AccountId: 011433970860
ContactId: ae379856-55fa-4645-9d34-32de178de3b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 790719 ms
Total Talk Time (AGENT): 250355 ms
Total Talk Time (CUSTOMER): 348324 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/ae379856-55fa-4645-9d34-32de178de3b1_20250403T19:01_UTC.wav
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[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, hello, um, I'm [PII]. I'm calling on behalf of the provider's office for the verification of eligibility and benefits on recorded line. Help me with that.
[AGENT][POSITIVE] I am so sorry, what is your name?
[CUSTOMER][NEUTRAL] Oh yes. My name is [PII]. And may I have yours as well?
[AGENT][NEUTRAL] Yes, [PII]. My name is [PII]. My last initial is [PII]. What, yes, thank you. What is your callback number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number?
[CUSTOMER][NEUTRAL] The policy number I have here is 02441159.
[AGENT][NEUTRAL] OK, I have that as 02441159. Thank you. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. Patient's first name here is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that verification process and you're calling to verify benefits for this member, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, I can help you with that. Uh, this number shows effective as of [PII], and this policy shows active for dental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] I can send over a fax back for you. You're welcome if you would like.
[CUSTOMER][NEUTRAL] Uh, I actually, I do have an appointment for this patient. I, we need to do it through calls. Is it OK if we can do it, uh, verb? Is that all right?
[AGENT][POSITIVE] Of course, I was just offering it fax back to you if you needed one. Thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, OK, let me just confirm the few informations I have here in my end, [PII], thank you very much. So let me just, thank you. Let me just start off from the group name group number that I have. The group name is Universal Tracking group number 15844.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, plan runs in calendar year and the COP standard.
[AGENT][NEUTRAL] Plan runs on a calendar year. It follows UCR usual customer and reasonable rates.
[CUSTOMER][POSITIVE] Mhm. Thank you very much. And I do have here the uh an annual max of $1500.50 dollars individual deductible, and $150 for family.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Thank you very much for confirming. And I do have here that the plan has no coverage for orthodontics, no missing tooth cloth supplies.
[CUSTOMER][NEUTRAL] Uh, oh, no, I'm sorry. There is a missing tooth cloth supplies and uh help me check the uh waiting period, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct. There is no orthodontic coverage. There is a missing tooth clause, and there is a 12-month waiting period for major services.
[CUSTOMER][NEUTRAL] OK, gotcha. Thank you very much for that. And uh just to confirm, uh, is there any used amount for this year from the annual max and may I know deductible me or not as well, please?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK. Thank you very much. And I do have here as well that this plan cover 100% for diagnostic preventive, AD for basic, and 40 for major.
[AGENT][NEUTRAL] According to which diagnostic procedure is billed, it may fall under preventative or basic.
[AGENT][NEUTRAL] But preventative is covered at 100% and basic at 80 and major will be covered at 40 or actually is covered at 40%. The 12 month waiting period has been met.
[CUSTOMER][NEUTRAL] OK, gotcha. OK.
[CUSTOMER][NEUTRAL] It should
[CUSTOMER][NEUTRAL] Oh, this so one wait here has already been met. OK, got you. Thank you very much. And then, uh, I do have your angel, the frequencies that was updated last year. So, uh, is there any changes or everything still the same?
[AGENT][NEUTRAL] There are no changes.
[CUSTOMER][NEUTRAL] No changes. OK. So since the frequencies still remain the same, uh, [PII], please help me here if there is any history on file for the patient that might affect the frequencies only.
[AGENT][NEUTRAL] I'm sorry, there is history on file for the patient. One moment, let me get that information for you.
[CUSTOMER][POSITIVE] Oh yeah, sure, thank you.
[AGENT][NEUTRAL] You're welcome. On [PII], the member had a pro fee.
[AGENT][NEUTRAL] Also bite wing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And an exam.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Help me again. OK, [PII]. Um, what was it again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, right wings exam and y. OK. Thank you very much. And is there any other history apart from that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm checking that for you now. One moment, thank you. [PII] and [PII].
[CUSTOMER][POSITIVE] OK. Oh, that's perfectly fine. I do apologize.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] The member had
[AGENT][NEUTRAL] FMX on [PII], uh, the member is not eligible for FMX or PA those share this one for five year period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got you. Thank you very much.
[CUSTOMER][NEUTRAL] And uh please help me check for SRP just in case if uh if there's 6 for the last two years.
[AGENT][NEUTRAL] OK, SRP.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] with that
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Moment.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Of the remaining
[AGENT][NEUTRAL] No, no history for SRP.
[CUSTOMER][POSITIVE] Thank you very much, [PII], for all the information that you in part to me for this patient. And uh shall we move on to the next patient that I have here, please?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] all that.
[CUSTOMER][NEUTRAL] Oh yeah sure.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Mhm. Policy number I have here is 02033644.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. Patient's name here is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, this member shows effective as of [PII]. This policy shows currently active for the member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you very much. And first, can you please help me with the fees schedule and the claim mailing address for this patient plan?
[AGENT][NEUTRAL] OK, this plan does participate in the Carrington PPO network.
[AGENT][NEUTRAL] And if the provider is not a participant of the network, it will follow UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And our mailing address for claims it is APL [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, [PII].
[AGENT][NEUTRAL] Oklahoma City, Oklahoma.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you very much. And may I have the group name, group number, please?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 70052.
[AGENT][NEUTRAL] Group name is Oxford Global Resources.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is APL
[AGENT][NEUTRAL] No, the group number is 70052 and the group name is Oxford Global Resources.
[CUSTOMER][NEUTRAL] OK, Oxford. OK, one moment. OX.
[CUSTOMER][NEUTRAL] Oxford Global Resources, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, got you. Thank you very much for that. And may I have here the effective date once again, the benefit period and the COB please?
[AGENT][NEUTRAL] The effective date shows [PII].
[AGENT][NEUTRAL] Shows current.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The plan follows UCR. We do not coordinate benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What other information do you need?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Uh yeah, help me with the annual max deductible used amount, and may I know deductible me not as well, please?
[AGENT][NEUTRAL] Please note verification of benefits provided does not guarantee payment $500 max $50 deductible. Nothing has been used or met. There's no history on file.
[CUSTOMER][POSITIVE] OK, thank you very much for that. And may I have here if there is any orthodontics coverage missing tooth cloths and waiting period, please?
[AGENT][NEGATIVE] There is no missing, excuse me, there is no orthodontic coverage. There is a missing tooth clause.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And what about the waiting period?
[AGENT][NEUTRAL] There is no waiting period.
[CUSTOMER][POSITIVE] OK, thank you very much for confirming. And um
[CUSTOMER][NEUTRAL] OK, can, may I help you, please, the co-insurance for diagnostic preventative, basic and measure?
[AGENT][NEUTRAL] There is no major coverage. Preventative is covered at 100% and basic at 80%.
[CUSTOMER][POSITIVE] OK. Thank you very much. So, uh do you downgrades and pastry composites?
[AGENT][POSITIVE] There are no downgrades on the policy.
[CUSTOMER][POSITIVE] OK, got you. Thank you very much. And then for uh SRP for Mart department arrested and pay maintenance, they are covered, right?
[AGENT][NEUTRAL] No, those are not covered. Those are considered major under this plan.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, OK, got you. Thank you very much for that, [PII], and would you please help me here with the frequencies for all the services in the preventative and basic, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time? I'm sorry, you're talking too fast.
[CUSTOMER][POSITIVE] Oh, I'm sorry. Thank [PII] you're letting me know or else.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the frequencies for the services and the preventative, like the frequencies for periodic exam? Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, thank you. So for profies those are once every 6 months.
[AGENT][NEUTRAL] Exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Might wings a 1 per 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me. Fluoride is 1 per 12 month period under the age of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And FMX and pans those actually fall under basic and those are 1 per 5 year period.
[CUSTOMER][NEUTRAL] 145 year period. OK. And what about ceiling, is it covered?
[AGENT][NEUTRAL] Um, sales and covered for dependent children under the age of [PII]. Those are 1 per 36 months, permanent molar teeth only.
[CUSTOMER][NEUTRAL] OK. Thank you very much for that. And just to confirm, uh, anesthesia and uh aguzal guard, are they covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, OK, thank you very much once again for all those information. I don't have any more questions to ask regarding the patients that I have for today. It's been a pleasure talking to you, and I hope you have a great day ahead. Looking forward to talk to you again soon. Thank you.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling AL. Take care. Thank you. Thank you. I appreciate that.
[CUSTOMER][POSITIVE] You've been so kind. Thank you very much. You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.