AccountId: 011433970860
ContactId: 900eb994-4547-4237-a572-c12780ad98c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406600 ms
Total Talk Time (AGENT): 195774 ms
Total Talk Time (CUSTOMER): 112638 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/900eb994-4547-4237-a572-c12780ad98c9_20250424T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from Dental Carelines. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] Yeah, I'm also doing good, thanks for asking. I need patient eligibility benefits. Could you please help me with that?
[AGENT][POSITIVE] Yeah, I could check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yep, it's uh [PII] and there is no extension.
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yep, it's 1831439.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah, it's um
[CUSTOMER][NEUTRAL] [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you the fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] I need only a few benefits. Could you please help me with that?
[AGENT][NEUTRAL] What was that? I'm sorry.
[CUSTOMER][NEUTRAL] I need only a few benefits. Could you please help me with that?
[AGENT][POSITIVE] Yes, I can definitely help you over the phone if you prefer um, what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep, it's a patient is policyholder.
[AGENT][NEUTRAL] Yes, and he is the only covered member.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Is the provider is in our auto network?
[AGENT][NEUTRAL] Uh, this policy does not have a network. It pays a percentage based off of UCR.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Could you please tell me the group number?
[AGENT][NEUTRAL] Uh yes one moment.
[AGENT][NEUTRAL] So that group number is 16358.
[CUSTOMER][NEUTRAL] It's 16358, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please tell me the deductibles and the max amount along with coin percentages, please?
[AGENT][NEUTRAL] Yeah, um, then of course I will let you know verification of coverage is not a guarantee of payment for claims. So that calendar year maximum is $1500. The calendar year deductible is $50 and that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What other information did you need? I'm sorry.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Could you please tell me the insurance personages please?
[AGENT][NEUTRAL] Um, so there's no coinsurance on this policy. Um, preventative is at 100% of UCR, uh, basic radiographs, FMX, uh, that's going to be at 80%, and then all major expenses including antiontic, uh, oral surgery, those are gonna be at 40%.
[AGENT][NEUTRAL] Of UCR.
[CUSTOMER][NEUTRAL] OK, it's 180, 40, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much and effectively it is [PII], right?
[AGENT][NEUTRAL] Uh, [PII], yes.
[CUSTOMER][NEUTRAL] Yup, uh, and is used amount from deductibles and yearly max amounts?
[AGENT][NEUTRAL] Uh, let me see if any has been used this year. Give me just a moment.
[CUSTOMER][POSITIVE] OK. Take your time, no problem.
[AGENT][NEUTRAL] Thank you. OK, yes, um, so he has met that $50 deductible.
[AGENT][NEUTRAL] And of the $1500 benefit he has used $266.40.
[CUSTOMER][NEUTRAL] It's 3666 and 40 cents, right?
[AGENT][NEUTRAL] $266.40.
[CUSTOMER][POSITIVE] OK, thank you so much. Is there any use from uh Family deductible?
[AGENT][NEUTRAL] Um, as he is the only one who is, uh, listed, uh, that would not apply.
[CUSTOMER][NEUTRAL] OK, from the individual ability is 50, right? Us amount.
[AGENT][NEUTRAL] Yes, he's, it's just an individual policy, yes, and he has met that deductible.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that. And is there any other left the max dollar amount?
[AGENT][NEUTRAL] Um, I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Is there any other left Max dollar amount?
[AGENT][NEUTRAL] The max amount was $1500 and he has used $266.40.
[CUSTOMER][NEUTRAL] Is there any orthodontics lifetime max?
[AGENT][NEUTRAL] No, not a lifetime max, just a yearly maximum.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for that. And is there any history for this patient which is actual frequencies?
[AGENT][NEUTRAL] Oh, give me just a moment.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] Let me see.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the most recent history I have, uh, for this year was on [PII], and that was just procedure code 2335, um, besides that.
[AGENT][NEUTRAL] He did have uh [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He did have a 0210.
[AGENT][NEUTRAL] And 11:10.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then that would be it for that. After that I have.
[AGENT][NEUTRAL] Let's see, it was um.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was 0230.
[AGENT][NEUTRAL] So nothing else that would apply to uh that would affect frequencies.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that. And does 0120 shares frequency with 0150?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh, which code, I'm sorry?
[CUSTOMER][NEUTRAL] Does 0120 share frequency with 0150 exams?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And thank you so much for that. And the 0, 1111 shots with 491?
[CUSTOMER][NEUTRAL] Frequency.
[AGENT][NEUTRAL] Uh, 4910 and which other? I'm sorry?
[CUSTOMER][NEUTRAL] Prophylaxis 1111.
[AGENT][NEUTRAL] Um, I don't believe so. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, they do not share uh frequency.
[CUSTOMER][POSITIVE] Thank you so much for that. I'm done with this patient. Thank you for assisting me. Could you please spell your name and call the number, please?
[AGENT][NEUTRAL] Oh, sure. So um the reference number would just be my first name, last initial, and today's date, and so my name is spelled [PII] [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No, thank you so much for that. Have a nice day, bye, [PII].
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL you too bye bye.