AccountId: 011433970860
ContactId: a03495ab-bf79-46c4-a7f2-abc2c57a3f75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 591609 ms
Total Talk Time (AGENT): 241464 ms
Total Talk Time (CUSTOMER): 166137 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/a03495ab-bf79-46c4-a7f2-abc2c57a3f75_20250324T17:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I have a patient that I'm having trouble pulling up information for them and I was hoping for some help for dental.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, I can assist with that. [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number please?
[CUSTOMER][NEUTRAL] Yes, um, policy is 02585605.
[AGENT][NEUTRAL] OK. And to repeat and confirm, I have that as 02585605. Thank you. And verify the patient's name and date of birth.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you very much for that verification, [PII]. I have her pulled up or him pulled up and you're calling for benefits for the member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can certainly help you with that, and I can also send over a fax back to you as well. Um, he shows effective as of, of course, of course, [PII], and the policy shows active for the member.
[CUSTOMER][POSITIVE] That would be great.
[AGENT][NEUTRAL] Um, this plan pays by UCR, usual customer in reasonable rates.
[AGENT][NEUTRAL] Um, please note verification of benefits provided does not guarantee payment. The member has a $1500 calendar year max with a $50 deductible.
[AGENT][NEUTRAL] The plan covers preventative at 100% of UCR. Basic services are covered at 80%, and major services will be covered at 40%. However, there is a 12 month waiting period for major services.
[CUSTOMER][NEUTRAL] OK. And is endoperio oral surgery considered basic or major?
[AGENT][NEUTRAL] Um, all are considered major.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] And the restoration is at 80?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what, what is the group name?
[AGENT][NEUTRAL] OK, the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Just universal trucking, nothing else.
[AGENT][NEUTRAL] Universal Trucking Superior.
[CUSTOMER][NEUTRAL] No LLC.
[AGENT][NEUTRAL] No, no LSC, no.
[CUSTOMER][NEUTRAL] OK, so I'm sorry, can you repeat that? So Universal tracking what?
[AGENT][NEUTRAL] Superior
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the group number is it 15844?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and the claims address.
[AGENT][NEUTRAL] OK, it is APL claims [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And posterior composites and crowns, do those downgrade?
[AGENT][POSITIVE] There are no downgrades on the plan.
[CUSTOMER][POSITIVE] No downgrades, OK.
[CUSTOMER][NEUTRAL] And could I get frequencies, please?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Cleanings are once every 6 months.
[AGENT][NEUTRAL] Excuse me, exams are 2 for 12. That also includes all of the limited.
[AGENT][NEUTRAL] Bite wings are 1 per 12 month period and those are covered under preventative.
[AGENT][NEUTRAL] FMX and pans, those are 1 per 5 year period and those are actually covered under basic at 80%.
[AGENT][NEUTRAL] Fluoride is 1 per 12 month period covered under.
[CUSTOMER][NEUTRAL] And deductible applies.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, I'm sorry, can you repeat the last one?
[AGENT][NEUTRAL] Of course fluoride is 1 for 12 month period.
[AGENT][NEUTRAL] Under the age of [PII].
[CUSTOMER][NEUTRAL] OK, sealants.
[AGENT][NEUTRAL] I'm still also covered under preventative. Those are 1 per 36 months permanent molar teeth only.
[AGENT][NEUTRAL] And limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have a
[CUSTOMER][NEUTRAL] Couple of other um.
[CUSTOMER][NEUTRAL] Questions, can I give you just the list of codes or do you need them one by one?
[AGENT][NEUTRAL] Well I'll take them one by one.
[CUSTOMER][NEUTRAL] OK, Crowns 2740.
[AGENT][NEUTRAL] OK, now are you wanting the
[AGENT][NEUTRAL] Frequency and coverage or just frequency?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The frequency please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for 2740 crowns, those are once every 7 years for 2.
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of the founder major.
[CUSTOMER][NEUTRAL] Um, SRP 4341.
[AGENT][NEUTRAL] OK, those are 1 for 24 months. All 4 can be done on the same visit.
[AGENT][NEUTRAL] And that's also under major.
[CUSTOMER][NEUTRAL] OK. Um, 43, 46?
[AGENT][NEUTRAL] OK, 43 46 1 moment just to make sure not that one,
[AGENT][NEUTRAL] 4346 is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 4910.
[AGENT][NEUTRAL] 4910 is once every 6 months does not share with regular profy, and that's also under major.
[CUSTOMER][NEUTRAL] OK, so 4910 does not share.
[CUSTOMER][NEUTRAL] And dentures 5110.
[AGENT][NEUTRAL] dentures and partials are once every 5 years.
[CUSTOMER][NEUTRAL] And are implants covered 6010?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And palliative, 9110.
[AGENT][NEUTRAL] OK, that is covered under basic and it has no frequency at 80%.
[CUSTOMER][NEUTRAL] OK. And just to double check, um, preventative and diagnostic, the, the deductible is waived.
[AGENT][NEUTRAL] On preventative it is waived.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] Um, SMX and Pano, is that at 100%?
[AGENT][NEUTRAL] No, those are under basic at 80%, so the uh deductible will apply for that, but not for bye weeks.
[CUSTOMER][NEUTRAL] At 80.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, uh, what about PA's?
[AGENT][NEGATIVE] PAs have no frequency and those are covered under basic at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK. And is there ortho coverage on the policy?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No wor it OK.
[CUSTOMER][NEUTRAL] Um, and if I could get that faxed to, I can give you the number.
[AGENT][POSITIVE] Oh of course I'm ready for the number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it is the same as your phone number? just wanna make certain of that.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, OK, and just to reconfirm that that was [PII] for the fax number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, and um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I could get your name again and a call reference?
[AGENT][NEUTRAL] Of course my name is [PII]. We do not use call reference numbers. However, please, [PII], you can use my name in today's date. My last initial is [PII] like [PII]. Is there anything else I can assist you with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not at this time. I'll be looking for the facts. Thank you very much, [PII].
[AGENT][POSITIVE] You're welcome. You're welcome, [PII], and thank you for calling ACL. Take care bye.
[CUSTOMER][NEUTRAL] You too bye bye.