AccountId: 011433970860
ContactId: ae161e0b-8e0b-42c4-b117-795738a37a84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1336859 ms
Total Talk Time (AGENT): 558149 ms
Total Talk Time (CUSTOMER): 443624 ms
Interruptions: 13
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ae161e0b-8e0b-42c4-b117-795738a37a84_20250108T16:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, [PII], my name is [PII]. I'm calling from a dental office to get benefits for 3 patients of ours.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have, um, they're all, is it like a family or they're all different members?
[CUSTOMER][NEUTRAL] Yeah, well, yeah, so it's, um, 3 children, um, they were just adding on to the father's plan, so the children are our patients, not the father.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be his social. It's gonna be the one I got is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate here. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And just to make sure I have the right person, can you verify his first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, this is it. OK, I'm pulling it up now. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the hm.
[AGENT][NEUTRAL] Well, I guess we can just verify the policyholder's uh date of birth because
[AGENT][NEUTRAL] I don't want to have to go through all the children and they're all on here.
[CUSTOMER][NEUTRAL] So it's I have [PII]. That's the those are the children that I'm calling about.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's all and then I have [PII]'s um date of birth is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And let me go ahead and give you their policy number.
[CUSTOMER][NEUTRAL] I think I have it. It's 02544828.
[AGENT][NEUTRAL] Oh, you do?
[AGENT][NEUTRAL] Oh, yes, that's the policy number.
[CUSTOMER][NEUTRAL] Sorry, I didn't see that right away whenever I called you.
[AGENT][NEUTRAL] Oh, you're fine. I just want to make sure you had it. OK, and then um what type of benefits did you want to go over?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, their dental benefits, so I just basically need to know, um, I have a few quotes if I can give them to you.
[AGENT][NEUTRAL] OK. Hold on one second. Wait, hold on one moment. I'm just trying to get to the facts back. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] And OK, so first.
[AGENT][NEUTRAL] OK, and then what's the codes you have?
[CUSTOMER][NEUTRAL] Um, 2930.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, if you can send me the fax back too, I do need that on file as well for all three if that's possible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it'll just be one, but the benefits are the same for everybody.
[CUSTOMER][NEUTRAL] OK, that's fine, that's fine, and then, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a uh well I have a lot of codes. I have a whole paper. I have to ask you questions first, so I don't know how you want me to start. Do you want me to just give you all the codes first and then ask my questions after or start from the top and go to the bottom?
[AGENT][NEUTRAL] Well, what are the questions that you have, because on the facts bag it lists several pages of codes and like their frequencies or limitations.
[CUSTOMER][NEUTRAL] Yeah, um, well, so the child will be here shortly, so I do have to ask you because I don't know how long the fax could take, but, um, what is the annual max?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The annual max for this policy is $1500 per calendar year per person.
[CUSTOMER][NEUTRAL] Just like.
[CUSTOMER][NEUTRAL] OK, and there's a patient deductible.
[AGENT][NEUTRAL] Of $50 up to $150 per family, and it doesn't apply to preventative. What's your um fax number? I can send this while we're doing this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Alright, so I just sent the fax back over to you and then did you, I guess, did you want to just give me like the list of codes that you have?
[CUSTOMER][NEUTRAL] Yes, 2930.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 29 3129 343,220 D [PII] 1351.
[CUSTOMER][NEUTRAL] 79 61 79 62 29 40 and 3120.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold while I go through the codes?
[CUSTOMER][POSITIVE] That's completely fine with me.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Just, just.
[AGENT][NEUTRAL] Alright, so this is major.
[AGENT][NEUTRAL] We need to be able to, to find like search so that we don't have to scroll up and down.
[AGENT][POSITIVE] Do everything easier for everybody else.
[AGENT][NEUTRAL] 2930 is nature.
[AGENT][NEUTRAL] At 40.
[AGENT][NEUTRAL] A A W.
[AGENT][NEUTRAL] That's what I'm gonna do. I'm gonna go through them. I'm gonna tell him major blah blah blah blah blah and then I'm gonna go through all the things I, I don't have to keep going up and down.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] It's ridiculous. 2931.
[AGENT][NEUTRAL] 31. OK, same thing.
[AGENT][NEUTRAL] 2934.
[AGENT][NEUTRAL] For
[AGENT][NEGATIVE] Not covered.
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] Major 4030.
[AGENT][NEGATIVE] No frequency.
[AGENT][NEUTRAL] D0150, is that what that is?
[AGENT][NEUTRAL] I don't even know dental clothes.
[AGENT][NEUTRAL] 0150 is.
[AGENT][NEUTRAL] Prevent 100.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] 1516.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Not covered.
[AGENT][NEGATIVE] Not cover.
[AGENT][NEUTRAL] Only 1515. OK. 1354.
[AGENT][NEUTRAL] 1351 is on here.
[AGENT][NEUTRAL] Pro 1100.
[AGENT][NEUTRAL] PGE.
[AGENT][NEUTRAL] 796 uh 0.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] 98.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] No, it says 796,120. I don't see 61. I don't see 62.
[AGENT][NEUTRAL] And then 2940.
[AGENT][NEUTRAL] Is preventive 1000.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] 3120.
[AGENT][NEUTRAL] Major.
[AGENT][NEUTRAL] 40
[AGENT][NEGATIVE] No frequency.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, I'm here.
[AGENT][POSITIVE] Hey, thank you so much for holding. I apologize for that wait. Um, so for each claim, I'm gonna give you the, uh,
[AGENT][NEUTRAL] Like if it's basic or major, the percentages, and then I'll give you the frequencies because they're on two different pages.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So for code 2930, it's for major at 40%.
[AGENT][NEUTRAL] 2931 is the same, major at 40%.
[AGENT][NEUTRAL] And you know what, I can do it this way. The frequency is maximum of 1 per seven-year period.
[CUSTOMER][NEUTRAL] For the SSCs.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm not familiar with the abbreviations for those two codes.
[CUSTOMER][NEUTRAL] OK, for those two codes you say once every 7 years?
[AGENT][NEUTRAL] And then it also has limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2934 is not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3220 is major at 40% with no frequency or no limitation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 01510 is under preventative at 100%.
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] Um, limited to two oral evaluations in any combination for 12-month period. It is paired with um 120, 140, 150, 160, or 180.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 1516, 1517, 1354 are all not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1351 is preventative at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only.
[AGENT][NEUTRAL] And limited to dependent children under age [PII].
[AGENT][NEUTRAL] Um, 7961 and 7962 are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2940 is preventative at 100%.
[AGENT][NEUTRAL] Um, the limitations are replacement of existing only is in place for 24 months.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And hold on one second. Let me make sure this is an I and not a lowercase l. Hold on one moment.
[AGENT][NEUTRAL] That's a, um, and maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then 3120 is major at 40% with no limitation.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] For the bite wings and for panel frequency, what's the panel frequency?
[CUSTOMER][POSITIVE] And by wing frequency I'm sorry.
[AGENT][NEUTRAL] Bite wings are once every 12, or once per 12 month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Full mouth X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] Um, exams.
[AGENT][NEUTRAL] Our 2 for 12 month period.
[CUSTOMER][NEUTRAL] Any time?
[AGENT][NEUTRAL] What, what do you mean anytime?
[CUSTOMER][NEUTRAL] Like they can come 2 times any time of the year? Like if they come, OK, and then pro fee.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Once every 6 months?
[CUSTOMER][NEUTRAL] And the fluoride.
[AGENT][NEUTRAL] Uh, let me see if there's a frequency.
[AGENT][NEUTRAL] Children.
[AGENT][NEUTRAL] Do you have a coat for fluoride cause that's not.
[CUSTOMER][NEUTRAL] Um, give me one second, let me ask somebody.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] On this frequency. OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] While she's getting the code, I do have a code for 4910.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] The name.
[AGENT][NEUTRAL] 4910 is under major at 40%.
[CUSTOMER][NEUTRAL] OK, and for Fluoride I have the, I'm sorry, for [PII] I have the code 1208.
[AGENT][NEUTRAL] Was a
[AGENT][NEUTRAL] With the, did you need the limitation for the other code?
[CUSTOMER][NEUTRAL] Uh, oh yes, yes, sorry.
[AGENT][NEUTRAL] For 4019.
[AGENT][NEUTRAL] It's a maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um for fluoride I have D121208.
[AGENT][NEUTRAL] 1208.
[AGENT][NEUTRAL] Um, 1208 is not a cover code on, on this fax bag.
[CUSTOMER][NEUTRAL] OK, before it's not covered um for preventative it's 100%, right? And what is go ahead. I will take it out because it will be difficult to be with the.
[AGENT][NEUTRAL] Mhm. Preventative is a 1.
[AGENT][NEUTRAL] Preventative is 100, basic, basic restorative, radiographs and FMX are all at 80%.
[AGENT][NEUTRAL] And then major um has a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, once you get it, you know, it's a show that's hang on.
[AGENT][NEUTRAL] And it's at 40%?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, for, for us, major includes endodontic, periodontic, proteodontic, and oral surgery.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, give me one second. 12 month major, um, and so root canal falls under that, so that's 40%. That's also in period so this SRP, the periodDonnell scaling, that's also falls under major.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, periodonic, mhm.
[CUSTOMER][NEUTRAL] OK, so 40, um, can I get the frequency for that as well?
[CUSTOMER][NEUTRAL] Then you need insight.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For, um, like, do you have, I would need codes because I'm not, I don't.
[CUSTOMER][NEUTRAL] OK, let me get the code. That's fine. I'll get the code 4341.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 4341, let me see, let me see.
[AGENT][NEUTRAL] Um, maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you do all four quads on the same day? Yes ma'am, and then for a major, um, it would it be paid on prep or delivery date cet date?
[AGENT][NEUTRAL] Um, you can, there's no specification for that part.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, either or.
[CUSTOMER][NEUTRAL] Uh, yeah, I'll let you know. OK. And um for posterior composite, uh, let me see if I can get you a code for filling sorry about that, um, code I can give you 2392 or 2391.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Um, 2392 is not covered. 2390, hold on one second. That wasn't 91 that you gave, that was 34. Hold on one second.
[CUSTOMER][NEUTRAL] there.
[CUSTOMER][NEUTRAL] So we got one out and tell you what.
[CUSTOMER][NEUTRAL] From the temporary I can't give give you the detail.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 2931, this is 23. Hold on one second.
[CUSTOMER][NEUTRAL] Yes, OK, alright, take a seat, OK.
[AGENT][NEUTRAL] So it's under major at 40%?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Major at 40.
[AGENT][NEUTRAL] And the limit, the limitation, um, maximum of 1 per 7-year period and limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK, and do they, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK, um, I'm sorry, did you say that they downgrade?
[AGENT][NEUTRAL] Oh, there's no downgrade.
[CUSTOMER][NEUTRAL] No downgrades, OK, and um.
[CUSTOMER][NEUTRAL] I just have 2950, 2740, and 2954. I have to ask those questions.
[AGENT][NEUTRAL] 2950, 29, what can you say that again?
[CUSTOMER][NEUTRAL] 295027402954.
[AGENT][NEUTRAL] Hold on one moment. 2950.
[AGENT][NEUTRAL] 7:40.
[AGENT][NEUTRAL] 2954.
[AGENT][NEUTRAL] OK, so they're all the same major at 40%?
[AGENT][NEUTRAL] The limitations are maximum of 1 per seven-year period.
[AGENT][NEUTRAL] And limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] OK, um, and.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII] to my last name is [PII].
[CUSTOMER][NEUTRAL] [PII], sorry
[CUSTOMER][NEUTRAL] OK, um, I just need, what is the name of the insurance? I'm sorry.
[AGENT][NEUTRAL] So our company is American Public Life. Um, let me see if this is on Carrington. Hold on one second.
[AGENT][NEUTRAL] Yeah, this isn't on Carrington. So it's American Public Life.
[CUSTOMER][NEUTRAL] So the fee schedules American Public Life.
[CUSTOMER][NEUTRAL] Or that's just the name of the insurance?
[AGENT][NEUTRAL] Right, it's just that, that's the name of the insurance company. This is just a standard fee schedule.
[CUSTOMER][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] And you said the fee schedule is just a standard fee schedule?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] and then can I have the um
[CUSTOMER][NEUTRAL] Address of the insurance.
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] um and can I have the payer ID?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] And um what day was this insurance effective?
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And the company name?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the insurance is through is with the company.
[CUSTOMER][NEUTRAL] Like it's the company's name, the insurance, the name of the company.
[AGENT][NEUTRAL] Yes, some of our dental policies are on Carrington network. This one is not. It's just APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] APL OK and um are you guys in network with us?
[AGENT][NEGATIVE] There's no network. This, this policy doesn't have a network.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and is this insurance in a calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And OK, that's it, uh, just a reference number if that's possible.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, thank you, thank you, Miss [PII]. You have a good day.
[AGENT][POSITIVE] You're welcome, sir. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No ma'am, that'll be it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] That.