AccountId: 011433970860
ContactId: a602c930-5ee8-413a-9464-b7f561db0e60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1496160 ms
Total Talk Time (AGENT): 457443 ms
Total Talk Time (CUSTOMER): 385580 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/a602c930-5ee8-413a-9464-b7f561db0e60_20250605T12:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, very good morning, ma'am. My name is [PII] calling from provider's office.
[AGENT][NEUTRAL] OK, I'm sorry, but your voice is not very clear.
[CUSTOMER][POSITIVE] Mm, thank for that. Now it is OK.
[AGENT][POSITIVE] Uh, that is a little better.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, [PII], good morning. And how can I help you this morning?
[CUSTOMER][NEUTRAL] I'm looking for a dental benefits for the patient.
[AGENT][NEUTRAL] OK, so for dental benefits, I can help you with that and [PII] for our dental policies, we have facts facts that has all of the members' information and cover benefits on there that I will be happy to send to you also. But first off, what is
[CUSTOMER][NEUTRAL] Um, ma'am, actually, uh,
[CUSTOMER][POSITIVE] Sorry, sorry to interrupting. Actually, for this case, yes, I'm here with you.
[AGENT][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] OK, [PII], I'm sorry, but I'm having a lot of trouble understanding you.
[CUSTOMER][NEUTRAL] Uh, sorry for that. For this particular patient, we have to take the benefits of call.
[AGENT][NEUTRAL] OK, we'll do the best that we can because I can hardly understand what you're saying.
[CUSTOMER][NEUTRAL] I'm asking
[CUSTOMER][NEUTRAL] I, I need benefits over call.
[AGENT][NEUTRAL] OK, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 2346809.
[AGENT][NEUTRAL] 2346809. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, [PII], so any information that is provided would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, does this plan run in calendar or contract here?
[AGENT][NEUTRAL] Calendar.
[CUSTOMER][NEUTRAL] Can you please check the provider is in network or out of network?
[AGENT][NEUTRAL] This is not a network plan. Covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] Oh, so you are saying there is no network, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, there is no network, but you will follow UCRC schedule.
[AGENT][NEUTRAL] We would cut this is based on the UCR, a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] OK, what is the group number and group name for billing purposes?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 19205.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] P as in Peter, and S as in Sam, transportation.
[CUSTOMER][NEUTRAL] It's the Universe Universal Trucking. P like Papa.
[CUSTOMER][NEUTRAL] And S like Sam transportation.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. What is the plant type?
[AGENT][NEUTRAL] This is, there is no plan type. This is a dental policy.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Like it is a PPO plan or something else?
[AGENT][NEUTRAL] Yes ma'am, I've already said that it was not a network plan.
[CUSTOMER][NEUTRAL] OK. What is the client's mailing address and payer ID?
[AGENT][NEUTRAL] The company name is APL.
[AGENT][NEUTRAL] And the address is [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Payer ID.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. Thank you. Is there any waiting period and missing tooth cloths?
[AGENT][NEUTRAL] There's a twelve-month waiting period for major endoperiodontic, prosthodontic, and oral surgery categories.
[CUSTOMER][POSITIVE] Uh, ma'am, uh, but the effective date was [PII]. I think the waiting period already satisfied.
[AGENT][NEUTRAL] That is correct, but the waiting period overall on these policies on the categories that I gave you is what the waiting period is. This policy does have waiting periods.
[CUSTOMER][NEUTRAL] OK, so how, uh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any machine to cross?
[AGENT][NEUTRAL] There is, yes.
[CUSTOMER][NEUTRAL] Oral surgery goes to medical or dental?
[AGENT][NEUTRAL] I'm sorry, what is your question?
[CUSTOMER][NEUTRAL] Oral surgery goes to medical or, OK. What about coordination of benefits?
[AGENT][NEUTRAL] Dental
[AGENT][NEUTRAL] Standard.
[CUSTOMER][NEUTRAL] What about the annual maximum for this patient?
[AGENT][NEUTRAL] $1500 for covered insured for covered services with a $50 calendar year deductible.
[CUSTOMER][NEUTRAL] How much is the patient using $1500?
[AGENT][NEUTRAL] For this calendar year?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] As of now he has used $386 for this calendar year and that's the deductible.
[CUSTOMER][NEUTRAL] 386, right?
[AGENT][NEUTRAL] Has been used.
[CUSTOMER][NEUTRAL] OK, 386, the deductible 50 is met. Thank you. Is there any separate implant maximum for the patient?
[AGENT][NEUTRAL] I'm sorry, is there any what?
[CUSTOMER][NEUTRAL] Separate maximum for implant services.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. Actually, I have some specific codes. Can you please give me the percentage and frequency limitations for those quotes?
[AGENT][NEUTRAL] How many codes do you have?
[CUSTOMER][NEUTRAL] Uh, I have 30 coats, ma'am.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] 3330.
[AGENT][NEUTRAL] OK, ma'am, for 30 codes, all of that information would be on the fax back.
[AGENT][NEGATIVE] Any code not on the fax that would not be covered.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK. Shall I provide you the, some of the procedure codes?
[AGENT][NEUTRAL] OK, so you, you need for me to check 30 codes to see if they're covered?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, if it is possible to you.
[AGENT][NEUTRAL] That's a lot of codes.
[CUSTOMER][NEUTRAL] Uh, actually, for, uh, only for 5 quotes I need percentage and frequency remaining all I just need coverage only.
[AGENT][NEUTRAL] OK, so you would, you're not sending me the fax back, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the first code?
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] And what do you need to know about that code?
[CUSTOMER][NEUTRAL] Percentage and frequency.
[AGENT][NEUTRAL] Did you say frequency?
[CUSTOMER][NEUTRAL] Percentage and frequency.
[AGENT][NEUTRAL] I'm, I didn't understand the first part of what you're asking.
[CUSTOMER][NEUTRAL] Coverage, coverage and frequency.
[AGENT][NEGATIVE] Falls under basic.
[CUSTOMER][NEUTRAL] Basic is covered it.
[AGENT][NEUTRAL] Limited to two oil evaluation procedures in any combination of 0120, 0140, 0150,0160,0180 for a 12 month period.
[AGENT][NEUTRAL] They stick is covered at 80%, 80% of the UCR subject to the calendar year deductibles.
[CUSTOMER][NEUTRAL] OK. And the basic is crowded which person?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK. 0150.
[AGENT][NEUTRAL] Preventative with the same exact limitation that I just read.
[CUSTOMER][NEUTRAL] OK. 9310.
[AGENT][NEUTRAL] Also under basic, no limitation?
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Radiographs FMX.
[AGENT][NEUTRAL] And the limitation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Limited to one X-ray procedure, 0210, 02770330 per five-year period.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next code.
[CUSTOMER][NEUTRAL] And they covered it, and they covered it?
[AGENT][NEUTRAL] I get I said that it was based on its radiographs and FMX that is also covered at 80% of the ECR subject to the calendar year deductible.
[CUSTOMER][POSITIVE] Thank you. 6010.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. 7111. Uh, for, for remaining costs, ma'am, just need coverage only, no need of frequency.
[AGENT][NEUTRAL] What is the last code that you gave me? Give it, give me the code again with the 6. What was that code number?
[CUSTOMER][NEUTRAL] 606,010.
[AGENT][NEUTRAL] OK, yes. Uh, that is not covered.
[AGENT][NEUTRAL] 0610.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, give me the code one more time, please. I'm sorry, [PII], it's not.
[CUSTOMER][NEUTRAL] 66, no problem, no problem. 6010.
[AGENT][NEGATIVE] Yes, not, not covered.
[CUSTOMER][NEUTRAL] OK. 7111. Just the coverage only, no need of frequency.
[AGENT][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] What was that one again? 7.
[AGENT][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] Oral surgery?
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] Uh, covered it.
[AGENT][NEUTRAL] 40% of UCR.
[CUSTOMER][NEUTRAL] OK. 7.
[CUSTOMER][NEUTRAL] OK. 70 to 20.
[AGENT][NEUTRAL] Also under oral surgery?
[CUSTOMER][NEUTRAL] 7230.
[AGENT][NEUTRAL] Oral surgery.
[CUSTOMER][NEUTRAL] 7240.
[AGENT][NEUTRAL] Oral surgery.
[CUSTOMER][NEUTRAL] 7241.
[AGENT][NEUTRAL] Oral surgery?
[CUSTOMER][NEUTRAL] 70 to 50.
[AGENT][NEUTRAL] Oral surgery?
[CUSTOMER][NEUTRAL] 7251.
[AGENT][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] 7251.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 7251 not covered. 7310.
[AGENT][NEUTRAL] Oral surgery?
[CUSTOMER][NEUTRAL] 773 11.
[AGENT][NEUTRAL] 7311. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7311 is also not covered. OK. 9222.
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEUTRAL] 9223.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] OK. 9222 not covered. 9223 is also not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] 7410.
[AGENT][NEUTRAL] For surgery?
[CUSTOMER][NEUTRAL] 7286
[AGENT][NEUTRAL] Or surgery?
[CUSTOMER][NEUTRAL] 7472.
[AGENT][NEUTRAL] Oral surgery.
[CUSTOMER][NEUTRAL] 7473
[AGENT][NEUTRAL] Oral surgery?
[CUSTOMER][NEUTRAL] 7956
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7957
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 6104
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7950.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7951.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7952
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] Did you say 7953?
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 792 1.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Thank you, ma'am. Is there any history, sir? 0330 and 0120?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] I'm asking, is there any history for 0?
[CUSTOMER][NEUTRAL] 330 and 0210.
[AGENT][NEUTRAL] For there mhm.
[AGENT][NEUTRAL] 0330? No.
[CUSTOMER][NEUTRAL] OK. 0210.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, let me get back on 033055 of 25.
[CUSTOMER][NEUTRAL] 55 of 2025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next code?
[CUSTOMER][NEUTRAL] 55 of 2025.
[CUSTOMER][NEUTRAL] Yeah, 0210.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any history for 0140?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so we're gonna need to go back over the codes on some of them because the system removed some of what I checked for you.
[AGENT][NEUTRAL] So first off, before I check that history, we're gonna need to go back to when you are asking after code 7241 regarding coverage. What was the next code?
[CUSTOMER][NEUTRAL] Oh, I'm asking for, after 7241, 7286.
[AGENT][NEUTRAL] Yes, ma'am, but I need you, yes, ma'am, but.
[AGENT][NEUTRAL] OK, so after 7241, it was 7286?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] You are asking for the history or for the coverage?
[AGENT][NEUTRAL] No, ma'am. When you were asking me to check 30 codes, I'm gonna need for you to repeat all of the codes that we checked after 7241.
[CUSTOMER][NEUTRAL] OK. 7286.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The next one?
[CUSTOMER][NEUTRAL] 7472.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 7473.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6 sorry, 7956.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 7957
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6104.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7950.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7951.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7952
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] Mhm. And 7921.
[CUSTOMER][NEUTRAL] 7921. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, then we did history for 0330. What was the next code after that?
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] OK, and so 0140. OK. 00140, that was 516 of 25?
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] 516 of 2025. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] 55 of 25.
[CUSTOMER][NEUTRAL] OK. D 015055 2025.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. 0120.
[AGENT][NEUTRAL] No history?
[CUSTOMER][NEUTRAL] So the patient is not eligible for exams, right? He already done two exams, one on [PII], and another one is [PII].
[AGENT][NEUTRAL] Yes, 0140 is 516 and 015055.
[CUSTOMER][NEUTRAL] Yeah, so the patient is not eligible for exams. Thank you. All preventative services applies to annual maximum.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, preventative services does not apply to maximum. Thank you. Same-day treatment allowed with 9310.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] There are no limitations.
[AGENT][NEUTRAL] 9310 is a consultation.
[CUSTOMER][NEUTRAL] Uh-huh. Same day.
[CUSTOMER][NEUTRAL] Will be allowed or not?
[AGENT][NEUTRAL] Again,
[AGENT][NEUTRAL] The the code falls under basic and that 9310 is a consultation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. Um, ma'am, sorry to asking you again. Uh, uh, I just have a little confusion on the waiting period. Sorry to ask you again for that.
[AGENT][NEUTRAL] What about the waiting period?
[CUSTOMER][NEUTRAL] Uh, ma'am, ma'am, you said that 12 month waiting period, but uh the effective date was [PII]. It has been met, right? So there is no waiting period.
[AGENT][POSITIVE] That's correct. That has been satisfied, you're correct, but I gave you the information on the policy, which is that it, this policy does have waiting periods on those categories, but yes, they have been satisfied.
[CUSTOMER][POSITIVE] Thank you. Thank you so much, ma'am. And uh
[CUSTOMER][POSITIVE] Uh, sorry to ask you again. And you said that there is no network for this patient, but you will follow UCRPC. OK, perfect. Thank you. Thank you so much. And how did you spell your name?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] [PII] and my name in today's date will be your call reference number. And once the claim has been submitted to APO for review, you can check our claim status by going to our portal website at [PII].
[CUSTOMER][NEUTRAL] OK. And you said that, ma'am, it is not in waiting, uh, it is not a PPO plan or HMO plan, it's just a dental plan.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you. Thank you so much and thanks for being patient with me. Have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. So if that's all I can help you with, thank you for calling APL and I hope that you have a nice day also.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.