AccountId: 011433970860
ContactId: 94baf863-2d44-4c7a-8263-a3e023eca6b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1826239 ms
Total Talk Time (AGENT): 428845 ms
Total Talk Time (CUSTOMER): 366282 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/94baf863-2d44-4c7a-8263-a3e023eca6b0_20250604T15:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. Good morning. This is [PII]. I'm calling from dental provider office. I want patient eligibility and benefit details. Could you provide me?
[AGENT][NEUTRAL] I can help you with eligibility. [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] But never.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] They're
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number 23468009.
[AGENT][NEUTRAL] I have 23468009, correct?
[CUSTOMER][NEUTRAL] Yes, sir. Yes, ma'am.
[AGENT][NEUTRAL] OK, give me just a minute.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] OK, [PII]
[CUSTOMER][NEUTRAL] Patient named [PII]. [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And were you wanting a fax back sent?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. I have specific questions for this patient.
[AGENT][NEUTRAL] Showing all of their benefits.
[CUSTOMER][NEUTRAL] I have specific questions for this patient. Could you provide me by call?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, what, what, what questions did you have?
[CUSTOMER][NEUTRAL] Could you cover the effective date for this patient plans?
[AGENT][NEUTRAL] OK, this patient is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] This plan runs in calendar era, fiscal year.
[CUSTOMER][NEUTRAL] I um.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] This plan runs in calendar year.
[CUSTOMER][NEUTRAL] Or physically yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm sorry, I can't understand. What are you asking?
[CUSTOMER][NEUTRAL] Plan runs in calendar year or fiscal year.
[AGENT][NEUTRAL] Oh, it goes by, uh,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It goes by calendar year.
[CUSTOMER][NEUTRAL] For oral surgery, file to medical first or dental first?
[AGENT][NEUTRAL] This is just for dental.
[CUSTOMER][NEUTRAL] What is the plan? It's a PPO plan?
[AGENT][NEGATIVE] No, this plan doesn't, um, this, this plan isn't in a PPO network.
[CUSTOMER][NEUTRAL] OK. Could you check the provider network status?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Provider is in network or out of network for this patient plan?
[AGENT][NEUTRAL] We don't do networks we just pay by percentage.
[CUSTOMER][NEUTRAL] Uh, provided network status, is in network or out of network providers?
[AGENT][NEUTRAL] We don't participate in networks, so we don't have networks in or out of network.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Could you provide the group number?
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] 19205.
[CUSTOMER][NEUTRAL] Would you provide the fee schedule for this provider?
[AGENT][NEUTRAL] We go off of percentage of UCR.
[CUSTOMER][NEUTRAL] OK. Could you spell out the group name?
[AGENT][NEUTRAL] The group name
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's Universal Trucking, P and S Transportation.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] UN
[AGENT][NEUTRAL] I V E R S A L.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Trucking T R U C K I N G.
[AGENT][NEUTRAL] P
[CUSTOMER][NEUTRAL] uh
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] Transportation, T R A N S P [PII] I O N.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][POSITIVE] Yes, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, could you provide the pay ID?
[AGENT][NEUTRAL] Payer ID
[AGENT][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Would you provide the claim's mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 8950.
[AGENT][NEUTRAL] In Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, you, ma'am?
[CUSTOMER][NEUTRAL] Uh, coordination of benefits covered as a standard or non-duplication?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] We will be covered as a standard or non-duplication.
[AGENT][NEUTRAL] Right, he should be covered under this plan.
[AGENT][NEUTRAL] I am showing that it's active.
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, were you asking if this was a duplication?
[CUSTOMER][NEUTRAL] COB coordination of benefits covered as a standard.
[AGENT][NEUTRAL] We don't have call reference numbers.
[CUSTOMER][NEUTRAL] COB ma'am. COB coordination of benefits covered as a standard or non-duplication.
[AGENT][NEUTRAL] Oh, give me just a moment.
[AGENT][NEUTRAL] OK, I'm not able to find that information um.
[AGENT][NEUTRAL] What exactly are you needing?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, please spell out your name.
[AGENT][NEUTRAL] It's [PII] Last initial [PII]
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Please give your
[CUSTOMER][NEUTRAL] Please give me a call reference number.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date.
[CUSTOMER][NEUTRAL] Ma'am, for this patient have any waiting period and missing tooth cloth?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEGATIVE] It does have a missing tooth clause.
[AGENT][NEUTRAL] And there is a waiting period of 12 months for major endodontic, periodontic, prosthetic repair, and oral surgery expenses.
[CUSTOMER][NEUTRAL] OK. Could you provide the individual deductible only?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] It looks like they have a calendar year deductible of $50 per covered person.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] How much is then, how much remaining?
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That doesn't
[CUSTOMER][NEUTRAL] You go.
[CUSTOMER][POSITIVE] you no problem, no problem, go to.
[AGENT][NEUTRAL] It looks like he has $1,114 left.
[AGENT][NEUTRAL] He has a calendar year maximum of 15.
[CUSTOMER][NEUTRAL] How much remaining?
[AGENT][NEUTRAL] He has a calendar year maximum of $1500.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] He has $1,114 remaining.
[CUSTOMER][NEUTRAL] How much is that?
[CUSTOMER][NEUTRAL] numbers so you know.
[AGENT][NEUTRAL] How much is what?
[CUSTOMER][NEUTRAL] Would you provide the used amount?
[AGENT][NEUTRAL] $386.
[CUSTOMER][NEUTRAL] Some individual deductible, how much is then how much remaining?
[AGENT][NEUTRAL] He has no deductible remaining.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Uh, ma'am, it's a primary plan or secondary plan?
[CUSTOMER][NEUTRAL] What about that.
[AGENT][NEUTRAL] This is a primary plan.
[CUSTOMER][NEUTRAL] I have some quotes for that quote. I want to know coverage percentage, and frequency. Could you provide me?
[AGENT][NEUTRAL] OK, what are the code numbers?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 0140
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Oh, give me just a moment. We'll go one by one.
[CUSTOMER][NEUTRAL] 9310?
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] 0140. Give me just a moment.
[AGENT][NEUTRAL] I'm not showing 0140.
[CUSTOMER][NEUTRAL] It's not covered?
[AGENT][NEUTRAL] I'm not seeing it. Oh, here it is. 0140.
[AGENT][NEUTRAL] OK, it is covered, let me see.
[AGENT][NEUTRAL] Limited to 2 oral evaluation procedures um in a 12-month period.
[CUSTOMER][NEUTRAL] It's shared with the D0120.
[AGENT][NEUTRAL] 30
[CUSTOMER][NEUTRAL] It's shared with 0120?
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] OK, um, that is the same. It is also covered.
[CUSTOMER][NEUTRAL] How much person covered?
[AGENT][NEUTRAL] They're limited to 2 oral evaluation procedures in any 12 month period.
[CUSTOMER][NEUTRAL] Yes, it's covered as 100% or 50% or 80%. How much percent covered?
[AGENT][NEUTRAL] 100%.
[CUSTOMER][NEUTRAL] OK. Uh, next 101 150.
[AGENT][NEUTRAL] Uh, it's the same.
[AGENT][POSITIVE] Covered at 100%.
[CUSTOMER][NEUTRAL] OK. 9310.
[AGENT][NEUTRAL] 9310.
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm not showing that one is covered.
[CUSTOMER][NEGATIVE] It's not covered.
[AGENT][NEGATIVE] I'm not able to find it, no.
[AGENT][NEUTRAL] Oh wait, 9, wait, 9310?
[CUSTOMER][NEUTRAL] 0330.
[CUSTOMER][NEUTRAL] 10
[AGENT][NEUTRAL] Yes, that one is, that one is covered and let me see.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It is covered at 80%.
[CUSTOMER][NEUTRAL] Frequency?
[AGENT][NEUTRAL] Um, I'm not showing a frequency on this one.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 0330, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, this one is covered.
[AGENT][NEUTRAL] At 80%.
[CUSTOMER][NEUTRAL] What is the frequency?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] Limited to one X-ray procedure in a five-year period.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] FMX and pan on both are shaded frequency.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] G FMX and Pano both are shared frequency.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Those will be at 80% in the same frequency, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] New
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said 6010, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] I'm not showing that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, from this score onwards, I just want coverage percentage only. No need frequency, 617111.
[AGENT][NEUTRAL] Give me just a moment. 7111.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing that one.
[CUSTOMER][NEUTRAL] 7140
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, I did find 7111.
[AGENT][NEUTRAL] Give me just a moment. It looks like it's covered under.
[AGENT][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 7140
[AGENT][NEUTRAL] And 7140 is also at 80%.
[CUSTOMER][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] He fruit.
[CUSTOMER][NEUTRAL] He is the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We have plenty of complete.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Is that 40%?
[CUSTOMER][NEUTRAL] 7220
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] Um, my one.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] Mailla on the mama.
[AGENT][NEUTRAL] 7210, is that 40%?
[CUSTOMER][NEUTRAL] 7220
[CUSTOMER][NEUTRAL] Ma'am, please provide me quickly.
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7230
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7240
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7241
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7250
[AGENT][NEUTRAL] It's also 40%.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 7310
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7311
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] You said 7311?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I'm not showing it.
[CUSTOMER][NEUTRAL] 9222
[AGENT][NEUTRAL] 9222.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing it.
[CUSTOMER][NEUTRAL] 7410. Anesthesia, ma'am. 9222.
[AGENT][NEUTRAL] I have 9221.
[AGENT][NEUTRAL] For anesthesia.
[CUSTOMER][NEUTRAL] How much person covered anesthesia?
[AGENT][NEUTRAL] And 9220.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] 9222.
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7410
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7286
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7472
[AGENT][NEUTRAL] 7272
[CUSTOMER][NEUTRAL] 7472.
[AGENT][NEGATIVE] I'm not finding it.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEUTRAL] 7473
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 7956
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] I'm not seeing it.
[CUSTOMER][NEUTRAL] 7957
[AGENT][NEUTRAL] What was that? 7297?
[CUSTOMER][NEUTRAL] No, 7957.
[AGENT][NEUTRAL] 7957.
[CUSTOMER][NEUTRAL] She, she.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] I'm not seeing it on here.
[CUSTOMER][NEUTRAL] 6010
[AGENT][NEUTRAL] Would you like a fax back that has all of the procedure codes in them?
[CUSTOMER][NEUTRAL] No, ma'am. I have 5 remaining only, please.
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] 60
[CUSTOMER][NEUTRAL] 6056.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] You said 6056?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] I'm not seeing that one.
[CUSTOMER][NEUTRAL] 6104
[AGENT][NEUTRAL] I'm not showing that one either.
[CUSTOMER][NEUTRAL] OK. 7950.
[AGENT][NEUTRAL] 7 950.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I'm not showing that one either.
[CUSTOMER][NEUTRAL] 7951
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm looking for it. Give me just a moment.
[AGENT][NEUTRAL] I'm not showing that one either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I'm not seeing it.
[CUSTOMER][NEUTRAL] 792 1
[AGENT][NEUTRAL] I'm not seeing 7921 either.
[CUSTOMER][NEUTRAL] OK. Now, I want the history for 4 cos. Could you provide me?
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] What history are you needing?
[CUSTOMER][NEUTRAL] For exam, pano and FMX only.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Do you have the procedure code?
[AGENT][NEUTRAL] For the first one?
[CUSTOMER][NEUTRAL] Yes, ma'am. 01 0140.
[AGENT][NEUTRAL] OK, I'm not showing he's had that done.
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] Or that one.
[CUSTOMER][NEUTRAL] 0 120
[AGENT][NEGATIVE] Not showing anything.
[CUSTOMER][NEUTRAL] 0330
[AGENT][NEUTRAL] Nothing?
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEGATIVE] Not showing anything for that one.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Take care.
[AGENT][POSITIVE] Great. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, no, ma'am. Thank you.
[AGENT][POSITIVE] Great thank you for calling.
[CUSTOMER][NEUTRAL] Deductible is applied to only basic and major services. Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Deductible is applied to only basic and major services.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it does cover um FMX mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you.
[AGENT][POSITIVE] Great thank you so much for calling ATL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK.