AccountId: 011433970860
ContactId: a9063894-6220-4d3d-a788-eee98f51513c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388670 ms
Total Talk Time (AGENT): 116106 ms
Total Talk Time (CUSTOMER): 161091 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/a9063894-6220-4d3d-a788-eee98f51513c_20250210T21:37_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I just have a few questions in regards to benefits.
[AGENT][NEUTRAL] OK, I can verify benefits for you and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, sure. Number is 01246519.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Oh, sure. Uh, no extension. It's [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, um, this is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, so the effective date is [PII]. Policy is active and now you just need a general breakdown of benefits or I can send a fax back?
[CUSTOMER][NEUTRAL] Oh, yeah, I requested a fax. I just have a few questions that I don't find on the, the paperwork, like the group name and group number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, see.
[AGENT][NEUTRAL] Uh, group number 15197.
[AGENT][NEUTRAL] Group name is Universal Trucking, DNJ.
[AGENT][NEUTRAL] Intermodel, N I N T E R M O D A L.
[CUSTOMER][NEUTRAL] And um also, uh, what is the fee schedule?
[CUSTOMER][NEUTRAL] And if they are uh in network.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Well, we don't have a network. Uh, the policy just pays by UCR for preventative pays 100% of usual customary reasonable, basic, basic restorative. FMX panoramic pays at 80 and major services pay at 40%.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the TV. And uh, for the coordination of benefits, is it standard?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] And is this a employee and spouse or family?
[CUSTOMER][NEUTRAL] with dependent children.
[AGENT][NEUTRAL] Uh, it shows family coverage. Mhm.
[CUSTOMER][NEUTRAL] I think family.
[CUSTOMER][NEUTRAL] And uh runs through a calendar year?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Oh, is it, uh, a calendar year or a fiscal year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] And uh also the accumulation of 1500 maximum and if there's any deductible accumulations.
[AGENT][NEUTRAL] Um, let me see, give me one moment.
[AGENT][NEGATIVE] I don't show any benefits have been used nor any deduct deductible has been met for this year.
[CUSTOMER][NEUTRAL] All right, great. Um, the preventive, does it apply to the maximum as well?
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] OK. And so no history yet for this year. Um, if I can't find the code on the list that um I received from the fax or email, is it not covered? Just like the, the fluoride?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So if it's not there, not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Uh, do you guys pay on seat or prep date?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Let me just go back.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Any waiting period or missing tooth loss?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, let's see.
[AGENT][POSITIVE] Say it one more time, I'm so sorry.
[CUSTOMER][NEUTRAL] Uh, is there a missing tooth gloss or waiting period?
[AGENT][NEUTRAL] Uh, there is a message of tooth clauses, but they've already passed their waiting period. It was a 12-month waiting period.
[CUSTOMER][NEUTRAL] Oh, OK. So no waiting period now.
[CUSTOMER][NEUTRAL] And can we do 4 quads in the same day for SRP 4341?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Yes, OK. And is there a healing period for period 4910 after the SRP?
[AGENT][NEUTRAL] Uh, there's no limitations are there. I don't see any.
[CUSTOMER][NEUTRAL] No healing period, OK. That's fine.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me just go back. Uh, for predetermination, is there an amount?
[CUSTOMER][NEUTRAL] Or is it just suggested?
[AGENT][NEUTRAL] Um, it's allowed. I mean, you can send a predetermination, but it's not a requirement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, lastly, for 2950, um, can we do that same day as Crown?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, the 9230, is it under major or basic?
[AGENT][NEUTRAL] Say it one more time.
[CUSTOMER][NEUTRAL] 9230, then nitrous oxide.
[AGENT][NEUTRAL] 9
[AGENT][NEUTRAL] Uh, this major.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Major. OK, great.
[CUSTOMER][POSITIVE] I, uh, just a, uh, reference number, please. Thank you so much.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much. You have a great day.
[AGENT][POSITIVE] Alright, you're welcome thank you for calling APL bye.
[CUSTOMER][NEUTRAL] You have been removed from the call. Goodbye.