AccountId: 011433970860
ContactId: 7fdac625-a1a8-4493-83b1-391311df8767
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407500 ms
Total Talk Time (AGENT): 140075 ms
Total Talk Time (CUSTOMER): 135303 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/7fdac625-a1a8-4493-83b1-391311df8767_20250501T19:28_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the dental office to check eligibility and benefits for a patient.
[AGENT][POSITIVE] Oh yeah, I can help you with eligibility and benefits. [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Just give me a minute. So it's uh.
[CUSTOMER][NEUTRAL] That is 026072, sorry, 02607024.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] That would be, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, it looks like this policy is effective [PII].
[AGENT][NEUTRAL] Um, I can fax over a fax back that shows everything that's covered, including all of the codes, um, or is there something that we can go over on the phone?
[CUSTOMER][NEUTRAL] Um, you can, uh, I do have only a couple of questions so we can go over the phone. So, um, yep, starting with, um, what will be the group name and the group number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, group name is.
[AGENT][NEUTRAL] A group name is Wagner W A G N E R Service solutions.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the group number is 70076.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And uh is it a single or uh is it a single or a family coverage?
[AGENT][NEUTRAL] coverage.
[CUSTOMER][NEUTRAL] All right. And um do you accept assignment of benefits to a non-participating provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And for non-coverage services to in-network providers, discounts apply.
[AGENT][NEUTRAL] Um, that's up to the dentist, and we can't determine that.
[CUSTOMER][NEUTRAL] All right. And even for um if benefits are exhausted, um, for the discounts, it's, it's up to dentist?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the deductible and maximum?
[AGENT][NEUTRAL] It's not a guarantee of payment, basic outline of the policy. Um, annual calendar year maximum is 500.
[AGENT][NEUTRAL] Annual calendar year deductible is 50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Correct. And um
[CUSTOMER][NEUTRAL] Do we have any coverage for orthodontics?
[AGENT][NEGATIVE] No coverage for Ortho.
[CUSTOMER][NEUTRAL] And is it a benefit year plan or a calendar year plan?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] And do you have a coverage for implants, 6 to 10?
[AGENT][NEUTRAL] No coverage for implants or any major services which includes Perrio and Endo.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And what will be the co-insurance for preventative and basic?
[AGENT][NEUTRAL] Preventative services pay 100%.
[AGENT][NEGATIVE] No deductible.
[AGENT][NEUTRAL] And then radiographs, including FMX and byte wings and basic expenses, pay 80% after a $50 deductible is met.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And for 7210 and 7140, are those covered?
[AGENT][NEGATIVE] 7140 is covered under basic and 7210 is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the claim's mailing address?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And do you have a waiting period or a missing tooth loss?
[AGENT][NEGATIVE] Oh, there's no waiting period. There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] And do we have any downgrade for fillings?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And um
[CUSTOMER][NEUTRAL] Just to confirm, uh, no major coverage on this plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Uh, even, um, for 49, 10 and 43, 41, those are not covered?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And lastly, I do have
[CUSTOMER][NEUTRAL] 4 codes to check. I only need the frequencies. So do you need all the codes at once or one by one?
[AGENT][NEUTRAL] Uh, one by one, please.
[CUSTOMER][NEUTRAL] OK. So the first would be 0150.
[AGENT][NEUTRAL] Uh, it's preventative and limited to 2 and a 12 month period.
[CUSTOMER][NEUTRAL] Got it. Next is 0274.
[AGENT][NEUTRAL] That's basic and that pays 80% after a $50 deductible, limited to one for 12 month period.
[CUSTOMER][NEUTRAL] Next is 0 to 10.
[AGENT][NEUTRAL] 0210 is 1 for 5 year period, basic.
[CUSTOMER][NEUTRAL] All right. And does it share frequency with panel?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the last is 1208.
[AGENT][NEUTRAL] Um, 1208 is not on the policy, but we do cover 1201, 1203, 1204, and 1205. They don't show coverage for 1208.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. And yes, I'm done with all my questions. And you can provide me the reference number to a call.
[AGENT][NEUTRAL] Uh, reference number is my name, [PII]. First initial to last name is [PII] as [PII], and today's date would be the reference, my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. And uh [PII], thank you so much for your assistance. And you have a wonderful day ahead.
[AGENT][POSITIVE] OK, thank you so much for calling APL. I hope you have a great day too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.