AccountId: 011433970860
ContactId: a2f718a1-8dde-4b69-835d-681c68e3eef9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 938380 ms
Total Talk Time (AGENT): 318781 ms
Total Talk Time (CUSTOMER): 491298 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/a2f718a1-8dde-4b69-835d-681c68e3eef9_20250527T17:43_UTC.wav
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[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the office of Doctor [PII] and Doctor [PII], and I was just calling to get some dental benefits on the patient.
[AGENT][POSITIVE] OK, I can help you with benefits. May I please get your name and your call back number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII] and I'm sorry, you said your name was is it you said [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII] thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Thank you. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] His name is [PII]. His date of birth is [PII]. It looks like his policy number, it looks like it's 02492089.
[CUSTOMER][NEUTRAL] We never verified benefits before um with this particular plan so I'm not sure if it's is it a PPO or what type of OK.
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with the eligibility and benefits for this patient. I'm gonna pull in his policy real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And um I may have to ask you to repeat yourself sometimes because the phone is breaking up when we when I'm hearing you it's just going in and out in and out in and out like really fast so I don't know what's going on.
[AGENT][POSITIVE] Oh no. OK. OK, I apologize for that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Is this a self-funded plan? I mean, or fully funded? How does this work?
[AGENT][NEUTRAL] Employee funded um.
[AGENT][NEUTRAL] Alright, so I have [PII] pulled up now.
[CUSTOMER][POSITIVE] It's fully funded so we don't have a con.
[CUSTOMER][NEUTRAL] OK, OK, so fully funded as if it's not covered benefit we charge our own fees on that?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Uh, the policy goes by UCR.
[AGENT][NEUTRAL] That's the fees for the policy UCR and it's through his employer.
[CUSTOMER][NEUTRAL] OK, so it is gonna be around.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's an employer?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it's, it's employee, his employer's Universal trucking transport design.
[CUSTOMER][NEUTRAL] OK, so let me just write that because it was a, it looks like it was an individual plan. He had 3 insurances. That's why I'm like, oh this must be his other one he added. So this is through his, yes, so this is through, he said, what's the name of his the group name?
[AGENT][NEUTRAL] Oh my
[AGENT][NEUTRAL] The name is Universal Trucking.
[AGENT][NEUTRAL] Transport design.
[CUSTOMER][NEUTRAL] OK, you broke up all, all I got was trucking, but I didn't get the first part of it.
[AGENT][NEUTRAL] Oh, I'm sorry, let me, let me see if I can help here. Just let me see if I can fix it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] What he had
[CUSTOMER][NEUTRAL] like that.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Alright, the name of his group is Universal Trucking.
[CUSTOMER][NEUTRAL] Um, at that.
[CUSTOMER][NEUTRAL] So truck. OK.
[AGENT][NEUTRAL] Transport design.
[CUSTOMER][NEUTRAL] up.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] Design OK.
[CUSTOMER][NEUTRAL] And the group number I had on here was 14481, is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK perfect OK.
[CUSTOMER][POSITIVE] Whatever you did did help some, yeah.
[AGENT][POSITIVE] Oh good, good deal, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, very good. So would this be considered his primary, which is through support he has a Delta and he also has another one which is beach of Omaha, so he has 3.
[AGENT][NEUTRAL] OK. It, it's not considered a primary or a secondary, um,
[CUSTOMER][NEUTRAL] I'm thinking
[CUSTOMER][NEUTRAL] Oh, I got it.
[AGENT][NEUTRAL] It's just, you just file the claim on it and we pay by the UCR schedule.
[CUSTOMER][NEUTRAL] And is this does this coordinate benefits?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][MIXED] Does not coordinate but OK.
[CUSTOMER][NEUTRAL] So this would probably have to be built up first because it's not gonna coordinate.
[CUSTOMER][NEUTRAL] Alright, so I'm here and then um what is your calendar max and deductible?
[AGENT][NEUTRAL] There is, um, if you want to give me your fax number I can send you a fax back with his fee schedule and benefit breakdown.
[CUSTOMER][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we're like we're an oral surgeon so that I'm not sure. I mean there were some, there's some codes on here probably I'm not sure. Does it have is it code related or can I, are they gonna show the codes on there?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Yes, it will show the codes and if you're looking for a code it's not on there then it's a non-covered service.
[CUSTOMER][NEUTRAL] OK, and if the
[CUSTOMER][NEUTRAL] It's a non coverage OK because he's coming in for um.
[CUSTOMER][NEUTRAL] And like some extractions and just wanted to see if those are covered and then a consultation as well.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let's um let me pull up his facts back real quick.
[CUSTOMER][NEUTRAL] OK, and also can I get the payer ID and.
[CUSTOMER][NEUTRAL] OK, and what's the payer ID on here [PII]?
[AGENT][NEUTRAL] Yes ma'am, um, the payer I.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801. OK, got it.
[AGENT][NEUTRAL] Yes ma'am, and that will also be on your fax back along with the um claims mailing address if you choose to mail it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think that is it. So those codes are gonna either be on there or not on there and his deductible on there and everything is billed to dental.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Not medical or anything first? OK.
[AGENT][NEUTRAL] No, ma'am. No medical.
[CUSTOMER][NEUTRAL] Uh, no, OK.
[CUSTOMER][NEUTRAL] Alright, perfect. And may I have, and [PII], can I uh [PII], I'm sorry, [PII], may I have a reference number?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK, that's [PII] it's flying by.
[CUSTOMER][NEUTRAL] Alright, alright, [PII], I'll go ahead and yeah it is it is it's kind of scary, especially when you get older.
[AGENT][POSITIVE] Yes, it is this month is almost gone in the blink of an eye.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Yes, I agree.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] And oh if there's and will they have any guidelines or um limitations to anesthesia on there as well.
[CUSTOMER][NEUTRAL] I'm missing two claws.
[AGENT][NEUTRAL] I don't believe anesthesia is covered under the policy. Uh, let me take a quick glance at it.
[CUSTOMER][NEUTRAL] Do you need quotes for that?
[AGENT][NEUTRAL] Yes, can you give me the code and let me just kinda uh pull it up real see if I can find it real quick for the anesthesia.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There's this
[CUSTOMER][NEUTRAL] There's there's a few there's 9222.
[CUSTOMER][NEUTRAL] 9223 and 9612 which is a drug push.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which is an IV.
[CUSTOMER][NEUTRAL] Sedation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] He has for and, and this is just to verify his benefits. It's not a guarantee of payment. He has deep sedation 9221.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] For each additional 15 minutes and then 9220 is deep sedation, general anesthesia for the 1st 30 minutes.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, he has those two under his policy and they have a limitation which is let me see what it is, what it says.
[CUSTOMER][NEUTRAL] OK, so the 9222 and 9223 is not a cover benefit.
[AGENT][NEUTRAL] T
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and that means the direct push no more likely won't be a covered benefit on there.
[AGENT][NEUTRAL] And is anesthesia says only in conjunction with listed complex oral surgery procedures and subject to review on this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and OK, that's, that sounds like a the the atypical guidelines for anesthesia, but unfortunately the 9222 and the 9223 is what we use when we go out so those will be covered for those procedure codes and in that, but at least the extractions will be covered. The 7210 and 7240, those should be covered is that on there I'm assuming right on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEUTRAL] What was the codes again? 7240?
[CUSTOMER][NEUTRAL] The 722 yes and 7210.
[AGENT][NEUTRAL] Yes, those are both on his policy.
[CUSTOMER][NEUTRAL] So he's
[CUSTOMER][NEUTRAL] Perfect. OK, is there a missing two clause with this policy or waiting period or anything like that?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] Uh, there is a missing tooth.
[CUSTOMER][NEUTRAL] There is a missing tooth? OK.
[AGENT][NEUTRAL] Yes, and he does have a waiting period for major endodontic, periodontic, prosthodontic, and oral surgery of 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he, so basically it was effective [PII], so he has until [PII] or [PII] of this year.
[AGENT][NEUTRAL] And he's had
[AGENT][NEUTRAL] Well, yes, he has, it was [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so that's when he started the policy, so he has the expired July, I I guess what uh 12 months on the day from the time when he started his policy, so I would say um.
[AGENT][NEUTRAL] On the day, yes.
[CUSTOMER][NEUTRAL] OK, so and that's for you said for major?
[CUSTOMER][NEUTRAL] And innoonics and and then what's the other one I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Periodontic, periodontic and prosthodontic and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So his extractions and that will not be covered. OK, so no extractions or surgery extractions. OK, so I think it will be covered is his consultation and his X-ray. It looks like at this point.
[AGENT][NEUTRAL] Oh no. Yes, ma'am.
[CUSTOMER][NEUTRAL] That's OK. He has 2 insurances, but no, he has 2 insurances to pick up.
[AGENT][NEUTRAL] Yeah, he has plenty. He, he's covered.
[CUSTOMER][NEUTRAL] Yes, and, and real quick on the on the 93 10s, I sometimes that's not on there but it, but they show that as an exam is a consultation on there by any chance?
[AGENT][NEUTRAL] What's the code? Because everything on here is by code.
[CUSTOMER][NEUTRAL] 90
[AGENT][NEUTRAL] 9
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] 9310. Let's look and see.
[AGENT][NEUTRAL] Yes, that is covered.
[CUSTOMER][NEUTRAL] Is that at 100%?
[AGENT][NEUTRAL] Uh, it's considered a basic expense, so his basic expenses are 80% of UCR.
[CUSTOMER][NEUTRAL] It's preventative and.
[CUSTOMER][NEUTRAL] OK, and that's um OK and the frequency is there frequency with that?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][POSITIVE] Oh, he's good. OK. And I, and his panel is 100%, is that correct that one of, I think I got one of every 3 years.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um, but I the 0330.
[AGENT][NEUTRAL] His full mouth X-ray panoramics are once every 5 years.
[CUSTOMER][NEUTRAL] 05 years. Why did they put 3 years on, OK, and um, OK, and that they share FMX, right? They share, um, frequency with the full mouth or the full mouth X-rays, right? Consides they share, OK. And is he any is your history with that by any chance? Is he eligible?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Let me see if he has anything.
[AGENT][NEUTRAL] He's never filed a claim with us, so I would believe that he would be eligible.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, alright, and alright, so he's eligible. I'm just looked on my email. I haven't seen that fax come in yet. I don't know if it takes some time, but um.
[AGENT][NEUTRAL] It's still sending on my, my end.
[CUSTOMER][NEUTRAL] OK, can I just real fast, get the calendar max and deductible, and I think that's all I need from those patients since he's not gonna be eligible for his, he has a waiting period.
[AGENT][NEUTRAL] Yes ma'am, he has a $1500 per covered insured calendar year maximum.
[AGENT][NEUTRAL] And then his deductible is $50 per covered insured up to $150 for family.
[CUSTOMER][NEUTRAL] OK, and he's, and he still has the full remaining benefits of the 50, I mean the 1500, and then he still owes the 50% deductible.
[AGENT][NEUTRAL] Right, because he's never filed a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it. Alright, I appreciate it thank you so much for for your help.
[AGENT][POSITIVE] Oh, you're very welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Oh no, that was it, [PII], and I'll just let the patient know that he has to wait till July of this year for getting this for his waiting period. I'm sure he will be OK with that since he has two other insurances, so.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh yes
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Alright, alright, alright, thank you so much. You have a great day.
[AGENT][POSITIVE] OK. You have a wonderful day too. I thank you for calling APL and you take care, Ms. [PII]. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you, oh.
[CUSTOMER][NEUTRAL] You're welcome, really quick, so when we bill out, is this go underneath the American Public Life APL?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Will that be to consider OK, I just didn't know if we had, uh, OK, just wanted to make sure because it's we're adding it to our billing so I just wanna make sure I put the correct information and then I do have the address of the, uh, PO box, the one that's in [PII]. Perfect, perfect. Alright, [PII], you will, you have a wonderful day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII]. You take care and again, thank you for calling APL.
[CUSTOMER][POSITIVE] OK good thank you have a good day bye.