AccountId: 011433970860
ContactId: a71f150f-6bd7-4bda-97ff-4ab1e04f8e35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485260 ms
Total Talk Time (AGENT): 173616 ms
Total Talk Time (CUSTOMER): 188171 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/a71f150f-6bd7-4bda-97ff-4ab1e04f8e35_20250520T21:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for benefit information.
[AGENT][NEUTRAL] OK, I'll verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes, I have 021-361777.
[AGENT][POSITIVE] Thank you, give me one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] I have um [PII], date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy. Are you just, and is this for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you just need a general breakdown of benefits or I can send you a fax back?
[CUSTOMER][NEUTRAL] So is, is this a PPO policy or is this a co-pay plan?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess PPO because it just it pays by UCR so it's no preferred provider.
[CUSTOMER][NEUTRAL] OK perfect um I already have a fax back but there's information that I'm not able to grab um off of this fax back. Can I go ahead and ask you those questions?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, can you let me know if there is a missing tooth cause?
[AGENT][NEGATIVE] Uh, there is a missing tooth cross.
[CUSTOMER][NEUTRAL] OK, and this is a standard policy?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK, and then um let's see.
[CUSTOMER][NEUTRAL] Um, does she have any history on file just because she's waiting in the office?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Uh, no, ma'am. She has no history.
[AGENT][NEGATIVE] It doesn't look like they've ever used the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK. Awesome. All right. Let's see. I need to know what's the frequency for fillings. I think there's a waiting period too.
[AGENT][NEUTRAL] Uh, no, ma'am. They've already passed any kind of waiting period for major, but fillings, um, it's every 24 months.
[CUSTOMER][POSITIVE] Oh, that's right.
[CUSTOMER][NEUTRAL] 12 months and then can you let me know if they downgrade?
[AGENT][POSITIVE] Uh, there are no downgrades.
[CUSTOMER][NEUTRAL] OK. And then that's covered at 80%.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then can you, can you let me know for code 2930, what is that covered at?
[AGENT][NEUTRAL] What the UCR amount?
[CUSTOMER][NEUTRAL] Yeah, mhm, and then the frequency as well.
[AGENT][NEUTRAL] Uh, what's the zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, see, this is for steel crown. Well, actually 2930. Give me one moment.
[AGENT][NEUTRAL] Uh, that would be considered major, so it pays 40%. Uh, showing the UCR amount for that code is 389, so, uh, 40% of 389.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And it's once every 7 years for that code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 in 7 years, OK. And then, um, also, let's see, can you let me know if code 01400160 is covered? It's not on the fax ma.
[AGENT][NEUTRAL] Uh, what are the codes again? 10,140 and 160?
[CUSTOMER][NEUTRAL] 01400160
[AGENT][NEUTRAL] Uh, they are, they are, they are basic and all exams share the same frequency of 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mm let's see if we can get.
[CUSTOMER][NEUTRAL] And then can you let me know if fillings downgrade?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] OK. And then can you let me know frequency for code 0220?
[AGENT][NEUTRAL] 220. OK.
[CUSTOMER][NEUTRAL] Also for Flo.
[AGENT][NEUTRAL] 220. 0, there's no uh frequency for PAs and for fluoride is under the age of [PII], I'm sorry, under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then can you, let's see.
[CUSTOMER][NEUTRAL] No problem. Can you let me know for code, um, what is the percentage and also the frequency for code 4341?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] 43 411.
[AGENT][NEUTRAL] Uh, that falls on a major and it's every 24 months and it pays at 40%.
[CUSTOMER][NEUTRAL] OK so 40%.
[CUSTOMER][NEUTRAL] And then can you also give me code 4355 and 4910?
[AGENT][NEUTRAL] Uh, 4355 is also major, once every 24 months, and 4910 is major and it's once every 6 months.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Awesome. And then is there any ortho coverage? I don't think there is on here.
[AGENT][NEUTRAL] Uh, no, ma'am. Ortho is not covered.
[CUSTOMER][NEUTRAL] OK. And then can you let me know, um,
[CUSTOMER][NEUTRAL] Uh, what's the fee schedule?
[AGENT][NEUTRAL] Uh, the policy doesn't pay by fee schedule, it pays by UCR.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then this is based off of the calendar year or plan year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can I get the group name and the group number please?
[AGENT][NEUTRAL] Sure, uh, let's see.
[AGENT][NEUTRAL] Group name is Universal Trucking Rig Runner.
[AGENT][NEUTRAL] Group number is 25017.
[CUSTOMER][NEUTRAL] And that was Universal Trucking Runner.
[AGENT][NEUTRAL] Uh, rig runner.
[CUSTOMER][NEUTRAL] Rig runner.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome
[CUSTOMER][NEUTRAL] Do you guys accept assignment of benefits?
[AGENT][NEUTRAL] Oh, we do.
[CUSTOMER][NEUTRAL] OK, um, I think that's all I need. Let's see.
[CUSTOMER][POSITIVE] Perfect. That's all I needed, ma'am. Can I please get a reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Awesome. Thank you so much, ma'am. You have a good uh you have a good day.
[AGENT][POSITIVE] Alright, you too. Thanks for calling APL. Bye.