AccountId: 011433970860
ContactId: ae373591-1d55-422d-ad75-2226445046b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565119 ms
Total Talk Time (AGENT): 238741 ms
Total Talk Time (CUSTOMER): 128110 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/ae373591-1d55-422d-ad75-2226445046b3_20250407T20:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Marketenter to verify patient and eligible and benefits.
[AGENT][NEUTRAL] OK and what was the name of the dental office you were calling from again please [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's from [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're wanting the eligibility and benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, sir. And what's the patient's date of birth, policy number?
[AGENT][NEUTRAL] A name.
[CUSTOMER][NEUTRAL] Uh, the date of birth on, yeah, date of birth was on [PII].
[CUSTOMER][NEUTRAL] And the patient's first name is uh [PII]. It's spelled as [PII] and the last name is uh [PII]
[AGENT][NEUTRAL] OK, and what is um the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it is uh 614283.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And if you can give me your fax number, I'll send you a fax back with the benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what was the termination date of this patient?
[AGENT][NEUTRAL] There's no termination date. The policy is active.
[AGENT][NEUTRAL] And what is your fax number?
[CUSTOMER][NEUTRAL] Sorry, what was the effect you did?
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][NEUTRAL] OK. So is there any possible to provide me the details in the call?
[AGENT][NEUTRAL] I can provide the details in the call.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me pull up his benefits real quick.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and what are your questions?
[CUSTOMER][NEUTRAL] Yeah, so for this patient, what was the individual family deductibles and yearly max amount?
[AGENT][NEUTRAL] OK, and this is just to verify benefits. It's not a guarantee of payment. The calendar year maximum is $1000 calendar year deductible is $50 per covered insured up to $150 for family.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what are the preventative, basic and the major coinsurance percentage?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, this uh policy goes by benefit amount.
[AGENT][POSITIVE] It's a set benefit amount.
[AGENT][NEUTRAL] So I'll need to send you the fax back so you can see that.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, no, just confirm me the percentage for the preventive of basic and the major services.
[AGENT][NEUTRAL] It doesn't go by percentage.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Can you please confirm the group number?
[AGENT][NEUTRAL] What can you repeat the question?
[CUSTOMER][NEUTRAL] Can you please confirm the group number?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, the group number is.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] It's actually their group number. This is an individual covered policy that is uh self.
[AGENT][NEUTRAL] Paid.
[CUSTOMER][NEUTRAL] Uh, just confirm me it's in a, uh, PPO plan or uh co-pay plan?
[AGENT][NEUTRAL] It is uh an individual policy.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] That goes by a set amount per covered procedure.
[CUSTOMER][NEUTRAL] OK, so for this patient, there is no group name and the group number, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And uh just confirm me the patient is in a Patola?
[AGENT][NEUTRAL] The patient is where, sir?
[CUSTOMER][NEUTRAL] Patient isn't a policyholder.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is there any waiting period and missing clause on this file?
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Period and no tooth claws.
[CUSTOMER][NEUTRAL] OK, and is there any history on the file that affect your frequency?
[AGENT][NEUTRAL] The frequency?
[AGENT][NEUTRAL] OK, so this is the
[CUSTOMER][NEUTRAL] That which effects a fren history.
[AGENT][NEUTRAL] OK, so let me give you the frequencies first.
[AGENT][NEUTRAL] Um, oral examinations are once every 6 months, cleanings are once every 6 months, bite wings are once every 6 months. Full mouth panoramics are once every 3 years, crowns and bridges are 1 every 5 years. Partials and dentures are 1 every 5 years.
[AGENT][NEUTRAL] Prophylaxis is once every 3 months. Full mouth debridement is once every 12 months. Gingividal cutterage or periodontal scaling is once every 12 months per quadrant. Fluoride is once every 12 months and sealants is once every 3 years. And the fluoride is limited to persons under [PII] of age. sealants are limited to persons under [PII] of age.
[AGENT][NEUTRAL] And, uh, this policy.
[CUSTOMER][NEUTRAL] OK. Uh, is there any history?
[AGENT][NEUTRAL] Let me look and there the policy does have a missing tooth clause and the policy does not grant downgrade.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, can you give me the procedure code for to look for history?
[CUSTOMER][NEUTRAL] Uh, that which affecting on the frequency for grounds, bridges, exams, and X-rays.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, I just gave that to you. Crowns and bridges is once every 5 years.
[CUSTOMER][NEUTRAL] Yeah, so is there any history on that?
[AGENT][NEUTRAL] OK, I'll need the procedure code please.
[CUSTOMER][NEUTRAL] Uh, it is 2740.
[AGENT][NEUTRAL] 2740. OK, let me look it up real quick.
[AGENT][NEUTRAL] OK, I do not see.
[AGENT][NEUTRAL] That that is um
[AGENT][NEUTRAL] A code that's been used for history.
[CUSTOMER][NEUTRAL] OK, for the code of 0150,0120 and 0140 enter the exams.
[AGENT][NEUTRAL] OK, you'll have to give me codes one at a time so I can review them. What was the first one?
[CUSTOMER][NEUTRAL] It is 0150.
[AGENT][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] OK, and the next code is uh
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEUTRAL] And I'm not showing that code either.
[CUSTOMER][NEUTRAL] OK, then got it. Can I get your call reference number?
[AGENT][NEUTRAL] Yes, sir, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] And could you spell your name? [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah, don't worry, got it. I'm done with my patience and I'm really appreciate for your time and patience and have a great day. Bye for now.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL. You have a good day also. Mm bye bye.
[CUSTOMER][NEUTRAL] Yeah.