AccountId: 011433970860
ContactId: a54c8754-165a-46c6-a9e8-def36aed9f0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 789140 ms
Total Talk Time (AGENT): 308502 ms
Total Talk Time (CUSTOMER): 200834 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/a54c8754-165a-46c6-a9e8-def36aed9f0b_20250121T14:12_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, good morning. Yes, ma'am. I was just wanting to get a verbal eligibility and breakdown for each your patient.
[AGENT][NEUTRAL] I have a call your name and a callback number.
[CUSTOMER][NEUTRAL] Yes my name is [PII]. A good callback number is [PII].
[AGENT][NEUTRAL] the spelling of your name.
[CUSTOMER][NEUTRAL] I'm sorry, it's kind of cutting in and out.
[AGENT][NEUTRAL] Could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Can I have a call back number for you and that policy number?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] [PII] and the policy number looks like 02538511.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, this policy has been active since [PII] and it's currently active. This member has a maximum benefit amount of $1500 per calendar year with a $50 deductible that does not apply to us preventative services up to $150 per family, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes ma'am, and just to confirm we are a network?
[AGENT][NEUTRAL] This policy does not have a network. It's just a standard dental policy that covers dental services with a 12 month waiting period on all major endopperoprosthesis or surgery crowns, bridges, ortho.
[AGENT][NEUTRAL] Um, surgical procedures, anything that's considered as major.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, and may I get the coverage for preventative basic and major?
[AGENT][NEUTRAL] Preventative is covered at 100, basic at 80, major at 40.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] And then um the coverage for orthoendo oral surgery and periodontics.
[AGENT][NEUTRAL] It's considered as major, covered at 40%.
[CUSTOMER][NEUTRAL] Major, yes ma'am, and then I do have a um I'm sorry, do composite downgrade and is there missing tooth cloth? No.
[AGENT][NEUTRAL] No.
[AGENT][MIXED] There is a missing too flaws but no downgrades on those services.
[CUSTOMER][NEUTRAL] Yes ma'am, and then um I do have a couple of ADA codes. Would you like them all together or one at a time?
[AGENT][NEUTRAL] One at a time, please.
[CUSTOMER][NEUTRAL] Yes ma'am, 0120.
[AGENT][NEUTRAL] Preventative at 100%.
[CUSTOMER][NEUTRAL] And the frequency?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 2 for 12 month period.
[CUSTOMER][POSITIVE] Thank you. 0140?
[AGENT][NEUTRAL] Prevent those
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] No this is 140.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Give me the procedure code one more time.
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] The files on the basic at 80%, the limitations are as followed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am, 11:20.
[AGENT][NEUTRAL] Limited to 2, limited to 2 or evaluation procedures and any combination of D0120 D0140 D0150 D0160 D0180 for 12 month period. What was your next goal?
[CUSTOMER][POSITIVE] Thank you. 11:20.
[AGENT][NEUTRAL] Um, falls on a preventative at 100%.
[CUSTOMER][POSITIVE] Thank you and 2 for 12 month period as well?
[AGENT][NEUTRAL] Maximum of 1 procedure for 6 months.
[CUSTOMER][POSITIVE] Thank you, 0272?
[AGENT][NEUTRAL] 272.
[AGENT][NEUTRAL] Major
[AGENT][NEUTRAL] 40%, 12 month waiting period has not exhausted.
[AGENT][NEUTRAL] Maximum of 1 to 7 year period.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] 1 per 7 year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] Is there fluoride.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Is on a preventative at 100%.
[AGENT][NEUTRAL] Limitations are as followed, limited to dependent children under the age of [PII], maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] Thank you. 0 3:30?
[AGENT][NEUTRAL] Preventative 100, I'm sorry, basic 80%, no limitation.
[CUSTOMER][NEUTRAL] 0 to 20.
[AGENT][NEUTRAL] 0220 basic 80% no limitation.
[CUSTOMER][NEUTRAL] 1351.
[AGENT][NEUTRAL] Prevent 100%.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Limitations are as follows maximum of 1 procedure for 36 months.
[AGENT][NEUTRAL] Limited to dependent children under the age of [PII], application made to permanent moti only. What was your name?
[CUSTOMER][NEUTRAL] 1516.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][POSITIVE] Thank you ma'am.
[CUSTOMER][NEUTRAL] Um, 1516.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the, what is the description of the code?
[CUSTOMER][NEUTRAL] Um, space maintainer.
[AGENT][NEUTRAL] Preventage of 100%.
[AGENT][NEUTRAL] Limitations are as followed.
[AGENT][NEUTRAL] Limited to dependent children under the age of [PII].
[AGENT][NEUTRAL] Maximum of one per lifetime per quadrant or arch arch.
[CUSTOMER][POSITIVE] Thank you 29:30.
[AGENT][NEUTRAL] 2930 yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Falls on the major 12 month waiting period.
[AGENT][NEUTRAL] 40%.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[CUSTOMER][POSITIVE] One for 7 years, thank you.
[CUSTOMER][NEUTRAL] 2934.
[AGENT][NEUTRAL] What is your description of that cold?
[CUSTOMER][NEUTRAL] White um SSC.
[AGENT][NEUTRAL] Could you elaborate cause I don't have knowledge of dental.
[CUSTOMER][POSITIVE] new smile.
[CUSTOMER][NEUTRAL] A white crown.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, I'm not showing that code is covered, but we have 2933.
[AGENT][NEUTRAL] Fabricated stainless steel crown with risen window.
[CUSTOMER][POSITIVE] I'll take it, yes ma'am.
[CUSTOMER][POSITIVE] Yes, I'll get that one as well.
[AGENT][NEUTRAL] OK, it falls under major 12 month waiting period.
[AGENT][NEUTRAL] Limitations are as followed maximum of 1 per seven year period.
[CUSTOMER][POSITIVE] Thank you ma'am. 30.
[AGENT][NEUTRAL] And limited to dependent children under the age of [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[CUSTOMER][NEUTRAL] Um 3120.
[AGENT][NEUTRAL] Major 40%, no limitation. 12 month waiting period has not been met.
[CUSTOMER][NEUTRAL] 3220?
[AGENT][NEUTRAL] 12 month waiting period.
[AGENT][NEUTRAL] Major has not, major waiting period has not been met 40%. No limitation.
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] 9 to 30.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Major 40%, 12 month waiting period, no limitation.
[CUSTOMER][NEUTRAL] 9248.
[AGENT][NEUTRAL] 9248.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is your description of 9248?
[CUSTOMER][NEUTRAL] hm, yeah, it's just a weird thing too yeah I'm gonna stuck with it, but
[AGENT][NEUTRAL] What is your description of 9248?
[CUSTOMER][NEUTRAL] Yes ma'am, sorry, conscious sedation.
[AGENT][NEUTRAL] So we have 9241 and 9242.
[AGENT][NEUTRAL] The 1st 30 minutes and the 1st 15 minutes falls on the major 40%.
[CUSTOMER][POSITIVE] Awesome 9944?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the description of the code?
[CUSTOMER][NEUTRAL] Night guard a cruiser guard.
[AGENT][NEUTRAL] We have 994-09951 and 9952 for occluser guard by report, occluser guard Occlusa adjustment Limited, closer adjustment complete falls on the major 40%, 12 month waiting period.
[CUSTOMER][POSITIVE] Thank you. And 7961.
[AGENT][NEUTRAL] 7961.
[AGENT][NEUTRAL] What's your description of that cold?
[CUSTOMER][NEUTRAL] Prenectomy?
[AGENT][NEUTRAL] So I have 7960 files on the major 40%, 12 month waiting period has not been exhausted, maximum of 1 per lifetime per quadrant or arch.
[CUSTOMER][POSITIVE] Thank you, and then may I get your name one more time?
[AGENT][NEUTRAL] Of course it's [PII], and today's date as a reference because unfortunately we don't provide reference numbers [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, um, and then one last thing, are you able to provide me a fax pack?
[AGENT][NEUTRAL] Yeah, I can.
[CUSTOMER][NEUTRAL] If I, yeah, I I if I request one for [PII]'s [PII] and then [PII]'s [PII].
[AGENT][NEUTRAL] So I could send you one for the entire family because their benefits are the same. What is your fax number?
[CUSTOMER][NEUTRAL] OK, that works [PII].
[AGENT][NEUTRAL] I have [PII]. May I place you on a brief hold while I send this over to you. Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], I've sent that information over for you by fax. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Hello. You're welcome.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you you have a good day.
[AGENT][POSITIVE] Thanks for calling API. You have a great one as well. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.