AccountId: 011433970860
ContactId: 877e0f0f-9afe-44be-9cba-fe896fff20e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 539260 ms
Total Talk Time (AGENT): 266837 ms
Total Talk Time (CUSTOMER): 161449 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/877e0f0f-9afe-44be-9cba-fe896fff20e4_20250508T21:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Jefferson Dental, calling to verify the dental eligibility and benefits. Could you please help me?
[AGENT][NEUTRAL] Sure, I can assist you with the eligibility and benefits, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line. That is my extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 00914813.
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is gonna be [PII] and the date of birth [PII].
[AGENT][NEUTRAL] Mm perfect. Thank you. And you said you need eligibility and benefits, you need this information given to you verbally or faxed over to you or you have a specific questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have some specific questions only.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Could you please confirm the patient is the policyholder, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Thank you so much for confirming. And may I know the effective date?
[AGENT][NEUTRAL] OK. Effective date on this one is [PII], and it is active at the moment.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, correct, yes. [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much for confirming. And may I know the deductibles and annual max for the plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We have a calendar year maximum of $1500 with the $50 deductible, and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What about the family deductible?
[AGENT][NEUTRAL] It's 150 if it's a family plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. And the percentages for preventative, basic and major services?
[AGENT][NEUTRAL] OK, preventative is 100%. Radiograph FMX is 80. Basic expense and basic restorative expense is 80. Major service including endodonic periodontists, prosthodontic repair, and oral surgery is all 40%.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the group number?
[AGENT][NEUTRAL] OK, bear with me, let me get that information.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] OK, that group number is.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] 1456 4.
[CUSTOMER][NEUTRAL] And the group name please?
[AGENT][NEUTRAL] Universal Trucking Anderson flatbed.
[CUSTOMER][NEUTRAL] And the payer ID is 60801. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much. And any user amount from the deductible and annual max, please?
[AGENT][NEUTRAL] OK, let me get that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. As of today, he has used $771.60. He has remaining $728.40 and he has met his deductible.
[CUSTOMER][NEUTRAL] OK. From the family deductible?
[AGENT][NEUTRAL] It's an individual plan.
[CUSTOMER][NEUTRAL] I think so
[CUSTOMER][NEUTRAL] OK. Individual deductible already met family nothing used on annual max is 771.60, right? The used amount.
[AGENT][NEUTRAL] OK, um, let me repeat again. He has used his, uh, he's already met his deductible of $50 and he has used $7771.60. He has remaining $728.40.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, OK. Thank you so much. And could you please confirm me uh the Do EC cover benefit for the plan?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any history that may affect the patient frequency?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so I have a 4341 um upper right on [PII]. I also have a 4341 for the low um upper lower and it's gonna be um the same date, [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Um, we're gonna have a
[AGENT][NEUTRAL] 4341.
[AGENT][NEUTRAL] And F for lower right.
[AGENT][NEUTRAL] And a 4341 for lower left, which all that took place on [PII].
[AGENT][NEUTRAL] And let's see, we have X-rays 2230 done on the same day.
[AGENT][NEUTRAL] We also have
[CUSTOMER][NEUTRAL] Just a minute. Could you please repeat the code?
[AGENT][NEUTRAL] 00230
[CUSTOMER][NEUTRAL] 0230. OK.
[AGENT][NEUTRAL] Mhm. For 222, 212, and 24.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's also a bit win on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is an examination, 00120 on [PII].
[CUSTOMER][NEUTRAL] It's the same
[CUSTOMER][NEUTRAL] Does it shares frequency with all other exams?
[AGENT][NEUTRAL] Which ones, um, the ones that share frequency is going to be, let's see, yes, it's limited to two oral evaluation procedures and any combination of 120, 140, 150, or 160 or 180 for 12 months.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like that's all for the history.
[CUSTOMER][NEUTRAL] Any history for FMX Santano?
[AGENT][NEUTRAL] Yes, the panel was completed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Does it shares frequency with FMX?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any other histories apart from this that that might fix the patient frequency?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] That's all I got.
[CUSTOMER][NEUTRAL] OK. That's missing too, does, does missing tooth clothss apply?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much. I'm feeling strongly then?
[AGENT][NEUTRAL] You don't downgrade.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any waiting period?
[AGENT][NEUTRAL] Uh, not for this one. let me see when waiting for you um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's, it's been out for a while. It, it was a 12 months, but he's been with us since [PII].
[CUSTOMER][NEUTRAL] OK. I have 2 quotes. Could you please help me with the frequency and percentage for those two quotes?
[AGENT][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] With the first one?
[CUSTOMER][NEUTRAL] It's the first one is 79, the first one is 7953.
[AGENT][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] And the next one is 6104. Mhm.
[AGENT][NEUTRAL] OK, one at a time, please. OK, 7953 is uh, is not listed.
[CUSTOMER][POSITIVE] Thank you. And the next one is 6104.
[AGENT][NEUTRAL] You're welcome. And what.
[AGENT][NEUTRAL] 6104.
[AGENT][NEUTRAL] 6104 is not listed either.
[CUSTOMER][POSITIVE] OK, OK, thank you so much. I'm done with the patient details. Thank you so much for patiently assisting me. Can I get the call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][NEUTRAL] $25
[CUSTOMER][NEUTRAL] Get
[CUSTOMER][POSITIVE] Thank you. Thank you so much for assisting me. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APM. bye-bye.