AccountId: 011433970860
ContactId: 8caaa425-2667-416e-bcf1-8fb3c77023ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484929 ms
Total Talk Time (AGENT): 185442 ms
Total Talk Time (CUSTOMER): 179388 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/8caaa425-2667-416e-bcf1-8fb3c77023ea_20250312T15:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling in regards to patient dental benefits.
[AGENT][POSITIVE] OK, I'm happy to check on benefits for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes I do. It is um 02013730.
[AGENT][NEUTRAL] All right, thank you for that. And if you don't mind, can I grab your first name and a callback number?
[CUSTOMER][NEUTRAL] Yes, it is going to be [PII] and then call back number it will be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is the patient name and date of birth?
[CUSTOMER][NEUTRAL] It is for [PII] [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you need us to list we can also send a fax back with a breakdown of benefits.
[CUSTOMER][NEUTRAL] Um, I already have that. I just, um, have a specific question, um, so is this a calendar or physical year?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this really quick. It looks like this is a calendar year.
[CUSTOMER][NEUTRAL] Is there any group name for this plan?
[AGENT][NEUTRAL] Let's see one moment.
[AGENT][NEUTRAL] Uh, the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Universal Trucking OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just like that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you know if the pro um the payment will be made to the provider to the subscriber?
[AGENT][NEUTRAL] Um, if you're submitting the claims, payment is submitted to the provider.
[CUSTOMER][NEUTRAL] OK, and the maximum does apply to preventative basic and major?
[AGENT][NEUTRAL] Uh, let's see, yes.
[CUSTOMER][NEUTRAL] OK, and for the preventative, basic and major, is it 180 and 40, is that correct? OK.
[AGENT][POSITIVE] Mhm. Correct, yes ma'am.
[CUSTOMER][NEUTRAL] And no waiting period for basic only for major?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Of 12 months correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and the missing tooth cloth would be permanent?
[AGENT][NEUTRAL] Uh, yes, looks like it.
[CUSTOMER][NEUTRAL] OK, OK, and I just have one question. If any, if, um, the code doesn't appear on the fax like that means it's not covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, one last question, let me see, um.
[CUSTOMER][NEUTRAL] For filling 2391 do they downgrade?
[AGENT][NEUTRAL] Uh, no downgrade.
[CUSTOMER][NEUTRAL] No downgrades, OK, and for 4341 is for quads, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, 2950, can we bill same day as the crown?
[AGENT][NEUTRAL] Uh, yes, it doesn't matter. You can do either prep or CD.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] For crowns, do they downgrade or no? No, OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No downgrade, yeah.
[CUSTOMER][NEUTRAL] For oral surgery, 7210 and 7240, do they go straight to dental or medical?
[AGENT][NEUTRAL] 72 times.
[AGENT][NEUTRAL] It looks like you can build them straight to dental.
[CUSTOMER][NEUTRAL] OK, got it, um.
[CUSTOMER][NEGATIVE] And then fluoride is just not covered at all?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][POSITIVE] I just wanna make sure on that one.
[AGENT][NEUTRAL] Usually, it is.
[CUSTOMER][NEUTRAL] The 1208.
[AGENT][NEUTRAL] 120, 0 yeah, 1208 is not covered.
[CUSTOMER][NEUTRAL] Got it. And for him nothing used nothing met no history?
[AGENT][NEUTRAL] Uh, let me just make sure, one moment.
[AGENT][NEUTRAL] Yeah it looks like last history on files [PII] so there shouldn't be any frequency problems.
[CUSTOMER][NEUTRAL] OK, no FMX or uh per uh or P.
[AGENT][NEUTRAL] Uh, let me
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like they had bite wings on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they had, it looks just like 4910 periodontal maintenance also.
[AGENT][NEUTRAL] But I'm not seeing any sort of.
[CUSTOMER][NEUTRAL] FMX source
[AGENT][NEUTRAL] The only other, yeah, the only other X-rays I see would be back from [PII].
[CUSTOMER][NEUTRAL] OK, but now 0 to 10 or 0330 correct?
[AGENT][NEUTRAL] Not that I'm seeing, no.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And can I check on a dependent?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Um, [PII] 6, I mean sorry.
[CUSTOMER][NEUTRAL] [PII] 332005.
[AGENT][NEUTRAL] OK. What do we need to check on [PII]?
[CUSTOMER][NEUTRAL] Um, the same thing if he has used anything and if there's any history.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, so for [PII] looks like last data service on file is for 217 of 25.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looks like they did have panos on that date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You did have a cleaning, it looks like 11:10.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and they also had bite wings, and that's the only history on file.
[CUSTOMER][NEUTRAL] That's the only history for him at all? OK, so has he used any of his maximum or deductible?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so for [PII], it looks like the $50 deductible has been met.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Out of the calendar maximum of $1500 it looks like $413.20 has been used. So the remaining balance is $1,086.80.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was the only history that the one you was done correct?
[AGENT][NEUTRAL] Mhm, that's the only history I found, yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, got it and that was all I needed. Can I just get a reference number and your name?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], which is [PII] My last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your help and you have a nice day and just one last question um.
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The what is the payer ID?
[AGENT][NEUTRAL] Oh, payer ID is 60801.
[CUSTOMER][POSITIVE] 60801 OK got it um thank you so much and you have a nice day.
[AGENT][NEUTRAL] You too, [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.