AccountId: 011433970860
ContactId: 9b81975a-c125-49ec-b4f4-9b8059f1ed7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1463160 ms
Total Talk Time (AGENT): 565149 ms
Total Talk Time (CUSTOMER): 396094 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/9b81975a-c125-49ec-b4f4-9b8059f1ed7e_20250502T13:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I just need to verify dental benefits.
[AGENT][NEUTRAL] OK, sure, I can assist you with dental benefits. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Sure. Callback number here is.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment. Sorry, my system is loading.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK. And may I have um the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Bear with me, sorry.
[CUSTOMER][NEUTRAL] Yes, the facility name is ANP Dana and Aesthetics LLC for Doctor [PII]. Do you need the tax ID or the NPI?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, it's fine. Thank you. Uh, I just needed the name of the doctor. OK. And may I have the patient's policy number, Msmith?
[CUSTOMER][NEUTRAL] Yes, I have here.
[CUSTOMER][NEUTRAL] Policy number is 02605937.
[AGENT][NEUTRAL] Thank you, one moment, let me pull that information.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, for [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. All right, and you need this benefit information given to you verbally or faxed over to you or you have a specific questions?
[CUSTOMER][NEUTRAL] Verbally, uh, hold on, the patient here is still active.
[AGENT][NEUTRAL] Yes, it is active. The effective date is [PII].
[AGENT][POSITIVE] It was just started yes.
[CUSTOMER][NEUTRAL] And this is a PPO plan?
[AGENT][NEUTRAL] This is uh not a PPO or an HMO it's a commercial.
[CUSTOMER][NEUTRAL] OK, it looks like an CPR right?
[AGENT][NEUTRAL] It doesn't have any network. We pay under us showing customer rates.
[CUSTOMER][NEUTRAL] OK, so there is no network.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, sure. So there's no network. Thank you. And yes, what is the group number and the group name?
[AGENT][POSITIVE] Mm. You're welcome.
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] OK, so the group number is 17626.
[AGENT][NEUTRAL] The group name is Universal Trucking Stevens Transport.
[CUSTOMER][NEUTRAL] Hold on Universal tracking Stevens.
[AGENT][NEUTRAL] Yeah, Transport. Stevens Transport. Mhm.
[CUSTOMER][NEUTRAL] 10 sports.
[CUSTOMER][POSITIVE] Thank you so much and yes, this is a calendar year plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, calendar year plan.
[CUSTOMER][NEUTRAL] And you said there is no network, can I have the maximum and adaptable of the patient?
[AGENT][NEUTRAL] This one has a calendar year maximum of $1500 with the $50 deductible.
[CUSTOMER][NEUTRAL] How about the family?
[AGENT][NEUTRAL] It's 150 is a family plan.
[CUSTOMER][NEUTRAL] Um, by the way, the patient here is also the subscriber.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. How, OK, so the maximum here applies to all services.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Deductible waived on preventive, right, only the basic measure.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any amount you still met?
[AGENT][NEUTRAL] I can check for you. Let's see.
[AGENT][NEUTRAL] OK. As of today, Ms. [PII] has not used her benefits, so she still has the $1550.
[AGENT][NEUTRAL] Deductible
[CUSTOMER][NEUTRAL] OK, nothing here is not met. Thank you. Well then, do you accept the summit of benefits?
[AGENT][NEUTRAL] We do.
[CUSTOMER][NEUTRAL] Thank you. How about the car insurance here, preventive diagnostic, basic and measure?
[AGENT][NEUTRAL] OK, so, uh, preventative is covered 100%. Radiograph FMX is covered at 80%. Basic and basic restorative is covered at 80%.
[AGENT][NEUTRAL] And then we have major it's gonna be covered at 40% after 12 month waiting period. There is a waiting period for major service.
[CUSTOMER][NEUTRAL] So, there is a 12 month waiting period for major. Thank you. How about the endopperio and oral? It falls under basic or measure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Major, that's all their major. So it's after the 12 month waiting period for those.
[CUSTOMER][NEUTRAL] OK, so they're all major. Thank you. The waiting period only for major, right? How about the missing tooth cloth here?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] It's for major as well.
[CUSTOMER][NEGATIVE] The missing tooth cloth.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] So there is a missing tooth cloth. Thank you. And there is an out of network benefits, right?
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Yes, um, there's no network, so we pay unusual customary rates.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Is there any downgrade for fillings and crowns?
[AGENT][NEGATIVE] No, we don't sound great.
[CUSTOMER][NEUTRAL] What is the frequency for 2392?
[AGENT][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me pull the schedule one moment, OK.
[AGENT][NEUTRAL] Replace the existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] So once in 24 months. And what is the replacement clause here crowns for just tures and partials?
[AGENT][NEUTRAL] OK, so that's going to be let's see.
[AGENT][NEUTRAL] go back to.
[AGENT][NEUTRAL] So for crowns and bridges, I'm sorry for crowns and bridges are gonna be once every 7 year per tooth.
[AGENT][NEUTRAL] And then for partial indentures this month every 5 years.
[CUSTOMER][NEUTRAL] So 1 in 7 years for crowns and breaches, 5 years for dentures and partials. Thank you. How many months for the timely filing limit for claims?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] No limits secure for implants, are they covered? The 6010, 6057 and 6058. OK, they're not covered. Exam here. They're 150 and 20, they share frequency.
[AGENT][NEUTRAL] No. No.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] And what is the frequency?
[AGENT][NEUTRAL] OK, so that's gonna be limited to two oral evaluation procedures in any combination of 120, 140, 150, 160, or 180 for 12 month period.
[CUSTOMER][NEUTRAL] So all the exams shows frequency including the 0140, right?
[AGENT][NEUTRAL] Yes, 0 and it's gonna be the 120, 140, 150, 160, and 180. Those all shared frequencies.
[CUSTOMER][NEUTRAL] OK. So they share frequency twice in 12 months. And the 0140 treatment is allowed in the same day?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, treatment is allowed on the same date. Mhm.
[CUSTOMER][NEUTRAL] How about PAs, by wings, FMX, cleaning fluoride sealants? What is the frequency and coverage?
[AGENT][NEUTRAL] OK, I'll have to go one by one, OK? Because I have to go to the schedule, I need to look at it and everything. So what's the first one?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] PA 02200230.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you said um.
[AGENT][NEUTRAL] 210 and 330.
[CUSTOMER][NEUTRAL] 022002200230 for pure X-ray.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So that's gonna be under basic expense. Basic expenses cover 80%.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And there's no limitation on those.
[CUSTOMER][NEUTRAL] OK. How about the 02 10 and the 0330?
[AGENT][NEUTRAL] OK, so that one is under, uh, let's see, limited to one X-ray procedure and any combination of 210, 277, or 330 per 5 year period.
[CUSTOMER][NEUTRAL] Basic as well, 80.
[AGENT][NEUTRAL] That one is basic correct. Mhm.
[CUSTOMER][POSITIVE] Thank you. They share frequency, right? The 02 10 and the 0330.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] How about the bite wings, the 0274?
[AGENT][NEUTRAL] OK, so limited to one by X-ray procedure and any combination of 270, 272, or 274.
[AGENT][NEUTRAL] So 1 in 12 months.
[CUSTOMER][NEUTRAL] What is the frequency, sorry?
[AGENT][NEUTRAL] 1 in 12 months.
[CUSTOMER][NEUTRAL] Once in 12 months preventive. This is preventive.
[AGENT][NEUTRAL] Um, this one is gonna fall under, let's see, bear with me.
[AGENT][NEUTRAL] Yes, per minute.
[CUSTOMER][NEUTRAL] How about the cleaning fluoride sealants?
[AGENT][NEUTRAL] OK, so for fluoride, um, let's see, we have
[AGENT][NEUTRAL] And those two are prevented, um, limited to dependent children aged [PII].
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Bear with me. Let me.
[AGENT][NEUTRAL] 1.
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months and that's for the fluoride. So it is limited to dependent children under the age of [PII] and maximum of 1 procedure per 12 um.
[AGENT][NEUTRAL] For 12 months. And then for the seats, uh, for the sealants, it's limited to dependent children under the age of [PII] and maximum of 1 procedure per 36 months and application made to the permanent molar teeth only.
[CUSTOMER][NEUTRAL] And for the sea length.
[CUSTOMER][NEUTRAL] 0431. Is it covered?
[AGENT][NEUTRAL] 0431.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] Cleaning here 110 is twice in 12 months also, right?
[AGENT][NEUTRAL] The cleaning 1110, that one is gonna be once every 6 months.
[CUSTOMER][NEUTRAL] Once in 6 months. Thank you. How about uh 4355?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can be done same day as the exam or no?
[AGENT][NEUTRAL] OK, so that one is periodontics. It can, but this one has a 12 month waiting period, OK? So it's not just yet.
[CUSTOMER][NEUTRAL] So, OK. So the measure here is not covered during the first year of the plan, right?
[AGENT][NEUTRAL] Correct. There's a 12-month waiting period for any major service including endodontics, periodontics, prosthodontic, repair, and neurosurgery.
[CUSTOMER][NEUTRAL] So they are not covered due to the waiting period?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, OK. After the waiting period, the 4355 is once per, per 12 months, you said, right?
[AGENT][NEUTRAL] Um, that one is going to be, let's see, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum 1 each quad for 24 months.
[CUSTOMER][NEUTRAL] 24 months. How about the 43, the 4910? She frequency with the 1110?
[AGENT][NEUTRAL] 49.
[AGENT][NEGATIVE] No, it doesn't share frequency.
[CUSTOMER][NEUTRAL] What is the frequency?
[AGENT][NEUTRAL] And you said 4910?
[CUSTOMER][NEUTRAL] Yes, the pure maintenance.
[AGENT][NEUTRAL] Mhm. OK, that one is also once every 6 months, but it doesn't share frequency.
[AGENT][NEUTRAL] This one is covered on the basic.
[CUSTOMER][NEUTRAL] Once in 6 months is it basic?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Once in 6 months. That's not your frequency with cleaning. How about the 43? Uh, sure.
[AGENT][NEUTRAL] Oh no, I do apologize. I'm sorry, 4910 is under major. I do apologize.
[CUSTOMER][NEUTRAL] OK. How about the 4346 shares frequency with the 1110?
[AGENT][NEUTRAL] 846, 1 moment.
[AGENT][NEUTRAL] 4346 is not covered.
[CUSTOMER][NEUTRAL] 43, the 4341.
[AGENT][NEUTRAL] 4341.
[AGENT][NEUTRAL] OK, 4341 is under period and so it's after the 12 month waiting period and it's one quad for 24 months.
[CUSTOMER][NEUTRAL] How many cards? Is it all cards?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For Orto, what is the lifetime max?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] At all?
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Thank you. No auto coverage at all, right, regardless of the age, one moment. 4 381 here, is it coveredin?
[AGENT][NEUTRAL] You said 3 what? I'm sorry?
[CUSTOMER][NEUTRAL] 4381.
[AGENT][NEUTRAL] 4381.
[AGENT][NEUTRAL] OK, so 4381, that's going to be under periodontics, which is after the 12 month waiting period. That's on the major, there's no limitation on that one.
[CUSTOMER][POSITIVE] Thank you. The 9310.
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] 9310.
[AGENT][NEUTRAL] OK, 9310 is under basic, um, so that's 80%. There's no limitation on that one.
[CUSTOMER][NEUTRAL] The 9951.
[AGENT][NEUTRAL] 951 that's going to be under major after the 12 month waiting period and let me check on the limit on that 11 moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so limited to those age [PII] and over, it's going to be maximum of 1 per 7 year period and it's going to be, let's see, not in conjunction with TMJ.
[CUSTOMER][NEUTRAL] No frequency, right? Only guidelines for the 9951?
[AGENT][NEUTRAL] Correct. Well, the frequency, yes, it is maximum of one per saving in your period.
[CUSTOMER][NEUTRAL] How about
[CUSTOMER][NEUTRAL] OK, once in 7 years for the 9951. The 9110.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 9110.
[AGENT][NEUTRAL] OK, so that one is going to be on the basic. There's no limitation on that one.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] 9944 is not covered.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] 2950 is under major, so it's after the 12 month waiting period and that's gonna be once every 7 years and the limited to patients age [PII] and over.
[CUSTOMER][NEUTRAL] OK, once in 5 years, right? 7 years rather, Ma.
[AGENT][NEUTRAL] 7 years. Yes.
[CUSTOMER][NEUTRAL] How about the 322, 3221?
[AGENT][NEUTRAL] That's gonna be under endodontics, which is after the 12 month waiting period. There's no limitation on that one.
[CUSTOMER][NEUTRAL] 3221, no major, no frequency. 7510.
[AGENT][NEUTRAL] It is major. Eoonyx is major. 3221 is major, it's after the 12 month waiting period, OK?
[AGENT][NEUTRAL] Uh, what's the next code?
[CUSTOMER][NEUTRAL] 7510.
[AGENT][NEUTRAL] 7510.
[AGENT][NEUTRAL] 7510, that's going to be under major as well. So after the 12 month waiting period, there's no limitation.
[CUSTOMER][NEUTRAL] No frequency, 75107953.
[AGENT][NEUTRAL] 7593.
[CUSTOMER][NEUTRAL] 75, I'm sorry, 797953, sorry.
[AGENT][NEUTRAL] That's not covered?
[AGENT][NEUTRAL] 7953. OK. That's still not covered.
[CUSTOMER][NEUTRAL] Not covered. 4266.
[AGENT][NEGATIVE] 4266 is not covered.
[CUSTOMER][NEUTRAL] 26,422,610.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] For and laying only the 2642 and 2610.
[AGENT][NEUTRAL] OK, 2610 is gonna be on the major which is after the 12 month waiting period and it's gonna be once every seven years and it's gonna be um limited to depend on children age [PII] and over.
[CUSTOMER][NEUTRAL] OK. And 2610.
[AGENT][NEUTRAL] OK, let me.
[AGENT][NEUTRAL] OK, that is 2610.
[CUSTOMER][NEUTRAL] 2642, sorry.
[AGENT][NEUTRAL] 2642, it's gonna be the same thing.
[CUSTOMER][NEUTRAL] OK. And the last code 92399243.
[AGENT][NEUTRAL] I'm sorry, can you give me one at a time, 91?
[CUSTOMER][NEUTRAL] Sorry, 923 9.
[AGENT][NEUTRAL] OK, 923-9 is not covered. What's the next one?
[CUSTOMER][NEUTRAL] 9243.
[AGENT][NEUTRAL] 9243 9243 is not covered.
[CUSTOMER][NEUTRAL] OK. They're not covered. Can I have the last history of the patient or was there any history?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] There's no history. She started the policy yesterday.
[CUSTOMER][NEUTRAL] Sure. No history at all. The claim's address, please.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm so sorry, what is the zip code?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So the [PII].
[CUSTOMER][NEUTRAL] And the ZIP code is [PII], right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] What is the peer ID?
[AGENT][NEUTRAL] 60801
[CUSTOMER][POSITIVE] 60801. Thank you so much. The claims should be sent to APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] APL or American Public Life. Mhm.
[CUSTOMER][NEUTRAL] Your name, the reference number.
[AGENT][NEUTRAL] My name is [PII], and we don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you so much for assisting me and have a great day. Bye now. Thank you.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] Thank you for calling APL bye bye Miss [PII].
[CUSTOMER][POSITIVE] Bye, thank you.