AccountId: 011433970860
ContactId: ab77c25b-23bd-4dfe-bb42-16aeb970d184
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1271849 ms
Total Talk Time (AGENT): 411570 ms
Total Talk Time (CUSTOMER): 400608 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/ab77c25b-23bd-4dfe-bb42-16aeb970d184_20250514T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm [PII]. I'm calling from Star Dental to verify dental benefits for a patient. Could you please help me with that?
[AGENT][NEUTRAL] Sure. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 4356177774.
[AGENT][NEUTRAL] Is that the policyholder's social?
[CUSTOMER][NEUTRAL] Uh, maybe I think so because I only have that one here.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Station name is [PII] and the DB is [PII].
[AGENT][NEUTRAL] OK, and [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK, it's uh [PII]. It's a direct line.
[AGENT][NEUTRAL] And see, I'm, when you're ready, I can give you his policy number.
[CUSTOMER][POSITIVE] Yeah, sure, thank you so much for that.
[AGENT][NEUTRAL] OK, policy number is 2483469.
[AGENT][NEUTRAL] Effective date of [PII] and the policy is active.
[AGENT][NEUTRAL] And you just need a general breakdown of benefits or I can send you a fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'm so sorry. We don't have any facts back for this uh services. I'm so sorry for that. Could you please uh help me verbally? Is it OK?
[AGENT][NEUTRAL] That's fine. Uh, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1500 per calendar year, and they have a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Preventative pays 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for major services which would include endodontics, perdontics, oral surgery, it pays at 40% of UCR.
[CUSTOMER][NEUTRAL] 40
[AGENT][NEUTRAL] 440, 40% of the UCR.
[CUSTOMER][NEUTRAL] OK, extractions and simple and surgical extractions, those were also under major.
[AGENT][NEUTRAL] Uh, except for the simple extraction of 7140 that falls under basic.
[CUSTOMER][POSITIVE] Basic. OK, thank you.
[CUSTOMER][NEUTRAL] Just a moment you said FMX and panel those were under basic, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Anything use from deductibles and yearly marks?
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Uh, showed he has $8 left from his deductible and $1,431 remaining for benefits.
[CUSTOMER][NEUTRAL] Sorry, could you please repeat that? $8 left from deductibles like family and uh
[CUSTOMER][NEUTRAL] Inviduals.
[AGENT][NEUTRAL] Individual
[AGENT][NEUTRAL] And he has remaining as far as the benefit of $1,431.
[CUSTOMER][NEUTRAL] OK, for
[CUSTOMER][NEUTRAL] From Max?
[AGENT][NEUTRAL] Yes, out of his benefit max of $1500 he has $1,431 remaining.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And anything use from family deductibles? Nothing?
[AGENT][NEUTRAL] For family, there's a $150 max for family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] And there's still $100 remaining for the family deductible.
[CUSTOMER][NEUTRAL] OK. Could you please
[CUSTOMER][NEUTRAL] And, OK, thank you for that. Could you please help me with the patient details, the patient data subscriber, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it is a PPO plan on their calendar year, am I right?
[AGENT][NEUTRAL] Sure, it's just uh pay by UCR we don't have a network.
[CUSTOMER][NEUTRAL] OK, it is a calendar year plan or benefit year?
[AGENT][NEUTRAL] It is a calendar year plan.
[CUSTOMER][NEUTRAL] OK, could you please help me with the group name and group number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Moment.
[AGENT][NEUTRAL] Group number 22209.
[AGENT][NEUTRAL] Group name is Universal Trucking, Bee Li Transportation.
[CUSTOMER][NEUTRAL] Universal, could you please spell the word after universal?
[AGENT][NEUTRAL] Trucking, T R U C K I N G Trucking.
[CUSTOMER][NEUTRAL] After that, be called BE or the single word B?
[AGENT][NEUTRAL] B as the B B E E line transportation.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][POSITIVE] Thank you just a moment.
[CUSTOMER][NEUTRAL] I'm putting that on.
[CUSTOMER][NEUTRAL] The number.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][POSITIVE] Thank you so much for that. And could you please uh verify that this patient has any coordination of benefits that you're following?
[AGENT][NEUTRAL] Uh, standard
[CUSTOMER][NEUTRAL] OK, is there any dollar amount for pre-authorization or pre-estimates?
[AGENT][NEUTRAL] Uh, it's not required.
[CUSTOMER][NEUTRAL] OK, it is not suggested over any dollar amount?
[AGENT][NEUTRAL] I'm not understanding what you're asking for a pre-treat?
[CUSTOMER][NEUTRAL] Like, mhm, yeah.
[AGENT][NEUTRAL] Well, for a pre-treat, they submit the pre-treat. We send out a pre-treat estimate, but it's not gonna pay a benefit for a pre-treat.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah, I get it. And uh is there any waiting period on missing two class?
[AGENT][MIXED] There is a waiting period for major which they've already satisfied, and there is a missing tooth clause.
[CUSTOMER][NEUTRAL] OK, satisfied or major services paid at proper policy date.
[AGENT][NEUTRAL] Either or
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, could you please help me with the order on the lifetime maximum?
[AGENT][NEGATIVE] Ortho it's not covered.
[CUSTOMER][NEUTRAL] Because of age limit or not covered at all for this plan?
[AGENT][NEGATIVE] Not covered at all for this plan.
[CUSTOMER][NEUTRAL] OK. Could you please uh help me with the frequencies for preventative services?
[AGENT][NEUTRAL] Sure, exams are 2 for 12 month period. All exams share the same frequency.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cleanings once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, bite wings one per 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Fluoride under the age of [PII], once every 12 months, sealants under the age of
[AGENT][NEUTRAL] [PII], once every 3 years, permanent molars online.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That cleaning share with 4910?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, they don't share FMX and share, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, 1 to 3 years.
[CUSTOMER][NEUTRAL] Uh, you said the age limit for sealants. Could you please repeat that?
[AGENT][NEUTRAL] Fees under the age of [PII].
[CUSTOMER][NEUTRAL] OK. And is there any pediatrical X-rays involved in preventative?
[AGENT][NEUTRAL] PAs are considered basic, and there is no frequency.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Just a moment, basic.
[CUSTOMER][NEUTRAL] OK, could you please help me with the fillings frequency and percentage?
[AGENT][NEUTRAL] Feelings are once every 24 months. They fall on our basic.
[CUSTOMER][NEUTRAL] Is there any, is there any downgrade for that?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] And for crowns?
[AGENT][NEUTRAL] Uh, crowns are once every 7 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mayor Major.
[CUSTOMER][NEUTRAL] Is there any downgrades for that?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] OK. And once in 7 years, it is the same for bridges and the ships.
[AGENT][NEUTRAL] Uh, partials and just give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, partial and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] Dangers, OK, for bridges it is same.
[CUSTOMER][NEUTRAL] 1 in 7 years.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] For partials and dentures or partials and dentures are every 5 years, crowns, bridges every 7.
[CUSTOMER][NEUTRAL] Or in less and all of the same.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was your other question?
[CUSTOMER][NEUTRAL] For unless
[CUSTOMER][NEUTRAL] In less only.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] In list and on list.
[AGENT][NEUTRAL] I'm not understanding what you're asking. Say again.
[CUSTOMER][NEUTRAL] Uh, for inless and on list, those are all the same as crowns.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, yes, that is once every 7 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] And for the code 9944, is it covered for paroxysm?
[AGENT][NEUTRAL] It is covered as major, and it's once every 7 years.
[CUSTOMER][NEUTRAL] Is there any books or medication?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, it is same as 9946?
[AGENT][NEUTRAL] What's 9946.
[CUSTOMER][NEUTRAL] It is same as 9944?
[AGENT][NEUTRAL] Then it's the same stipulations when every 7 years falls on a major.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and thank you so much for the description, sir, for helping me out, and I just left with some limited quotes which I don't have a description with that. Could you please help me with those for frequency and percentages?
[AGENT][NEUTRAL] What are the codes and how many codes do you have?
[CUSTOMER][NEUTRAL] Just uh.
[CUSTOMER][NEUTRAL] 1220 codes with me.
[AGENT][NEUTRAL] OK, what are the codes?
[CUSTOMER][NEUTRAL] Should I provide all at once or one by one would be fine?
[AGENT][NEUTRAL] All at once, please.
[CUSTOMER][NEUTRAL] OK, and the postcode I have is [PII].
[CUSTOMER][NEUTRAL] 0210.
[CUSTOMER][NEUTRAL] And 0367.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 435-543-464341.
[CUSTOMER][NEUTRAL] 4910295055115650581058215912911092229230923993109612.
[CUSTOMER][NEUTRAL] 963-099-473221.
[CUSTOMER][NEUTRAL] 492 1
[CUSTOMER][NEUTRAL] 601061046190605660576058. And the last 1, 7953.
[AGENT][NEUTRAL] OK, thank you. Let me put you on a brief hold, OK?
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 7953.
[AGENT][NEUTRAL] OK, Ms. [PII], are you ready?
[CUSTOMER][POSITIVE] Yeah thank you so much.
[AGENT][NEGATIVE] Uh-huh. Code 240 not covered.
[AGENT][NEUTRAL] Code 210 is basic, once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 367 not covered.
[AGENT][NEGATIVE] 1516 not covered. 4381 is major, no frequency.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4355 is major, once every 24 months, 4346 not covered, 4341 is major, once every 24 months, 4910 is major once every 6 months, 2950 is major once every 7 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Codes 5511565058105821 and 5912, not covered.
[AGENT][NEUTRAL] 9110 is basic, no frequency.
[AGENT][NEGATIVE] 9222 is major no frequency 9230 is major no frequency 92399310961296309947322 0 well and from from there 9947 not covered so from 9239 to 9947 not covered.
[AGENT][NEUTRAL] 3221 is major, no frequency, 4921, 6110, 6104, 6190, 6056, and 6057, 6058 and 7953 are not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] 0240 is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, how many quadrants can be done on a single day for SRP?
[AGENT][NEUTRAL] All 4
[CUSTOMER][NEUTRAL] OK, last question, and could you please cross check for the code 0150. Is there any frequency related to the provider like one per provider per lifetime on the guidelines?
[AGENT][NEUTRAL] You said 150 for an exam?
[CUSTOMER][NEUTRAL] Anything like that?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] Exams are 2 for 12 month period. All exams share the same frequency.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it. There is no guidelines related to the provider's frequency.
[AGENT][NEUTRAL] That is it, uh to uh for 12-month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. And last question from my end, did you see any history which might affect the frequencies for preventative and basic services?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, I'm showing last bite wing, [PII], as well as last exam.
[CUSTOMER][NEUTRAL] [PII] exam. OK. And is there anything else?
[AGENT][NEUTRAL] And bite wing.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anything related to last year for anything?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] For Max and down or nothing recorded.
[AGENT][NEUTRAL] There's no history of FMX or Pano.
[CUSTOMER][POSITIVE] OK, thank you so much. Could you please spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the reference number?
[AGENT][NEUTRAL] Uh, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. I really, really appreciate your patience and uh have a great day ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You too, thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye.