AccountId: 011433970860
ContactId: ac4c7132-803b-4040-b4b2-b1f6c03169c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449559 ms
Total Talk Time (AGENT): 241460 ms
Total Talk Time (CUSTOMER): 148877 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ac4c7132-803b-4040-b4b2-b1f6c03169c3_20250527T22:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Um, I'm calling from the patient's dental provider. I actually just spoke to another, um, person from this number, and I was waiting on a fax back, but I still haven't received it, so I was gonna see if I could just get some verbal information in case it comes later.
[AGENT][NEUTRAL] OK, I can help you um with the benefits for a patient. Can you please give me your callback number, Miss [PII], just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is the name of your facility one more time again, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's Mint Dentistry, M I N T.
[AGENT][NEUTRAL] OK. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] You may 1st name is [PII]. Date of birth [PII] and his policy number is 2191951.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[AGENT][NEUTRAL] Alright, I do see that [PII] does have an active policy with us. The effective date is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up his benefits real quick so that we can look on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Over together.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] It's gonna be just a minute while the computer pulls them in for us.
[CUSTOMER][POSITIVE] Mm, no problem, yeah.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, I've got him pulled up and what questions did you have?
[CUSTOMER][NEUTRAL] So I do pretty much need a full breakdown. He's never been to our office before, um, so maximum deductible, co-insurances, frequencies, those types of things.
[AGENT][NEUTRAL] OK, and this is just to verify his benefits. It's not a guarantee of payment. He has a calendar year maximum of $1500 per covered insured. He has a calendar year deductible of $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, his policy is preventative, is 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And the deductible does not apply to preventative expenses.
[AGENT][NEUTRAL] Radio graphs and FMX expenses is 80% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic expenses is 80% of UCR.
[AGENT][NEUTRAL] Basic restorative expenses is 80% of UCR.
[AGENT][NEUTRAL] Major expenses are 40% of UCR with a 12 month waiting period.
[AGENT][NEUTRAL] Endoonic is 40% of UCR with the 12-month waiting period.
[AGENT][NEUTRAL] Periodontic is 40% of UCR with a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Prosthodontic repairs is 40% of UCR with the 12 month.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oral surgery is 40% of UCR with the 12 month waiting period. The policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] TMJ and orthodontic services are not covered on this policy.
[AGENT][NEUTRAL] Implants, placement, removal and related services are also not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, his cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] His exams are 2 every 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] His fight wings are once every 12-month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Full mouth X-rays and panoramics are once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Crowns and bridges are once every 7 years per tooth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Partials and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, let's see, can I also get the frequency for, um, SRP and perio maintenance?
[AGENT][NEUTRAL] Uh, would that follow on the periodontic expenses?
[CUSTOMER][NEUTRAL] Period. uh-huh, the 4341 and the 49, yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, that's 40% of UCR and the waiting period is 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how often is that allowed?
[CUSTOMER][NEUTRAL] Or is there no frequency?
[AGENT][NEUTRAL] Uh, what was the code again?
[CUSTOMER][NEUTRAL] 4341 and then 4910.
[AGENT][NEUTRAL] 4341, uh, let's see, he does have a limitation on that. Let me see what it is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months, that's the 4341 and then what was the next code?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No one, it's 4910, that's per maintenance.
[AGENT][NEUTRAL] 49 plan, OK.
[AGENT][NEUTRAL] And that does have a limitation, let me tell you, maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that that falls under major as well or is that um.
[CUSTOMER][NEUTRAL] Preventive.
[CUSTOMER][NEUTRAL] Or basic or something other.
[AGENT][NEUTRAL] That is going to be.
[AGENT][NEUTRAL] is going to be under his periodontic.
[CUSTOMER][NEUTRAL] OK, so, so it is covered under Peria, so at 40%. OK, sometimes that one is covered at the preventive, which whatever. And then let's see, the only other code that I was gonna see what the coinsurance for is um the 9110, the palliative treatment.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] That's a minor procedure and there are not, are no limitations on it, but it is on his right, it is on the fact, so it is a covered procedure under basic.
[CUSTOMER][NEUTRAL] Well, OK.
[CUSTOMER][POSITIVE] OK, perfect
[CUSTOMER][NEUTRAL] And the basic right so.
[CUSTOMER][NEUTRAL] That is everything. I I already got the history from the last rep, so, um, I guess I'll just get another reference number from you if that's OK.
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII]
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. I appreciate your help.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a good night and thank you for calling APL ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thanks you have a good one too bye bye.
[AGENT][NEUTRAL] All right.