AccountId: 011433970860
ContactId: a23a3cdb-4465-45fb-93b9-2544637a1f9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2526739 ms
Total Talk Time (AGENT): 707688 ms
Total Talk Time (CUSTOMER): 840498 ms
Interruptions: 9
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/a23a3cdb-4465-45fb-93b9-2544637a1f9b_20250414T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] from Keep On Smile Dentistry. How are you today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good, thank you for asking. I was calling to check on eligibility and benefits one of our patients being seen today.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you for
[CUSTOMER][NEGATIVE] And no extension.
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 16068.
[CUSTOMER][NEUTRAL] Yeah, I don't know that. I usually I have a schedule, but it could have been.
[AGENT][NEUTRAL] Do you have a copy of the ID card available?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says policy er um cert number or certification number?
[CUSTOMER][NEUTRAL] Oh wait, sorry, I don't, I don't have that policy number. The only thing I have is the group number and the member ID number. I apologize about that.
[AGENT][NEUTRAL] It's OK. The member ID doesn't start with a D like dog or a 01 or 02.
[CUSTOMER][NEUTRAL] 02
[AGENT][NEUTRAL] OK, that's the policy number.
[CUSTOMER][NEUTRAL] OK, sorry, sorry about that. I thought you were referring to the group number.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][POSITIVE] Thank you, you ready for it?
[AGENT][POSITIVE] Uh, alrighty.
[CUSTOMER][NEUTRAL] 02569284
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] I'm gonna put carry your maintenance in here for him and then I'll let you put whatever else you needs. She's scheduled on Wednesday at uh.
[CUSTOMER][NEUTRAL] At [PII]
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][POSITIVE] That's funny that you called back
[CUSTOMER][NEUTRAL] Uh, [PII], um.
[CUSTOMER][NEUTRAL] [PII] and that date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see what type of policy they have. Hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And did you need a copy of the fax back sent over or you have particular questions about it?
[CUSTOMER][NEUTRAL] Um, both.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's it
[CUSTOMER][NEUTRAL] I would like to request a fast check and I have questions.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what questions did you have?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Well, first I will need um a full breakdown of the policy, and I just have some questions on it as well and a few codes as well.
[AGENT][NEUTRAL] So the breakdown is the fax back. I'm sending that to you, but we can do it over the phone too.
[CUSTOMER][POSITIVE] Yes, ma'am. I would prefer both since we're seeing a patient today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the question? I'm sending you the facts already.
[CUSTOMER][NEUTRAL] Are you saying you can't do fax backs over the phone? or are you saying you're able to?
[AGENT][NEUTRAL] No, I'm asking you what would you like me to answer the the information from the fax back, so I'm gonna go through it over the phone with you and I'm faxing it to you as well.
[CUSTOMER][NEUTRAL] Yes, ma'am, you can start with the full.
[AGENT][NEUTRAL] So what questions did you have?
[CUSTOMER][NEUTRAL] Um, with your permission, is Ms. [PII] on the line now?
[CUSTOMER][NEUTRAL] Um, you can give me a full breakdown first. I think I'm answering your questions right. Are you saying like, I know you're saying with the fact that it will provide that information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I'm saying, can I give it, can you give it to me over the phone as well?
[AGENT][NEUTRAL] Yes, ma'am. I'm just waiting for, so when you say you just want me, OK, so the calendar year max for this policy is $1500 per covered person.
[CUSTOMER][POSITIVE] Thank you, sorry about that, Miss [PII]. I didn't mean to confuse you or confuse myself.
[AGENT][NEUTRAL] It's OK. No, you're fine.
[AGENT][POSITIVE] You're totally fine.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] The the deductible is $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Um, so the policy covers preventative, OK, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh no, go ahead, you're good.
[AGENT][NEUTRAL] So the policy covers preventative, basic, and major. Preventative is covered at 100%.
[AGENT][NEUTRAL] Radio, you're welcome. Radiographs, FMX expenses, basic and basic restorative are all at 80%.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding for me, Mr. [PII]. Are you available at [PII] tomorrow?
[AGENT][NEUTRAL] Major expenses um for us include endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] There shouldn't be any paperwork
[AGENT][NEUTRAL] It's covered at 40%.
[CUSTOMER][NEUTRAL] anything that
[AGENT][NEUTRAL] And there is a 12
[CUSTOMER][POSITIVE] Thank you and you did say that is.
[AGENT][NEUTRAL] No, you're fine. Go ahead.
[CUSTOMER][NEUTRAL] You did say that's including endo and Perio as major, correct?
[AGENT][NEUTRAL] Right, endoperio, um, prosoon and oral surgeries are major for us.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much. I know you're saying something about a waiting period.
[AGENT][NEUTRAL] Yes, Major has a 12-month waiting period, so he won't be able to use Major until [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Trophies and cleanings are once every 6 months?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I thought he was hold on I thought he was a new patient. I didn't realize it was white and I guess I didn't really look at it. I just saw he was on there.
[AGENT][NEUTRAL] Exams are 2 per 12-month period.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Bite wings.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, once per 12 month period.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Full mouth X-rays and panels. Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][POSITIVE] Mhm. Oh no, you're good. You can go ahead and answer that question after you uh answer that I have a question about another exam.
[AGENT][NEUTRAL] OK, um, the full mouth X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] OK, thank you. And um for the limited exam 0140, um what would be the frequency on that and is that covered at 100%?
[AGENT][NEUTRAL] 0, 140 is the exam, so it's 2 for 12 month period and it's paired with
[AGENT][NEUTRAL] I think it's 12, 120, 140, 150, 60 or 80.
[CUSTOMER][NEUTRAL] OK, and those do share frequencies.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And um what are the, sorry you can go ahead.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, 33 like 3 rounds it come in.
[AGENT][NEUTRAL] Crowns and bridges are once every 7 years per tooth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is that also including 5 of 51 to 10?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] For, uh, I know you said crowns are every 7 years, that also include 5110?
[CUSTOMER][NEGATIVE] She gave me down
[AGENT][NEUTRAL] What is it? Let me see what that is. Hold on one second.
[CUSTOMER][POSITIVE] No, you're good.
[CUSTOMER][POSITIVE] Alright, Mr. [PII], you take care and have a great rest of your day, OK.
[AGENT][NEUTRAL] Um, it, it, that's not specified on the fax back, but 5110 has a limitation of a maximum of 1 per 5-year period. The crowns and bridges were 7. I don't know if that helps.
[CUSTOMER][NEUTRAL] Yes ma'am, it does, um, dentures, well, 5110 is every 10 years and that's would that also be covered at uh 40%.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The dentures?
[CUSTOMER][NEUTRAL] Yes, 5110.
[AGENT][NEUTRAL] Yes, that's under major at 40%.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and is 6010, uh, what's the frequency on those as well?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] 6010. Hold on one second.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm like no, I, I, that one didn't pop up to begin with. I typed in the whole word but.
[AGENT][NEUTRAL] Let me see if it's in another category. Hold on one moment. It's, it's a list.
[CUSTOMER][NEUTRAL] Probably.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I don't see 0610 on the fax back for the for the list of cover codes.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] OK, I'm not covered, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, for, um.
[CUSTOMER][NEUTRAL] 11351 and 1 and 1206 could you give me the uh frequency and the percentage those are covered at?
[AGENT][NEUTRAL] You said 1351 and what was the other code?
[CUSTOMER][NEUTRAL] 1206.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] So yeah that that.
[CUSTOMER][NEUTRAL] It's gonna be all.
[AGENT][NEUTRAL] Um, 120.
[CUSTOMER][NEUTRAL] And limitation if.
[AGENT][NEUTRAL] Oh, sorry, um, 1206 is not on the list of covered charges or charges codes and 1351 um is under preventative at 100%.
[CUSTOMER][NEUTRAL] So you could you say that.
[AGENT][NEUTRAL] Um, let me see the limitations. Hold on. Maximum of 1 procedure for 36 months, applications made to molar teeth only.
[CUSTOMER][NEUTRAL] I know
[AGENT][NEUTRAL] And limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] And is that including or excluding [PII]?
[AGENT][NEUTRAL] You said excluding or
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Hold on. Say that one more time.
[CUSTOMER][NEUTRAL] Including [PII]. Sorry, Ms. [PII], is that including or excluding the age of [PII]?
[AGENT][NEUTRAL] Learn to dependent children under age [PII]. So it's
[AGENT][NEUTRAL] Including them, I mean excluding them.
[CUSTOMER][POSITIVE] Excluded more than likely.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Also have um some specific codes for um.
[CUSTOMER][NEUTRAL] The frequency and percentages to make sure I have those.
[AGENT][NEUTRAL] OK. And what's the code?
[CUSTOMER][NEUTRAL] Do you want them all at once or one by one?
[AGENT][NEUTRAL] Mm. All at once, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 43 41 43 42.
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 4346.
[CUSTOMER][NEUTRAL] 02200230
[CUSTOMER][NEUTRAL] 04702950
[CUSTOMER][NEUTRAL] 5 sorry, 4355.
[CUSTOMER][NEUTRAL] 492 1.
[CUSTOMER][NEUTRAL] 71,407,210
[CUSTOMER][NEUTRAL] 92309248.
[CUSTOMER][NEUTRAL] And 9944.
[AGENT][NEUTRAL] OK. And do you mind if I place you on just a brief hold while I go through the codes?
[CUSTOMER][POSITIVE] No ma'am that's fine thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What in the world?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, can you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], sorry.
[AGENT][POSITIVE] Hey, no, you're fine. Thank you so much for holding. I apologize for that wait. Um, so for 43, 41.
[AGENT][NEUTRAL] And 43, 42, they're both major at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] And per visit you can only do one quadrant.
[AGENT][NEUTRAL] Oh, it's no specification. It's just 1 per 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Uh, for 4910 is major at 40%, max 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What procedure.
[CUSTOMER][POSITIVE] OK, thank you, sorry about that. I'm ready to move on when you are.
[AGENT][NEUTRAL] You're welcome. Um, 4346 is not covered.
[AGENT][NEUTRAL] 0220 and 0230 are both basic at 40%, no limitation.
[CUSTOMER][NEUTRAL] OK, and give me one second while I update those two, and that was 0220 and 0230?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Mhm, yes, that's correct.
[CUSTOMER][NEGATIVE] And 4346 is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Um, 0470 is major at 40%, um, limitation of maximum 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2950 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to patients [PII] and over.
[CUSTOMER][POSITIVE] OK thank you let me update that.
[CUSTOMER][NEUTRAL] For later this morning
[CUSTOMER][NEUTRAL] No, I had one. It was a new patient that they scheduled.
[CUSTOMER][NEUTRAL] Yeah and and and.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. 4355 is major at 40%. Wait, did we just do that one? No, um, 4355 is major at 40%, um, max 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] 4355.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4921 is not covered.
[CUSTOMER][NEUTRAL] Yeah, they're coming in on Wednesday, I mean Thursday at [PII].
[AGENT][NEUTRAL] 7140 is basic at 80%.
[CUSTOMER][NEUTRAL] Check the cavity.
[AGENT][NEUTRAL] Maximum one time per tooth.
[CUSTOMER][NEUTRAL] I'm sorry, which, could you, I apologize, Ms. [PII], could you go back?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Two times I you said 4355 is covered at um 40%, and you said 11 per quadrant?
[AGENT][NEUTRAL] Mhm, maximum.
[CUSTOMER][NEUTRAL] A full mouth debridement.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Yes, full mouth deri 04355 is under periodontic, which is major at 40%.
[AGENT][NEUTRAL] And the limitation is maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] So we were on 7210 and 7140.
[CUSTOMER][NEUTRAL] Uh, the 1st 17 to 10, whichever one you're doing, yes.
[AGENT][NEUTRAL] 7210.
[AGENT][NEUTRAL] OK, so that one was major at 40% with no limitations.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. 9230 is major at 40%.
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So it's both 71, 40 and 7210, are those both at 40%?
[AGENT][NEUTRAL] No, 7140 is basic, um, 80%.
[CUSTOMER][POSITIVE] OK, sorry about that thank you.
[AGENT][POSITIVE] Maximum of 1 time per 20 no, you're OK.
[CUSTOMER][NEUTRAL] OK, and uh 9230, that's 40%.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then 9248 and 9944 are both not covered.
[CUSTOMER][NEUTRAL] 9248 and no.
[CUSTOMER][NEUTRAL] 4 not covered, OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] And for the waiting period, how long is the waiting period? I know you said they'll be able to uh get major procedures after [PII] of uh.
[CUSTOMER][NEUTRAL] [PII], but how long is that waiting period?
[AGENT][NEUTRAL] One minute. Um, I don't think it's, it's, it's 12 months, um, from the effective date, but I don't think it was May. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][POSITIVE] Oh, OK. I'm, I apologize about that.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] OK, let me see if that's all that I need from you.
[CUSTOMER][NEUTRAL] For right now.
[CUSTOMER][NEUTRAL] And you said 49 4921 is not covered?
[AGENT][NEUTRAL] 49. Yes, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and for this plan, do they have any ortho benefits?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's see. So there's no orthodontic treatment?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] Um, TMJ services are not covered.
[AGENT][NEUTRAL] And implants, removal or related services are not covered.
[CUSTOMER][POSITIVE] Thank you and for um
[CUSTOMER][NEUTRAL] 2740.
[CUSTOMER][NEUTRAL] 5110 and Partials.
[CUSTOMER][NEUTRAL] You don't pay prey date.
[AGENT][NEUTRAL] Um, either or.
[CUSTOMER][NEUTRAL] OK, so both.
[AGENT][NEUTRAL] Mhm, whichever is no specification, whichever one y'all prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um I know you said for exams that share free seat that is including limited like all the exams 00150 and 0140, those are those do share frequencies.
[AGENT][NEUTRAL] Yes, 101 2040 50, hold on, let me see.
[AGENT][NEUTRAL] 2040, 50, 60, and 80.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, can you check and see any of these shared frequencies? I have specific codes for them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have um 4910.
[CUSTOMER][NEUTRAL] 4355
[CUSTOMER][NEUTRAL] 11:10.
[AGENT][NEUTRAL] And you want me to see if these have any shared codes?
[CUSTOMER][NEUTRAL] Do they share frequencies like do they share frequency and can they be done on the same day?
[AGENT][NEUTRAL] Let's see, hold on.
[AGENT][NEUTRAL] So 49 0.
[AGENT][NEUTRAL] 4910 does not have a shared frequency. I mean, well.
[AGENT][NEUTRAL] When you say shared frequency, are you saying like 4910 has a maximum of one procedure per 6 months, that's the same as a regular profi. Is that what you mean? Or are you saying like how 120, 40, and 50 are all together in any combination?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like that, like the second option that you said.
[AGENT][NEUTRAL] OK. Well, then, um, 4910 does not have a shared frequency.
[AGENT][NEUTRAL] With anything.
[AGENT][NEUTRAL] Um, but it is once per 6 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4355.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEGATIVE] Doesn't have a shared frequency.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The limitation is max 1 each quadrant for 24 months.
[AGENT][NEUTRAL] And 11:10, I don't think that one does either, but let me double check.
[AGENT][NEUTRAL] Yeah, 1110 doesn't share with anything, but um let me see what the limitation is. Oh, wait a minute.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK. 1110 doesn't have a shared frequency, but it is once per 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could like um.
[CUSTOMER][NEUTRAL] Could a 4910 and um 1110, could that be done on the same day or no?
[AGENT][NEUTRAL] Um, there's no specification.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, and um for.
[CUSTOMER][NEUTRAL] 4341 and 4342, you said it doesn't specify how many quads we could do a visit?
[AGENT][NEUTRAL] 43, 41, hold on one second.
[AGENT][NEUTRAL] You said 4341 and 4342?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the question?
[CUSTOMER][NEUTRAL] How many quads could you do per visit?
[CUSTOMER][NEUTRAL] Are
[AGENT][NEUTRAL] Oh, so it's a max of 1 kua per 24 months.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Probably one class per visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what makes sense to me. And um is there a healing period after 4910er maintenance?
[AGENT][NEUTRAL] Um, the, um, if it, so the fact like doesn't specify that, so, um.
[AGENT][NEUTRAL] I don't really know how to answer that.
[AGENT][NEUTRAL] Um, we don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're not sure.
[AGENT][NEUTRAL] Yeah, cause for 4910 per maintenance, all it says is maximum procedure for 6 months. So healing periods, I don't know, we don't really speak towards that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am. OK, thank you, um, for uh 2391 and 2740, are there any downgrade codes to those?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, no downgrade codes.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And for the fax back, do you know how long it will take to come through?
[AGENT][NEUTRAL] Oh, I already received the confirmation. Let me see. Hold on one second.
[AGENT][NEUTRAL] Yes, sent back to you at [PII] my time. Um, it's [PII] now.
[CUSTOMER][NEUTRAL] Mhm, yeah, for some reason it didn't come through on my end, could you? OK.
[AGENT][NEUTRAL] Actually, hold on.
[AGENT][NEUTRAL] It says the line was abandoned. Um, it's fax number [PII]?
[CUSTOMER][NEUTRAL] No, ma'am. It's 731-7. Sorry about that.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Good afternoon, thanks for calling.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sure
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] have that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, insurances and your job.
[CUSTOMER][NEUTRAL] OK, all right, we are.
[CUSTOMER][NEUTRAL] And um right now at this moment.
[CUSTOMER][POSITIVE] And a free consultation for this so um just.
[AGENT][NEUTRAL] OK, it's [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I just sent it.
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][NEUTRAL] OK, thank you and um can you check and see are we in network?
[CUSTOMER][NEUTRAL] And what uh fee schedule it follows?
[AGENT][NEUTRAL] So this is on the Carrington fee schedule, um, in terms of network, there's no network for this policy?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that um let me see.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So for um wait, do they have any history on file and I have certain codes for specific history that I need.
[AGENT][NEUTRAL] There's no history on file yet for them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So traditional.
[CUSTOMER][NEUTRAL] And um with the fax back include you guys um.
[CUSTOMER][NEUTRAL] Address?
[AGENT][NEUTRAL] Yes, so the fax back has the payer ID, the mailing address, and the uh fax information.
[CUSTOMER][NEUTRAL] Whole year cover the sta.
[CUSTOMER][NEUTRAL] OK, thank you and um does this plan have a group name?
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] So the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna spell the last word. I think it's Herschelbach, but it's H [PII] Harry, [PII]
[CUSTOMER][NEUTRAL] Oh wait.
[CUSTOMER][NEUTRAL] I'm sorry, [PII], can you start over? I thought you were saying like the first part is like [PII], can you just repeat it for me? I apologize.
[AGENT][NEUTRAL] Mhm. The, so it's Universal Trucking.
[CUSTOMER][NEUTRAL] 3 months
[AGENT][NEUTRAL] OK, wait. So hold on one second. The fax just came back again saying that it was abandoned. Is that, oh, that might be for the one that ended with a 6. I'll keep watching it. Um, OK, so Hersheba is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] IR
[AGENT][NEUTRAL] SCH
[AGENT][NEUTRAL] B A C H.
[CUSTOMER][NEUTRAL] B A C H.
[AGENT][NEUTRAL] And the group number is, uh, you're welcome. The group number is 16068.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] 16068. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And um just the last thing I need. May I have a reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, thank you Ms. [PII], um, that is all I need for you um so I know you say you're looking on watch for the fax back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, OK. And it should come.
[AGENT][NEUTRAL] Yeah, because at first we sent it to the one.
[AGENT][NEUTRAL] Um, ending in the [PII] and then I sent it again, yeah.
[CUSTOMER][NEUTRAL] With the wrong nu mhm.
[CUSTOMER][NEUTRAL] OK, and since the patient is being seen today and I haven't got the fax back, could you, uh, give me the address please? you guys' address.
[AGENT][NEUTRAL] Sure, the claim, the claim's address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] I'm sorry, what, um.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] City
[CUSTOMER][NEUTRAL] Street.
[CUSTOMER][POSITIVE] OK, give me one second, Miss [PII]. Sorry, I'm trying to make sure I don't need you for anything else. Thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] No, you're fine. Take your time. OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And that was the one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what's the uh electronic ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, give me one more second.
[CUSTOMER][NEUTRAL] Sorry, Ms. [PII], could you give me that um
[CUSTOMER][NEUTRAL] Add again.
[AGENT][NEUTRAL] Mhm. The payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you. uh, let me see, I think that's everything.
[CUSTOMER][POSITIVE] OK, uh, thank you, Ms. [PII], uh, that's all I need from you today. I appreciate your patience as well.
[AGENT][POSITIVE] Oh, you're very welcome. Well, thank you for calling APL and I hope you have a good day, OK?
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] I