AccountId: 011433970860
ContactId: 75a7092e-27dd-448c-8896-ff90e717d827
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371299 ms
Total Talk Time (AGENT): 111570 ms
Total Talk Time (CUSTOMER): 156920 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/75a7092e-27dd-448c-8896-ff90e717d827_20250616T14:35_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. I'm calling from a dental provider's office. Uh, my name is [PII]. I wanted to see if I can get a breakdown over the phone. I was supposed to be receiving a fax, but I still haven't received it yet, so I was trying to see if somebody can help me out over the phone.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01714286. It's for um [PII].
[AGENT][NEUTRAL] And then [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] The patient's uh date of birth?
[CUSTOMER][NEUTRAL] Uh, you and the.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And that fax was sent to [PII]?
[CUSTOMER][NEUTRAL] [PII] yes.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, I hear the machine ringing, but um it's because our machine's been like not working for a while, so I'm not too sure if it's even going through or not because, um, we get our faxes through online too, so I'm in the online stuff and I still haven't seen it and then we get them through email too but I still haven't received it and I have a patient coming in like 30 minutes that's the only reason why I'm trying to rush it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, looks like the policy is effective [PII]. It's not a guarantee of payment, basic outline of the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so you just need like the breakdown and frequency and duration.
[CUSTOMER][NEUTRAL] Like it's probably the
[CUSTOMER][NEUTRAL] Yeah and like the claim address and then um usually in our office we go through pre-authorization so anything the patient will need um will more than likely preauthorization at first.
[AGENT][NEUTRAL] OK, um, so they have a calendar year maximum of 1500.
[AGENT][NEUTRAL] Um, preventative services pay 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, FMX expenses, basic expenses, basic restorative, I'll pay 80% after a $50 deductible.
[AGENT][NEUTRAL] And then major, endo, perio, prosthodontic repair, and oral surgery all pay 40%.
[AGENT][NEUTRAL] After a $50 deductible?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Um, do you mind if I give you, uh, dental codes?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's the first one.
[CUSTOMER][NEUTRAL] Um, it's 0150. Do you want me to get them to you one by one or all at once?
[AGENT][NEUTRAL] Uh, uh, one by one. Do you need the frequencies?
[CUSTOMER][NEUTRAL] Uh, yeah, just right now since he's coming in I'll just basically need the 0 150 and the 0210. That's the one I'm gonna use for the exam and then I'll just wait for the rest for the.
[CUSTOMER][NEUTRAL] Uh, facts.
[AGENT][NEUTRAL] Um, so for exam, it's gonna be
[AGENT][NEUTRAL] 2 for 12 month period, it's preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you said 0210?
[CUSTOMER][NEUTRAL] Yes, 0210.
[AGENT][NEUTRAL] Um, that one is.
[AGENT][NEUTRAL] Pays 80% after a $50 deductible, and
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, it's 1 per 5-year period.
[CUSTOMER][NEUTRAL] Does he have any uh history on file?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEGATIVE] Uh, no, he does not.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For 7210 and 7230 are those um basic or major?
[AGENT][NEUTRAL] Uh, those are major.
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] And then um uh oral surgery, uh, extractions, they get billed out to dental or medical.
[AGENT][NEUTRAL] Uh, this is under dental.
[CUSTOMER][NEUTRAL] Dental.
[CUSTOMER][NEUTRAL] And then you said like perio like the deep cleanings like for example 4341 um that's covered under major as well too, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then uh for majors like for crowns, bridges, and dentures, um, what's the frequency limitation between those like 1 in 5 years or?
[AGENT][NEUTRAL] Um, it.
[AGENT][NEUTRAL] Uh, 1 for seven-year period.
[CUSTOMER][NEUTRAL] OK, sounds good then I'll just uh wait for the remaining of the uh fax.
[AGENT][NEUTRAL] OK, is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Um, actually, just one more thing, I'm so sorry, um, just your claims address.
[AGENT][NEUTRAL] Our claim's mailing address is [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what's your guys' payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801 it was 248-950 [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK sounds good thank you so much for your help and what was your name again? I'm sorry.
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII], do you mind giving me a reference number?
[AGENT][NEUTRAL] Yeah, it's my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK sounds good thank you so much for your help.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.