AccountId: 011433970860
ContactId: 8b514b02-12f9-479f-8761-e7f714f77378
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 871739 ms
Total Talk Time (AGENT): 231992 ms
Total Talk Time (CUSTOMER): 318479 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/8b514b02-12f9-479f-8761-e7f714f77378_20250625T15:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the dental provider office to check eligibility and benefits for a patient on a recorded line. Can you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify benefits and eligibility for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02460720.
[AGENT][NEUTRAL] Uh, say that one more time. I apologize.
[CUSTOMER][NEUTRAL] Sure. It's gonna be 02460720.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What's what's.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure. The good callback number is [PII], and it's a direct line, no extension.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The member's name is [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] OK, and you say you're calling to verify eligibility and benefits, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII] and he is active on the policy.
[AGENT][NEUTRAL] And are you needing general benefits or I can send a fax back?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, no, actually, I just need the general benefits and can you please help me, like I have some certain questions on it. Can you start with the group name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Group name is Universal Trucking, P and S Transportation.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Trucking, right? T R U C K I N G.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Trucking then universal trucking and
[AGENT][NEUTRAL] P and S Transportation.
[CUSTOMER][NEUTRAL] TNS Transportation.
[AGENT][NEUTRAL] P as in Papa, and S as in Sierra transportation.
[CUSTOMER][NEUTRAL] PS Transportation, correct?
[AGENT][NEUTRAL] P and S. So they have and between P and S.
[CUSTOMER][NEUTRAL] Yes, Papa and Sierra.
[AGENT][NEUTRAL] Mhm. Transportation.
[CUSTOMER][NEUTRAL] Transportation.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Can you help me with the group number?
[AGENT][NEUTRAL] 19205.
[CUSTOMER][POSITIVE] Thank you so much. Transportation. OK. And it's, I believe it's a single coverage plan, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's family coverage.
[CUSTOMER][POSITIVE] Thank you so much. And now, can you help me with the um fee share with it? And can you help, please help me with the providers and network out of network?
[AGENT][NEUTRAL] Well, we don't have a network, so the policy is open to where they can go to any dental provider and it doesn't pay by fee schedule, it pays by UCR, usual custom and reasonable.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Just bear with me a moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, I'm still there. I'm just finding the uh insurance. Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Just one minute more. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Now, can you help me with the PO box address for this one?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much for this. And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And second, do you accept assignment of benefit to a non-participating provider?
[AGENT][NEUTRAL] We do take assignment.
[CUSTOMER][POSITIVE] Brilliant.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you help me now with the uh deductible individual?
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment, just a verification of coverage. The patient has a deductible of $50 that does apply to everything but preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It applies to preventive basic and major, right?
[AGENT][NEUTRAL] It applies to everything but for preventative, so it applies towards basic and major services.
[CUSTOMER][NEUTRAL] OK, got it. Can you help me with the uh
[CUSTOMER][NEUTRAL] Maximum for individual, maximum deductible.
[AGENT][NEUTRAL] I, um, benefit max of 1500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. Orthodontics, is it a covered benefit?
[AGENT][NEGATIVE] Ortho it's not covered.
[CUSTOMER][POSITIVE] Thank you so much. And can you help me like with the
[CUSTOMER][NEUTRAL] Uh, the providers out of network, right?
[AGENT][NEUTRAL] As I stated, we don't have a network, so the policy is open, meaning the patient can go to any dental provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the policy is open.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As it is a UCR, uh, UCR policy, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Got it. Just a second.
[CUSTOMER][NEUTRAL] And now,
[CUSTOMER][NEUTRAL] Can you help me with the coverage? Like, uh, is it for 180, 50 for the diagnostic, basic and major?
[AGENT][NEUTRAL] It's 18,040. Major is 40% of UCR.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And uh do you have, uh, there, is there any waiting period?
[AGENT][POSITIVE] Uh, there is a 12-month waiting period for Major, but he's already satisfied that waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So there is no waiting period, right?
[AGENT][POSITIVE] He has satisfied his waiting period.
[CUSTOMER][NEUTRAL] Got it. And endoperia and oral surgery, are they covered?
[AGENT][NEUTRAL] They're a major.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK. And uh for that, there is no waiting period, right?
[AGENT][POSITIVE] He satisfied his waiting period.
[CUSTOMER][NEUTRAL] Got it. Implants, are they covered benefits?
[AGENT][NEUTRAL] Uh, no. Implant and implant crowns are not covered under the policy.
[CUSTOMER][NEGATIVE] Implant and crowns are not covered. Bridges and dentures?
[AGENT][NEUTRAL] And plant crowns
[AGENT][MIXED] Bridges and dentures are covered as major. It covers crowns like regular crowns, but implant crowns are not covered.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And uh can you help me with the frequency for exam cleaning bite wings?
[AGENT][NEUTRAL] Exams are 2 for 12 month period, cleanings once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bi wings once every 12.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got it. Uh, for FMX pan fluoride.
[AGENT][NEUTRAL] FMX and Peno is once every 5 years. Fluoride is under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] So fluoride is 1 in 12 months, right?
[AGENT][NEUTRAL] Correct. Under the age of [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] At the age of [PII]. Got it.
[CUSTOMER][NEUTRAL] And the PDO maintenance that is 4910. Is it under measure?
[AGENT][NEUTRAL] That falls under a major.
[CUSTOMER][NEUTRAL] OK. And uh what should be the frequency?
[AGENT][NEUTRAL] Uh, per maintenance is once every 6 months.
[AGENT][NEGATIVE] And it does not share frequency with the regular cleaning.
[CUSTOMER][POSITIVE] Thank you so much. And mhm.
[CUSTOMER][NEUTRAL] OK, got it. Uh, and a simple extraction, are they covered in the basic or major?
[AGENT][NEUTRAL] Uh, basic.
[CUSTOMER][POSITIVE] Basic. Thank you so much. Is there any missing two clause under the plan?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][POSITIVE] Thank you so much. And for PSRP that is 4341. Can you help me with the frequency and for oral cancer screening also.
[AGENT][NEUTRAL] It's once every.
[AGENT][NEUTRAL] Uh, for the 4341, it's once every 24 months and it's considered major. Oral cancer screening is not covered.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not covered. Thank you so much. And can you lastly help me with the dentist, bridges and crown frequency?
[AGENT][NEUTRAL] Uh, they are once every 5 years.
[CUSTOMER][NEUTRAL] Uh, bridges also same, once in 5 years.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. And our crown bridges restoration on Molar downgraded to cast predominantly base metal restorations.
[AGENT][NEUTRAL] Uh, there's no downgrades.
[CUSTOMER][NEUTRAL] No, thank you. Our posterior composite feelings downgrade to an amalgam feeling?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] Thank you. Is pre-determination mandatory?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's only suggested, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is it suggested
[AGENT][NEUTRAL] I suggested, but it's not a requirement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not mandatory. OK, got it.
[CUSTOMER][NEUTRAL] Can you help me with your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] [PII] and can he, can you help me with the card reference number for this call?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, [PII]. [PII], uh, one more question, like all 4 cards can be done on the same day?
[AGENT][POSITIVE] Yes, for SRP yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Q U OK, cards can be done on the same day.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for your assistance. Have a great day. Stay safe. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day for now.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you. Bye.