AccountId: 011433970860
ContactId: 9be99f42-146a-4d8b-a015-0d695284f1be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501380 ms
Total Talk Time (AGENT): 198656 ms
Total Talk Time (CUSTOMER): 202391 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/9be99f42-146a-4d8b-a015-0d695284f1be_20250217T18:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is how may I assist you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. This is [PII], and I'm calling you on behalf of a dental office on this recorded line. I would like you to help me with the patient eligibility and benefits. But before that, may I have your good name and your last name initial, Miss?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, Mr. [PII]. My name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] Uh-huh. And so how are you doing today?
[AGENT][POSITIVE] I'm good thank you and may I have a call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]. This is a direct line number and we don't have extensions for this.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient's policy number is 025.
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] 028.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The first name for the patient is [PII] Last name is [PII] Date of birth, [PII].
[CUSTOMER][NEUTRAL] I'm sorry, that's [PII] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and you said you need eligibility and benefits. You need the information given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, I want you to help me work on this recorded line and I'm already having the benefits with me, so I'm having just a couple of questions and I want you to help me with them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead with the questions.
[CUSTOMER][NEUTRAL] OK. So, uh, can you just help me with a couple of, uh, codes and their frequency, please?
[AGENT][NEUTRAL] OK, bear with me just a second if it's broken. One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me make sure this is the 500.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead with the first code.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] D. 0210120.
[AGENT][NEUTRAL] 02120 or can you repeat that number one more time?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Money, OK. So the oral evaluation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that one is under preventative, which is 100% and let's see, uh, the limitation on that one is going to be limited to two oral evaluation procedures and any combination of 120, 140, 150, or 160 for 12 month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That is once in 12 months.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] Evaluation procedures and, yes, any combination. Mhm.
[CUSTOMER][NEUTRAL] 212.
[CUSTOMER][POSITIVE] OK. Thank you. Mhm. Thank you so much. And can you now help me with the full mouth X-ray, please? 0210.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the 0210 is under radiograph FMX which is gonna be 80% and the limitation on that one is limited to one X-ray procedure and any combination of 210, 277, or 330 per five-year period.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] On in 5 years and it shares a frequency with uh uh panel 0330 as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, it's combined with panel, yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm. What about buying 0274.
[AGENT][NEUTRAL] No, but when this part of preventative.
[CUSTOMER][NEUTRAL] Mhm. So what is the frequency?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for bite wings, we have limited to one bite X-ray procedure and any combination of 27, 272, and 274 per 12 month period.
[CUSTOMER][POSITIVE] OK. Once in 12 months. Thank you so much. And can you also help me with the information regarding 1110?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Payments for the [PII].
[AGENT][NEUTRAL] OK, so that's a profy and that's going to be under preventative which is 100%, and that one is gonna be once every 6 months.
[CUSTOMER][NEUTRAL] Once every 6 months. And can you also help me with the information regarding fluoride 12061208.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] OK, for the fluoride, um, let's see, that's also gonna be under preventative, which is 100%. Let me give you the limitation on that one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's maximum procedure 1 for 12 month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Mhm. So the patient is not eligible for this.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What about 1208?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's the same thing.
[CUSTOMER][NEUTRAL] Mhm. 1351.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 1351 Chilis.
[AGENT][NEUTRAL] OK, for fillings, it's gonna be um Clans. Selans is gonna be and they're preventative. It does have a limitation under the age of [PII], an application made to the molar teeth only.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But what is the limit? I'm sorry, what is the frequency once you know?
[AGENT][NEUTRAL] OK, so this one again is going to be, let's see.
[AGENT][NEUTRAL] Maximum of 1 procedure for 36 months limited to dependent children under the age of [PII] and application made to the permanent molar teeth only.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for all the information you provided me. And can you also help me, is there uh
[CUSTOMER][NEUTRAL] Family deductibles?
[AGENT][NEUTRAL] OK, the family deductible is 150 if it's a family plan, this one is an individual plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And can you also help me with the information regarding any history for the patient? Is there any history?
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] There's no history for this member.
[CUSTOMER][POSITIVE] OK. Thank you so much for all the information you provided me and I really appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No problem. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All the information provided by you is very useful to me. No, that's all for today. As of now, [PII]. Thank you so much. And before we end up this call, can you please help me with the call reference number to call, please?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, no worries. So thank you so much. Bye-bye. Take care. Have a good day and uh take care, bye.
[AGENT][POSITIVE] Yes, sir. Thank you for calling APR.