a regular cleaning, 1110.
[AGENT][NEUTRAL] Cleaning was also done [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, bottling 0274.
[AGENT][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Uh, bite wings have not been done since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And FMX or Pano um 0210 or 0330.
[AGENT][NEUTRAL] Uh, OK, so we have a 0 to 10 was done back in [PII] and what was the other one? 0.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] 0 0330 was last uh paid [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there a frequency for filling?
[AGENT][NEUTRAL] Do you have a code for the filling?
[CUSTOMER][NEUTRAL] Um, 2391.
[AGENT][NEUTRAL] 39
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I do not show a frequency for the fillings.
[AGENT][NEUTRAL] Um, uh, yeah, I don't show frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] For SRP for 43, 41, can you do, can we do all four quads on the same date of service or does it have to be split 2 and 2?
[AGENT][NEUTRAL] Quadrant let me make sure there's.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do not show that it has to be uh separated. They can be performed on the same date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for crowns and prosthetics, are they paid on the prep date or seat date?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you said paid on the prep date or the?
[CUSTOMER][NEUTRAL] For the seat date, um, and I can give you your code if you need one like for a crown 2.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] OK, I'm not showing 2740. Uh, let me make sure let me go down 2.
[AGENT][NEUTRAL] I don't show 2740.
[AGENT][NEUTRAL] Oh here it is OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Here it is
[AGENT][NEGATIVE] It doesn't specify um.
[AGENT][NEUTRAL] The, the date, seat date or prep date, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK, I think that will answer all my questions. Everything else I can get from the facts because this is a plan where it pays a specific amount for each code percentage. OK, so if it's not listed on that schedule, that table of allowance, it's not covered.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It's not a covered benefit, correct.
[CUSTOMER][NEUTRAL] Do you think the amounts have changed in the last year?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, they haven't. Um, I don't show a change, the one you have. OK, OK.
[CUSTOMER][NEUTRAL] OK, then I'll just go with the tab.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Alright, well I appreciate your help.
[CUSTOMER][NEUTRAL] No, ma'am, that'll be it.
[AGENT][POSITIVE] OK, you have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.