AccountId: 011433970860
ContactId: 993b3a9e-3bdc-420f-a608-d37a68bd4bd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1105140 ms
Total Talk Time (AGENT): 340822 ms
Total Talk Time (CUSTOMER): 282550 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/993b3a9e-3bdc-420f-a608-d37a68bd4bd7_20250103T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello there. This is [PII]. I'm looking for dental benefit for my patient.
[AGENT][POSITIVE] Alright, I'm happy to check benefits. What's the policy number?
[CUSTOMER][NEUTRAL] Yes, that will be.
[CUSTOMER][NEUTRAL] 01822695.
[AGENT][NEUTRAL] And can I get your first name again and a callback number, please?
[CUSTOMER][NEUTRAL] [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What's the patient name and date of birth, please?
[CUSTOMER][NEUTRAL] His name is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you for that. So patient plan is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and uh for this future termination date.
[AGENT][NEUTRAL] No termination date.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] OK. And uh ma'am, what will be the group number?
[AGENT][NEUTRAL] Group number is 17626.
[CUSTOMER][NEUTRAL] And the group name?
[AGENT][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] Uh, is it T R U C K A N C?
[AGENT][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] OK. And uh what is the annual maximum?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The annual maximum amount.
[AGENT][NEUTRAL] Calendar year maximum is 1500 per covered insured. The calendar year deductible is $50 per covered up to $150 per family.
[CUSTOMER][NEUTRAL] So individual deductible amount is 15 and family is 150, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh what will be, uh, is it metal or meth?
[AGENT][NEUTRAL] One moment, let me check.
[AGENT][NEUTRAL] Uh, the patient still has left the deductible in the full calendar year maximum.
[CUSTOMER][NEUTRAL] So nothing is used from the maximum and deductible, right? Any other coverage?
[AGENT][NEUTRAL] No or coverage.
[CUSTOMER][NEUTRAL] OK. Any waiting period?
[AGENT][NEUTRAL] Uh, there is a 12-month waiting period for major endodontic periodontic oral surgery expenses.
[CUSTOMER][NEUTRAL] Uh, can you just repeat that one more time, uh, major end of period and also.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. 12-month waiting period, major expenses, endodontic expenses, periodontic expenses, oral surgery.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And any missing tooth loss?
[AGENT][NEGATIVE] Uh, yes, this policy does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] And uh what will be the coverage percentage for diagnosis basic measure?
[AGENT][NEUTRAL] Preventative is covered at 100% of UCR. Basic is at 80% of UCR.
[CUSTOMER][NEUTRAL] You don't want
[AGENT][NEUTRAL] Majors 40% of UCR.
[CUSTOMER][NEUTRAL] And uh what about the endo period oral? Is it come under the basic or major?
[AGENT][NEUTRAL] Major 40% of UCR.
[CUSTOMER][NEUTRAL] OK, and ma'am, uh, deductible applies to basic and major services, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and uh replacement clothes for prosthetics.
[AGENT][NEUTRAL] Replacement clause for prosthetics. Is that what you said?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, looks like repair expenses are 40% covered at 40% of UCR.
[CUSTOMER][NEUTRAL] And the crowns are paid on potato seed dates.
[AGENT][NEUTRAL] Either.
[CUSTOMER][NEUTRAL] And uh for this patient, I do have some codes. Can I get it frequency and percentage?
[AGENT][NEUTRAL] Um, yeah, I can check those for you. Just one moment, please.
[CUSTOMER][NEUTRAL] Again.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] What's the first code [PII] that you'd like checked?
[CUSTOMER][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] I need to, you know.
[AGENT][NEUTRAL] 0120 is covered under preventative and so that's at 100%. Uh, the frequency is limited to two oral evaluation procedures in combination with 0 140, 0 150. They share the same frequency.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, what about 1110?
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Covered at 100%. It's a maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] And 07, sorry, 0274.
[AGENT][NEUTRAL] 0274 is covered at a 100%. Uh, it is limited to one bite X-ray procedure per 12 month period.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And the 0210.
[CUSTOMER][NEUTRAL] or.
[AGENT][NEUTRAL] 0210.
[AGENT][NEUTRAL] Oh, so radiograph FMX are covered at 80%.
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] Limited to 1 X-ray procedure per 5 year, seems to share frequency as 0210, 0277 and 0330.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] What about 1351?
[AGENT][NEUTRAL] It's covered under preventative at 100%. Um, it looks like it is a maximum of 1 procedure per 36 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is um applications to molar teeth only.
[AGENT][NEUTRAL] And it is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And ma'am, uh, you said it was 100% covered, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And what about 1206?
[AGENT][NEGATIVE] 1206 is not listed, therefore not covered.
[CUSTOMER][NEUTRAL] And uh 0431.
[AGENT][NEUTRAL] 0431.
[AGENT][NEGATIVE] I don't see 431 listed here, so therefore it would not be covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And uh 0703.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 0703 correct?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK, 11.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I'm not seeing 0703 listed, so it would not be covered.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] What about 4341?
[AGENT][NEUTRAL] 4341.
[CUSTOMER][NEUTRAL] It was.
[AGENT][NEUTRAL] Uh, that is covered. It's a maximum of 1 quadrant per 36 months at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh how many cos for visits allowed?
[AGENT][NEUTRAL] 1 quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK. And uh 4910.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, it's a maximum of 1 procedure per 36 months covered at 80%.
[CUSTOMER][NEUTRAL] And does it a frequency with 1110.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And 4355.
[AGENT][NEUTRAL] 4355 is covered at 80%. It looks like it does carry a limitation of a maximum of 1 quadrant per 24 months.
[CUSTOMER][NEUTRAL] And uh 4266.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can I.
[CUSTOMER][NEUTRAL] Let's move.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] 4266 is not showing, therefore not covered.
[CUSTOMER][NEUTRAL] And 9944.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] I didn't know this is not I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] about
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I'm not showing 9944 listed, so it would not be covered.
[CUSTOMER][NEUTRAL] What about 3310?
[AGENT][NEUTRAL] 3310 is covered. It looks like at 80% there's no limitation.
[CUSTOMER][NEUTRAL] 333 0.
[AGENT][NEUTRAL] Uh, given the frequency on that one.
[AGENT][NEUTRAL] 33.
[AGENT][NEUTRAL] 30.
[AGENT][NEUTRAL] 3330 is covered at 80%. There's no limitation.
[CUSTOMER][NEUTRAL] And that's a downgrade to amalgam.
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] And 9911.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] Don't see 99/11 listed.
[CUSTOMER][NEUTRAL] 9951.
[AGENT][NEUTRAL] 951.
[CUSTOMER][NEUTRAL] 9951
[AGENT][NEUTRAL] Alright, so that one's covered at 80%. It's limited to those ages [PII] and older.
[AGENT][NEUTRAL] The maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And it's not in conjunction with TMJ.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And 2750?
[AGENT][NEUTRAL] Covered under major.
[AGENT][NEUTRAL] And it's a maximum of 1 per 7.
[AGENT][NEUTRAL] Your period.
[AGENT][NEUTRAL] Limited to patients ages [PII] and older.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And as a downgrade.
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] And uh 2950.
[AGENT][NEUTRAL] 2950 is covered under major and it looks like it is a maximum of 1 for 7 years.
[AGENT][NEUTRAL] Limited to patients ages [PII] and over.
[CUSTOMER][NEUTRAL] 6010
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Don't show 6010 listed.
[CUSTOMER][NEUTRAL] 6057
[CUSTOMER][NEUTRAL] Well
[AGENT][NEGATIVE] 605-7 not listed, not covered.
[CUSTOMER][NEUTRAL] 6065
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Do not show that listed, therefore not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do not show 7953 listed?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And 7210.
[CUSTOMER][NEUTRAL] Yes, sorry [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Covered under oral surgery at 40%, no limitation.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And ma'am, uh, for this patient, uh, can I get all the history for this year or any history from previous year that matter for the frequency?
[CUSTOMER][NEUTRAL] OK so.
[AGENT][NEUTRAL] Mhm. Last day of service that I show is on [PII].
[AGENT][NEUTRAL] Patient had procedure code 11:10 prior to that it was 3-18 of 24.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is the only history?
[AGENT][NEUTRAL] For [PII], correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, profy two dates of service, [PII] and [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you for that. And ma'am, can I get the reference number for this call?
[AGENT][NEUTRAL] Call references my name with my last initial in today's date. My name again is spelled [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you. Have a good day and bye for now, ma'am.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.