AccountId: 011433970860
ContactId: a84172b8-bbad-428b-85bd-719651124426
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 803969 ms
Total Talk Time (AGENT): 267300 ms
Total Talk Time (CUSTOMER): 264332 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/a84172b8-bbad-428b-85bd-719651124426_20250131T21:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. I'm calling you today on behalf of the dental office to check the eligibility and benefits for a specific patient on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] Yes, I can help you. Can you please give me the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] Sure. I'm calling you for Aspen Dental.
[AGENT][NEUTRAL] OK, [PII], what is your um callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is the patient's name?
[CUSTOMER][NEUTRAL] Sure. The name of the patient is [PII].
[AGENT][NEUTRAL] OK, and then what is?
[CUSTOMER][NEUTRAL] I also have the uh ID.
[AGENT][NEUTRAL] Mhm. Yes, what is that, please?
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of birth?
[CUSTOMER][NEUTRAL] Sure. The date of birth for [PII] is [PII].
[AGENT][NEUTRAL] OK, let me go ahead and pull that policy up for us.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And if you give me your fax number I can send you a fax back with her complete benefit breakdown.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. Actually, I do have the appointment of this patient in the next 15 minutes and I request you to kindly help me with the, the information on call. It will I I hardly have some specific questions.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] Thank you so much for being so kind. Thank you for being so kind today. And uh is this a single policy or a family policy plan?
[AGENT][NEUTRAL] It's single.
[CUSTOMER][POSITIVE] Great. What about the group name and the number, please?
[AGENT][NEUTRAL] The group name is Partners Personnel Management Services.
[CUSTOMER][NEUTRAL] Partners personal.
[CUSTOMER][NEUTRAL] Management.
[CUSTOMER][NEUTRAL] Services, correct?
[AGENT][NEUTRAL] Services.
[AGENT][NEUTRAL] Yes, and the group number is 70087.
[CUSTOMER][POSITIVE] Amazing.
[CUSTOMER][NEUTRAL] Thank you. And uh can you please check if the provider is in network?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] She can use any network that she wants to, any dentist that she wants to.
[CUSTOMER][NEUTRAL] Oh, OK, so is this a discount plan or this is uh.
[AGENT][NEUTRAL] She's under APL.
[CUSTOMER][NEUTRAL] Uh, APO. It's basically like a type of a PPO policy.
[AGENT][NEUTRAL] It's no, it's uh it's a standalone policy with American Public Life and we build based on UCR.
[CUSTOMER][NEUTRAL] Oh, OK. I do understand. So this is basically, sir, OK, you see that as a bus fee schedule. So the name of the policy is American Public Life, correct?
[AGENT][NEUTRAL] Just the fee schedule.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Bear with me for a quick minute. American Public Life, got that. Thank you so much. And uh
[CUSTOMER][NEUTRAL] What about the claims mailing address please?
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] Amazing. Thank you so much. What about the deductibles and the annual amounts on the policy, please?
[AGENT][NEUTRAL] Uh, she has a $50 per calendar year deductible.
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. I'm, I'm so sorry your voice was breaking in between, so I couldn't get the information about the annual max.
[AGENT][NEUTRAL] The annual maximum is 500.
[CUSTOMER][POSITIVE] Thank you. Calendar plan. And uh
[CUSTOMER][NEUTRAL] What about the deductibles? are they applicable to basic and major services?
[AGENT][NEUTRAL] Yes, she has a $50 deductible per calendar year.
[AGENT][NEUTRAL] She has basic preventative um and basic restorative, but she does not have major.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] I do understand that, absolutely. That will even, you know, go ahead and uh minimize my questions. So just wanted to verify, uh, deductibles are applicable to basic services only as you told me. So what about the orthodontics? Is orthodontics covered on this policy?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][POSITIVE] Great. What is the co-insurance for preventative and basic services, please?
[AGENT][NEUTRAL] Preventative is 100% of allowable.
[AGENT][NEUTRAL] Basic is 80% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Amazing. What about endoperio and oral surgery, please? Are they covered on this policy?
[AGENT][NEUTRAL] Endo oral, do you have a um procedure code?
[CUSTOMER][NEUTRAL] Yes, please. I do have that as well. So for and it is 3330.
[AGENT][NEUTRAL] Let me look and see if that's on her fee schedule.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] No, it is not covered.
[CUSTOMER][NEUTRAL] Thank you. What about periodontics 4341?
[AGENT][NEUTRAL] Mm let me see.
[AGENT][NEGATIVE] That is not on the fee schedule either so it's not covered.
[CUSTOMER][NEUTRAL] Thank you. What about 7210?
[AGENT][NEUTRAL] That is not on the fee schedule either.
[CUSTOMER][POSITIVE] Great. What about 7140?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] That is not oh yes it is.
[AGENT][NEUTRAL] Yes, that is basic expense.
[CUSTOMER][POSITIVE] Excellent. Thank you. Any missing tooth loss and waiting period on this policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, we have a missing tooth loss, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But we don't have a waiting period for either basic or a preventative service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Amazing. Just wanted to confirm crowns, bridges, dentures, and implants. They are not covered on this policy, correct?
[AGENT][NEUTRAL] Right, it's it's major.
[CUSTOMER][POSITIVE] Amazing. Now, what about downgrades? Do we have any downgrades for filling on this policy?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. What about predetermination? Is it mandatory or suggestion?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you. Now,
[CUSTOMER][NEUTRAL] Coming to the last set of questions, I do have some codes with me, hardly 8 to 9 codes. Can you please help me with the frequency and the age limit for these codes?
[AGENT][NEUTRAL] Oh OK. What is the first code?
[CUSTOMER][NEUTRAL] Sure. The first one is 0120.
[AGENT][NEUTRAL] OK, let me see, 0120 is preventative and it is limited to two oral evaluation procedures in any combination of 0120014001500150.
[AGENT][NEUTRAL] Oh, I'm sorry, 0160 per 12 month period.
[CUSTOMER][NEUTRAL] Thank you. What about 11:10?
[AGENT][NEUTRAL] OK, that's preventative.
[AGENT][NEUTRAL] Maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Great. What about 0274?
[AGENT][NEUTRAL] I'm looking for it.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Bite Wing is 4 films and
[AGENT][NEUTRAL] Limited to one bite wing X-ray procedure 027002720274 per 12 month period.
[CUSTOMER][POSITIVE] Amazing. What about 0210?
[AGENT][NEUTRAL] OK, looking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I do not see 0 to 10 on the fee schedule.
[CUSTOMER][NEUTRAL] OK, so that is not covered.
[CUSTOMER][NEUTRAL] So, do you also see 0330 on this policy?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that is limited to one X-ray procedure for 02100277 and 0330 per five year period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that means 0210 is also covered.
[AGENT][NEUTRAL] Yes, I do see that now.
[CUSTOMER][POSITIVE] Amazing. What about 1208?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I do not. I'm looking if there's a lot of uh benefits for me to scroll through sorry this is a fax back that I was gonna send you they're all listed on here so I'm having to scroll down.
[CUSTOMER][POSITIVE] Do understand that. Please take your time.
[AGENT][NEUTRAL] I do not
[AGENT][NEUTRAL] Yes, and I do not see that one.
[CUSTOMER][POSITIVE] Amazing. And we are left with only 3 to 4 codes now. What about 4910? Is that covered on this policy?
[CUSTOMER][NEUTRAL] PO maintenance.
[AGENT][NEUTRAL] 4190, let me look.
[CUSTOMER][NEUTRAL] Uh, it's 4910.
[AGENT][NEUTRAL] 4910.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that is not on the fee schedule.
[CUSTOMER][NEGATIVE] OK. And even 4341 is not covered.
[CUSTOMER][NEUTRAL] Because that the code I gave you for periodontics. Last question, what about 0431?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, I do not see 0431.
[CUSTOMER][POSITIVE] Excellent. I'm done with all my questions. If you can please spell me your name.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Thank you. What about the call reference number for this patient, please?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] Great. Thank you so much for uh helping me today, [PII], and for being so kind today on this call. And it was very nice talking to you and you have a blessed weekend ahead. Bye-bye.
[AGENT][POSITIVE] You, you too, [PII] thank you you have a blessed weekend also. You take care. Thanks for calling APL.
[CUSTOMER][POSITIVE] Same to you. Take care, ma'am. Bye.
[CUSTOMER][NEUTRAL] Mhm