AccountId: 011433970860
ContactId: 7f11fcfd-c78b-4b98-934d-0d0dddb08c4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1349569 ms
Total Talk Time (AGENT): 436510 ms
Total Talk Time (CUSTOMER): 229098 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/7f11fcfd-c78b-4b98-934d-0d0dddb08c4d_20250602T20:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] This is [PII] from dental office. I have a patient. I need to some benefits for us.
[AGENT][NEUTRAL] OK, I can help you with the dental benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02579759.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Remember, first name is [PII] and the [PII], and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And this is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll have for us to um.
[AGENT][NEUTRAL] Look into the date of birth. We're showing a different date of birth on file. Um, can you verify the policyholder's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active.
[CUSTOMER][NEUTRAL] Uh, and the
[CUSTOMER][NEUTRAL] And the patient's date of birth is [PII], correct?
[AGENT][NEUTRAL] Correct. Thank you for correcting it from [PII]. Um, so I am showing that the policy is active. It's been effective since [PII]. And hold on one moment, I'm just waiting for the benefits to populate here.
[AGENT][NEUTRAL] And did you need a copy of the fax back or do you have particular questions?
[CUSTOMER][NEUTRAL] Uh, first, tell me the deductible and maximum amount.
[AGENT][NEUTRAL] Sure, I can provide you with the maximum. Um, it's $1500 per calendar year per person. There's a $50 deductible.
[AGENT][NEUTRAL] Up to 150 per family.
[AGENT][NEUTRAL] And that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] And deductible and maximum is yours.
[AGENT][NEUTRAL] Um, let me see, hold on one moment.
[AGENT][NEGATIVE] Um, no, the maximum has not been used, nor has the deductible been met.
[CUSTOMER][NEUTRAL] Mhm. Dependent age limit is.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The dependent age limit.
[AGENT][NEUTRAL] To what code?
[CUSTOMER][NEUTRAL] Dependent or student age limit?
[AGENT][NEUTRAL] I understand what you're saying to me. When I'm asking you is which code would you like the age limit for, it differs depending on the code. Do you have a particular code you'd like me to look for the limitation on?
[CUSTOMER][NEUTRAL] Uh, I, I am, sir, age limit for dependent on this insurance.
[AGENT][NEUTRAL] OK, some of them are [PII], some of them are [PII], some of it is [PII]. There's no standard age limit for this policy. It depends on the coding. Are you asking?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If for an age out.
[CUSTOMER][NEUTRAL] OK, tell me the percentage of this.
[AGENT][NEUTRAL] I'm sorry, can you repeat that? I was speaking.
[CUSTOMER][NEUTRAL] Uh, tell me the percentage of preventative, basic and measure.
[AGENT][NEUTRAL] Preventative is 100%, basic is 80%, and major is 40%.
[AGENT][NEUTRAL] With the 12-month waiting period.
[CUSTOMER][NEUTRAL] Uh, waiting period for major.
[AGENT][NEUTRAL] Yes, again, 12-month waiting period.
[CUSTOMER][NEUTRAL] And uh coordination of benefits.
[AGENT][NEUTRAL] There is no coordination of benefits?
[CUSTOMER][NEUTRAL] Uh, you said lender your plan?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It is a lander plan.
[AGENT][NEUTRAL] Yes, calendar year.
[CUSTOMER][NEUTRAL] Uh, tell me the
[CUSTOMER][NEUTRAL] Dental history of this patient?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There's no history on file currently for the patient?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, there is no dental history for [PII].
[AGENT][NEUTRAL] There is no dental history at all for any person on this policy. We haven't processed the claim yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the minimum age limit for adult prophy prophylaxis?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] APR.
[AGENT][NEUTRAL] For appropriate, the age limit is limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And what's the frequency and percentage of code 1120?
[CUSTOMER][NEUTRAL] your
[AGENT][NEUTRAL] I don't, can you repeat your question, please?
[CUSTOMER][NEUTRAL] Tell me the frequency and percentage of code 1120.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The frequency is 100%, I'm sorry, the percentage is 100% and the frequency is once every 6 months.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do you have a list of calls that you'd like to give me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm ready for the code when you are.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Code [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2391292929302934.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you please um say this slowly, sir, I'm typing. Can you repeat that slowly, please? Start at 7410. Thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is it alright if I place you on a brief hold while I go through the codes?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait.
[AGENT][NEUTRAL] So code 1354 is not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Code 0120 is preventative at 100%.
[AGENT][NEUTRAL] Limited to 2 or evaluations in any combination per 12-month period.
[AGENT][NEUTRAL] It's paired with 140, 150, 160, and 180.
[AGENT][NEUTRAL] 0145 is not covered?
[AGENT][NEUTRAL] 210 is under radiograph FMX at 80%.
[AGENT][NEUTRAL] Limited to one X-ray procedure per five-year period.
[AGENT][NEUTRAL] It's paired with 277 and 330.
[AGENT][NEUTRAL] 0220 and 0240 are both at 80%, no limitations.
[AGENT][NEUTRAL] 1354, 12:06, 1551, and 1516 are all not covered?
[AGENT][NEUTRAL] 1351 is at a 100% preventative.
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only?
[AGENT][NEUTRAL] And limited to dependent children under age [PII]?
[AGENT][NEUTRAL] 2740 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And and limited to patients aged [PII] and over?
[AGENT][NEUTRAL] 2391 is that 80%?
[AGENT][NEUTRAL] Replacement of existing only if in place for 24 months?
[AGENT][NEUTRAL] And maximum of 1 per 5-year period per tooth.
[CUSTOMER][NEUTRAL] Uh, can you repeat again?
[AGENT][NEUTRAL] Maximum of maximum of 1 per 5-year period per tooth.
[CUSTOMER][NEUTRAL] For this
[CUSTOMER][NEUTRAL] Uh, code is
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you repeat for the code?
[AGENT][NEUTRAL] This is called 2391.
[CUSTOMER][NEUTRAL] And what's the frequency?
[AGENT][NEUTRAL] OK, so 2391 is 80%.
[AGENT][NEUTRAL] Replacement of existing only if in place for 24 months.
[AGENT][NEUTRAL] A maximum of 1 each tooth per 24 months.
[CUSTOMER][NEGATIVE] And downgrade, no downgrade.
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] And crown is down there.
[AGENT][NEUTRAL] There's no downgrades on the policy?
[CUSTOMER][NEUTRAL] A ground be seated update.
[AGENT][NEUTRAL] Either or did you want to go through your list of codes?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you want to continue the list of codes before the questions?
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Code 2929 is not covered?
[AGENT][NEUTRAL] Code 2930 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to dependent children under age [PII]?
[AGENT][NEUTRAL] 2934 is not covered?
[AGENT][NEUTRAL] 3220 is major at 40%.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[AGENT][NEUTRAL] 4346 is not covered?
[AGENT][NEUTRAL] 7140 is 80%.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Maximum one time purchase.
[AGENT][NEUTRAL] 72, 10 and 7410 are both major at 40%, no limitations.
[AGENT][NEUTRAL] 7961 is not covered?
[AGENT][NEUTRAL] 9110 is basic at 80%.
[CUSTOMER][NEUTRAL] Uh, can you repeat again? Uh,
[AGENT][NEUTRAL] Maximum of 1
[CUSTOMER][NEUTRAL] Uh, from, uh, 4346 after 4346 years.
[AGENT][NEUTRAL] I'm sorry. So you need 71, 40, 72, 10s, you need all of those again?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] 7140 is 80%.
[AGENT][NEUTRAL] Maximum of one time per tooth.
[AGENT][NEUTRAL] 7210 and 7410 are both major at 40% with no limitation.
[AGENT][NEUTRAL] 7961 is not covered?
[AGENT][NEUTRAL] 9110 is basic at 80%.
[AGENT][NEUTRAL] Maximum one time per tooth.
[AGENT][NEUTRAL] 90 to 30 is major at 40%, no limitations.
[AGENT][NEUTRAL] 9248 and 9420 are both not covered on the policy?
[AGENT][NEUTRAL] And what questions did you have?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, tell me the timely firing limit.
[AGENT][NEUTRAL] Can I provide the timely filing limit? Yes, um, there's no timely filing limit as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK. Gro accept assignment of benefits.
[AGENT][NEUTRAL] Um, yes, we accept assignment of benefits.
[CUSTOMER][NEUTRAL] Uh, can you tell me the schedule of my doctor?
[AGENT][NEUTRAL] Um, hold on one moment. This policy is not on a, um, fee schedule. It uses, um, usual and customary charges.
[CUSTOMER][NEUTRAL] Uh, and provider is in network or out of network?
[AGENT][NEUTRAL] Again, this policy does not have a network. It uses usual and customary charges. So there's no PPO, there's no HMO.
[AGENT][NEUTRAL] It'll pay a percentage of the charges.
[CUSTOMER][NEUTRAL] Kash.
[CUSTOMER][NEUTRAL] OK. Uh, tell me the reference number.
[AGENT][NEUTRAL] Can I provide the reference number? Sure. So there's no call reference number, but you can use my name in today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thanks for the information. Have a nice day goodbye. Can you send me a fax of the station?
[AGENT][POSITIVE] Yes, I can send you a fax of the fax back. What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The question is, should I put attention [PII] on the facts?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll go ahead and send the fax for you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Just send me a fax.
[CUSTOMER][NEUTRAL] OK, bye. And what's up?
[AGENT][NEUTRAL] But