AccountId: 011433970860
ContactId: 9532f260-0f52-4bad-9431-c5fde386361a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417239 ms
Total Talk Time (AGENT): 204427 ms
Total Talk Time (CUSTOMER): 126461 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/9532f260-0f52-4bad-9431-c5fde386361a_20250429T13:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is how may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, what's your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Oh hi there. This is [PII] calling from the provider's office. I would like to check patients' dental benefits.
[AGENT][NEUTRAL] OK, sure. I can assist you with dental benefits, and I'm sorry, I didn't quite catch your name or can you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] [PII], yeah, [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, that would be 02576161.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you. And you need this information given to you verbally or faxed over to you?
[CUSTOMER][POSITIVE] Uh, this is very funny.
[AGENT][NEUTRAL] Mhm, OK. Do you have like a specific question or do you need a full breakdown?
[CUSTOMER][NEUTRAL] Yeah, can I get a full breakdown instead?
[AGENT][POSITIVE] Yes, sure, no problem. OK, let me go ahead and get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And before I give you benefits, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And let's see, so this one has a calendar year maximum of $500 per cover insured with a $50 deductible and deductible does not apply to preventative.
[AGENT][NEUTRAL] This is one of our basic dentals, so it does not cover major. So endodontics, periodontics, prosthodontic repair, oral surgery count just the partial and dentures are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, preventative, I cover 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Radiograph FMX is cover 80%.
[AGENT][NEUTRAL] Basic expense and basic restorative expenses covered 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for the frequencies, um, we have Profi cleanings once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] But wings is once per 12 month period.
[AGENT][NEUTRAL] Emphoma, X-rays or panels are once every 5 years.
[AGENT][NEUTRAL] Orthodontics and implants are not covered on the policy.
[CUSTOMER][NEUTRAL] I see. Um, how about for 2391?
[AGENT][NEUTRAL] Oh, what code again I'm sorry.
[CUSTOMER][NEUTRAL] 2391 for the um restorative for the fillings.
[AGENT][NEUTRAL] 23. OK, 23. 91. OK. So that's basic restorative which is 80% and that one is gonna have um replaced sing only in place for 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. And there's no downgrades, correct?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right, thank you. Um, how about for 12:06 and 1351?
[AGENT][NEUTRAL] 1206 is gonna be floor. That one is not listed. Um, I believe the one that we cover is 1208 and the one for 1208 is going to be, let's see, limited to dependent children aged [PII] and I believe it's maximum of 1 per 12. Let me double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, maximum of 1 procedure for 12 months. Mhm.
[AGENT][NEUTRAL] What's the other code that you mentioned?
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] For sealants, 1351.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, for ceilings, there is an age limit as well. Um, the ceilings are limited to dependent children aged [PII], uh, maximum of 1 procedure for 36 months, and application made to the permanent molar teeth only.
[CUSTOMER][NEUTRAL] All right, thank you. Um, for the calendar year max, will it apply to all services?
[AGENT][NEUTRAL] Oh yes, mhm.
[CUSTOMER][NEUTRAL] All right. Thank you. And there's a $50 deductible, correct, on the plan?
[AGENT][NEUTRAL] Mm
[AGENT][MIXED] Correct, yes, but the deductible does not apply to preventative, so it's just gonna be for radiograph FMX, and basic and basic.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I see. All right, thank you. And no or coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right, thank you. Uh, for, uh, for the white wings, that's under preventive, correct? Only FMSN panel is under basic?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, how about for the clothes.
[CUSTOMER][NEUTRAL] 0220 and 0230. Is that also under basic service?
[AGENT][NEUTRAL] 0220 is basic, um 0230 is also basic. Yes, those two are on basic and there's no limitation.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And no history on file for the patient?
[AGENT][NEUTRAL] I can check
[AGENT][NEUTRAL] Nope, no history on file.
[CUSTOMER][NEUTRAL] All right. Thank you very much. Um, for the code 4910 for uh period maintenance, is that covered or no?
[AGENT][NEGATIVE] Yes, it's not covered.
[CUSTOMER][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All right. Thank you. Um, yeah, I guess that would be all the information I needed for this patient. Can I also get the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK. I see. All right. Well, thank you again so for all the help and enjoy the rest of your day. Bye for now.
[AGENT][POSITIVE] You're welcome. You as well, Ms. [PII]. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye.