AccountId: 011433970860
ContactId: 836e99dd-bb52-4136-82fa-7bc33fd4f5e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 513590 ms
Total Talk Time (AGENT): 238724 ms
Total Talk Time (CUSTOMER): 227440 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/836e99dd-bb52-4136-82fa-7bc33fd4f5e8_20250303T22:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, uh [PII]. My name is [PII] calling for dental eligibility and benefits. Can you help me out with this?
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're needing dental eligibility and benefits. Is that also correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], on our dental policies, we have facts facts of the member's benefits that I will be happy to send to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your callback number?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] That is 01266497.
[AGENT][NEUTRAL] OK, thank you. So give me just a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] That is yes.
[CUSTOMER][NEUTRAL] OK. And then, uh, for this one, can I know the auto billing, would they be paid automatic quarter on your monthly?
[AGENT][NEUTRAL] And the information that I do provide for you today, [PII], will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name, it's going, oh, just give me.
[AGENT][NEUTRAL] Mhm. Sure. You're fine.
[CUSTOMER][NEUTRAL] Just, just bear with me sure second please, something went wrong.
[CUSTOMER][NEUTRAL] All right. So sorry for that. So the patient will be [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this dental policy, [PII], and it is active with an effective date of [PII], sorry, I was about to give you his date of birth. Let's try that again. The policy is active, effective [PII].
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you, it's a calendar year plan, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. What about?
[AGENT][NEUTRAL] And what is a good fax number that I can send his benefit information to you?
[CUSTOMER][NEUTRAL] All right. That's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and will it need to have your name on there? Does it need to say attention [PII] or is that not necessary?
[CUSTOMER][NEUTRAL] You can do that. That's fine.
[AGENT][NEUTRAL] Yes, OK, alright, just one moment.
[AGENT][NEUTRAL] And what is it, and again, you said that your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] OK, so I have just sent that to you, so you should be receiving that within the next several minutes and anything that is not on that faxite, [PII], means it would not be covered under the member's policy.
[CUSTOMER][NEGATIVE] Alright, apart from that, like the max deductible, missing tooth cloths.
[AGENT][NEUTRAL] Yes, sir, all of that information. Uh-huh, it's all of that information is on there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Group name, group number will be there, right?
[AGENT][NEUTRAL] I can give you the group name and the group number. That information is not included, but the group number for this policy is 17,970.
[AGENT][NEUTRAL] And the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] And then capital XPO logistics.
[CUSTOMER][POSITIVE] Thank you. Mind if I can ask a few questions?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, starting with the, you know, it's a calendar year plan, right?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] What about coordination of benefits?
[CUSTOMER][NEUTRAL] Any
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] OK, this, uh, waiting period and missing two clause will those apply?
[AGENT][NEUTRAL] There is a missing tooth cloth and yes, there are waiting periods that they have all been satisfied for the categories that have a waiting period.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Alright, so max deductible, you said those will be there in the fax back. Uh, this, uh, fillings and crowns on this plan, did they downgrade?
[AGENT][NEGATIVE] No, they do not.
[CUSTOMER][NEUTRAL] And the crowns are paid on prep date or seat date. Set date on the SRP if all four coops will be allowed to perform.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] And then can I also know like for the
[AGENT][NEUTRAL] What is the code that you need for me to check because all of the limitations are also on the fax back?
[CUSTOMER][NEUTRAL] At the SRP like 4341.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] No worries. OK. So then I think, you know, that's all the information that I needed for this patient here and if you don't mind us, can I get the call reference number for this entire call session.
[AGENT][NEUTRAL] OK, 4341 for periodontal scaling and root planing, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] The limitation on that is a maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Uh no, I can, so like all the quadrant won't be allowed to perform in a single visit, is that what you mean.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] Again, on here, let me go back to that screen. It states on here, maximum of 1 each quadrant, so the maximum of 1 per quadrant for 12 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right. Thank you for that. Uh, just a few questions on the orthodontics. Uh, firstly, will the auto be covered so that I can proceed with the question.
[AGENT][NEGATIVE] There are no benefits for Ortho.
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][NEUTRAL] OK, then I guess I'll skip that part. Uh, the provider, if you don't mind, just to help me check the provider status, then the fee schedule to be used.
[AGENT][NEUTRAL] OK, there is this is not a network plan, this plan.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pays for covered services based on a percentage of the covered services of the UCR of the service region.
[CUSTOMER][POSITIVE] Alright, thank you, mind if you can help me spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, this is all then, uh, [PII]. I'll wait for the fax back then. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and [PII] if you all do file a claim with APO on this policy, we do have a portals that you should be able to check claim status in once it has been processed by going to [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Oh, with that, uh, I remember that. If you don't mind to give me the clear mailing address along with the payer ID, please.
[AGENT][NEUTRAL] Yes sir, and that information is also on the fax back. Do you still want it verbally?
[CUSTOMER][NEUTRAL] No, that's OK if it's there, then that's fine. Let's, let, let, let me trouble you.
[AGENT][NEUTRAL] Yes, so the claims, the payer ID, the mailing address, and the claims fax number are all on the fax back on page one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Alright, uh, this will be all then. Thank you. You have a wonderful uh day uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I hope you do too, if that's all then, [PII], that I can help you with. Thank you again for calling APL. Have a nice evening.
[CUSTOMER][NEUTRAL] Mhm.