AccountId: 011433970860
ContactId: 82ae75d0-c8cf-4af1-8f6c-641a919eefed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409570 ms
Total Talk Time (AGENT): 192171 ms
Total Talk Time (CUSTOMER): 156159 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/82ae75d0-c8cf-4af1-8f6c-641a919eefed_20250117T14:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I have a few questions about a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your questions and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] 235 2335618.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] [PII] OK or
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII] [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. It's been effective since [PII]. And what type of questions did you have in reference to the policy?
[CUSTOMER][NEUTRAL] Um, can you tell me if your PAs have a frequency? 0220?
[AGENT][NEUTRAL] Hold on one moment let me pull up the.
[AGENT][NEGATIVE] Fas back.
[CUSTOMER][NEUTRAL] Then.
[AGENT][NEUTRAL] You said 0223?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] 0220, sorry.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] You of course.
[CUSTOMER][NEUTRAL] I read that they were at 80, but I couldn't tell if they had a frequency.
[AGENT][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] There's no frequency.
[CUSTOMER][NEUTRAL] OK, and then do you cover the 0367?
[AGENT][NEUTRAL] 0367. Hold on one moment let me see if that's on here.
[AGENT][NEUTRAL] 367.
[CUSTOMER][NEUTRAL] The starting on that that pad right there.
[AGENT][NEUTRAL] No, I'm not showing 0367 on the fax bag, so that's not a cover code.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, and I didn't see the 4346 on there, but I could have just overlooked it.
[AGENT][NEUTRAL] 43, 41, 2.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] 55. No, there's no 43, 46 on here.
[CUSTOMER][NEUTRAL] OK, and I couldn't catch, um, for the SRP, is there any other guidelines other than 1 in 24 months? So can all four quads be on the same day?
[AGENT][NEUTRAL] Um, there's no specification, so that, yes, all four classs can be on the same day.
[CUSTOMER][NEUTRAL] OK, and then I didn't see the 4910, but I could just be blind. This fax like is kind of.
[AGENT][NEUTRAL] 4910. 4910 is under periodontic, so that's covered at 40% and there's no, oh, wait a minute.
[CUSTOMER][NEUTRAL] Um, jumbled up.
[AGENT][NEUTRAL] There is a frequency, um, max of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] OK, so I'm assuming it shares for going see with your 1110.
[AGENT][NEUTRAL] Um, it's not, I mean, it's the same frequency, but they're not like grouped together like an evaluation.
[CUSTOMER][NEUTRAL] OK, and then, um, is there a healing period after an SRP to perform a 4910 or there's no other guidelines?
[AGENT][NEUTRAL] Um, I don't see, no, there's no guidelines on that.
[CUSTOMER][NEUTRAL] Got you. Do you downgrade on your crowns or your fillings?
[AGENT][POSITIVE] There's no downgrades.
[CUSTOMER][NEUTRAL] OK, and then do you pay on prep date or seat date?
[AGENT][NEUTRAL] Um, either or.
[CUSTOMER][NEUTRAL] OK, and then, um, for implants I see like the implant crowns were covered if I'm not mistaken, are actual implants covered the 6010?
[AGENT][NEUTRAL] 6010.
[AGENT][NEUTRAL] Oh, no, that's 160, you said 6010.
[AGENT][NEUTRAL] Um, no, I don't see a 6010 on the list either.
[CUSTOMER][NEUTRAL] OK, and then what about your refusal guard? I didn't, I don't think I saw that, but.
[AGENT][NEUTRAL] Oh, Klozoguard is under, what is this?
[AGENT][NEUTRAL] Major, um.
[AGENT][NEUTRAL] So like [PII], there's a few different accrual codes.
[CUSTOMER][NEUTRAL] 0 9944 sorry.
[AGENT][NEUTRAL] OK, 9944 is not a cover code. It's just those three on the fax back.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, and then for your 2920 I didn't understand it. I thought, well, actually, no, I saw 2910. Is there a 2920 on there?
[AGENT][NEUTRAL] 29, 20 recement Crown. Yes, it's under major.
[AGENT][NEUTRAL] Um, let me see what the
[AGENT][NEUTRAL] It's a max of 1 per 7-year period and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] OK, and then for your oral surgery is 7210. I saw 7140, but I didn't see a 7210.
[AGENT][NEUTRAL] Yes, under oral surgery, 7210 is the first code there. It's no frequency though.
[CUSTOMER][NEUTRAL] OK, is it, it's under major though, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then does that have to go to medical first or can it go straight to y'all?
[AGENT][NEUTRAL] Um, whichever, however we receive the claim, we'll process it. So if we're before or after, it doesn't matter.
[CUSTOMER][NEUTRAL] Got you and then um is there a deductible or did I read that wrong?
[AGENT][NEUTRAL] There is a deductible, um, it's $50 per insured up to $150 per family, and it does not apply to preventative services.
[CUSTOMER][NEUTRAL] Does your maximum apply to preventative?
[AGENT][NEUTRAL] Does does the max, yes, the max applies that.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK and then um there's no waiting period?
[AGENT][NEUTRAL] For major services, there are, um, there's a twelve-month waiting period. For us, major includes endodontic, periodontic, prosodontic, and oral surgery, and the policy has been
[CUSTOMER][NEUTRAL] From the effective date, sorry, go ahead.
[AGENT][NEUTRAL] The policy has been active since [PII], so that twelve-month waiting period is over.
[CUSTOMER][NEUTRAL] OK, and then which um fee schedule do we follow?
[AGENT][NEUTRAL] Um, this is just a standard free schedule.
[CUSTOMER][NEUTRAL] So we submit our fees?
[AGENT][NEUTRAL] Yes, you submit your fees.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII] and my name is [PII]
[CUSTOMER][POSITIVE] OK, thank you so much you have a good day OK?
[AGENT][POSITIVE] You're welcome, [PII]. You also, is there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you.