AccountId: 011433970860
ContactId: 9429910a-d77b-4cec-bca2-427e0a6f43f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330769 ms
Total Talk Time (AGENT): 120250 ms
Total Talk Time (CUSTOMER): 147379 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/9429910a-d77b-4cec-bca2-427e0a6f43f4_20250130T14:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. My name is [PII]. I'm calling from a provider's office and I've received a fax back for our patients, um, but I just have like 2-3 questions additional about the fax that I received.
[AGENT][NEUTRAL] OK, and I can help you with the fax back. [PII], may I have a good contact number in case we're disconnected and then the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, contact number is [PII], no extension. The policy number is, let's see.
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 01691413
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. Hold on one moment, let me see what kind of dental policy.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. And um what questions did you have about the fax back?
[CUSTOMER][NEGATIVE] OK, so the fax cuts off, um, on the very last page, um, I believe that it's telling me that paying FMX are at 80%, but the FF limitation part, the very last code on the limitation that cut off so I can't see exactly what it says.
[AGENT][NEUTRAL] Oh, OK. So that says limited to one X-ray procedure per 5-year period and it's paired with 210, 277, and 3,300,330.
[CUSTOMER][NEUTRAL] Got and based off of that first page where it says radiograph FMX, those would be at 80%.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] Got you. So we also have, um, by wins is 100, but PAs and emergency exam is also 80% under basic.
[AGENT][NEUTRAL] PAs and exams, um, what's the code? I, I don't.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] The 0140 and 0220.
[AGENT][NEUTRAL] Hold on one second. 0140.
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] I wish they were in, I, I guess it's group by the type. I wish it was in group by the number. One second. 0220.
[CUSTOMER][NEUTRAL] You right.
[AGENT][NEUTRAL] Here it is. OK, basic 80, yes.
[CUSTOMER][NEUTRAL] I do know that they.
[CUSTOMER][POSITIVE] Perfect, got you.
[AGENT][NEUTRAL] And 140, yes.
[CUSTOMER][NEUTRAL] Alright, so those are both 80. I don't see anything that says otherwise, um, but are they allowed treatment the same day?
[AGENT][NEUTRAL] Yes, it's not specified.
[CUSTOMER][NEUTRAL] Alright, yes ma'am and then my only other question that I wasn't clear about I'm assuming it does not because I didn't see where it said otherwise um but it's posterior composites downgrade.
[AGENT][NEUTRAL] Oh, no downgrades.
[CUSTOMER][NEUTRAL] Perfect alright and history does he have any history on file?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so yes, but do you have like particular code you want me to look for because like to find the history, I have to go through each of the claims to see what codes were on that claim to see what he's used, um.
[CUSTOMER][NEUTRAL] Um, any history for like 10 SMX or 02100330 and that should be the only thing that would count or matter I believe.
[AGENT][NEUTRAL] Let me see, hold on one second.
[CUSTOMER][NEUTRAL] Or maybe if anything for this year.
[AGENT][NEUTRAL] 00210, um, last day of service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And 00330. Let me see.
[AGENT][NEUTRAL] And there's no history on file for um 00330.
[CUSTOMER][NEUTRAL] Alrighty and then how about like 02741110?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, nothing for 00274, and then what was the second one?
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEGATIVE] And nothing on file for 01110.
[CUSTOMER][NEUTRAL] Alrighty and nothing on file as well for 0120.
[AGENT][NEUTRAL] 0 120.
[AGENT][NEGATIVE] And nothing for 00120 either.
[CUSTOMER][POSITIVE] Alright well perfect that is all I need thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.