AccountId: 011433970860
ContactId: b001f334-c0d7-43ee-8c87-bb10b2cbd5de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 837820 ms
Total Talk Time (AGENT): 267079 ms
Total Talk Time (CUSTOMER): 232315 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/b001f334-c0d7-43ee-8c87-bb10b2cbd5de_20250501T16:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is KQ. May I help you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to verify benefits for a patient. Can you help me with that?
[AGENT][POSITIVE] Yes, ma'am. I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] Yeah, because, uh, she was here already in January.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, [PII], I'm sorry.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy number is gonna be.
[CUSTOMER][NEUTRAL] 02585603
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah, it should be in the form for.
[AGENT][NEUTRAL] And do you have a callback number in case the call dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is gonna be.
[CUSTOMER][NEUTRAL] [PII] something like that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And you say you're calling to verify benefits for this patient, correct?
[CUSTOMER][POSITIVE] Correct for dental.
[AGENT][NEUTRAL] Oh, OK, it is a dental policy. OK, I show effective date of [PII], policy is active, and now you just need a general breakdown or I can send you a fax back?
[CUSTOMER][NEUTRAL] Can you tell me what type of insurance this is? Is it a PPO policy?
[AGENT][NEUTRAL] Uh, no, there's no preferred provider. The policy is just a group dental, uh, to where they can go to any dental provider and we just pay according to the UCR.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do we just um charge them UCR fees and then they give you what they paid?
[AGENT][NEUTRAL] Uh, you can just submit the claim to our office for processing and then it states patient responsibility on the EOB once received.
[CUSTOMER][NEUTRAL] Oh, OK, because I've never heard of this. Do you know what fees, so it's under UCR, right?
[AGENT][NEUTRAL] We pay by UCR, correct.
[CUSTOMER][NEUTRAL] Does she have a fre like is there frequency to her her um treatment on here?
[AGENT][NEUTRAL] Yes, there's frequency and limit uh limitations. Yes, ma'am.
[CUSTOMER][NEUTRAL] On this insurance?
[CUSTOMER][NEUTRAL] So we would be under UCR, OK, so give me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I have to get a verbal breakdown from you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claims address would be the [PII], right?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it would be under UCR.
[CUSTOMER][NEUTRAL] And you said we would just send that to the claims address correct?
[AGENT][NEUTRAL] Uh, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Effective day [PII] and what's the maximum on her policy?
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification coverage. She has a benefit max up to 1500 per calendar year.
[CUSTOMER][NEUTRAL] What's um does she have a deductible?
[AGENT][NEUTRAL] She has a, has a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEGATIVE] Give me 1 2nd because I did this wrong.
[CUSTOMER][NEUTRAL] So $500.05 5 $1500 right max.
[AGENT][NEUTRAL] Uh, $1500 benefit max, $50 deductible.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh, what's your preventative basic and major?
[AGENT][NEUTRAL] Uh, preventative pays 100% of UCR.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80% and for major services it pays at 40%.
[CUSTOMER][NEUTRAL] OK, perioendo and oral surgery falls under what?
[AGENT][NEUTRAL] Uh, they found a major.
[AGENT][NEUTRAL] Oh, and for major services, there is a 12-month waiting period.
[CUSTOMER][NEUTRAL] So everything perioendo, and oral surgery is all under major, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, let me put that in the notes.
[CUSTOMER][NEUTRAL] What's uh when does the waiting period end?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You said [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and we can start with her exams [PII], and [PII].
[AGENT][NEUTRAL] Uh, exams are 2 for 12-month period and all exams share the same frequency.
[CUSTOMER][NEUTRAL] Mm, the regular pro fee?
[AGENT][NEUTRAL] Uh, once every 6 months.
[CUSTOMER][NEUTRAL] Fluorine.
[AGENT][NEUTRAL] Uh, under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] Was that for crown?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 0274 is a bye wings.
[AGENT][NEUTRAL] Bite wings, uh, sorry, it's once every 12 months.
[CUSTOMER][NEUTRAL] And that's for the child too?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Same frequency for children?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and vertical by 10277?
[AGENT][NEUTRAL] Uh, fall on a preventative and I don't, uh, once every 5 years.
[CUSTOMER][NEUTRAL] 90,210.
[AGENT][NEUTRAL] Uh, full mouth and panoramics are once every 5 years, and they do share a frequency.
[CUSTOMER][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] And that's preventative correct?
[AGENT][NEUTRAL] Uh, no, uh, FMX panel falls on a major, uh, basic, sorry.
[CUSTOMER][NEUTRAL] OK, the PA.
[AGENT][NEUTRAL] Uh, there's no frequency in a phone or basic.
[CUSTOMER][NEUTRAL] And 1351 which is the one?
[AGENT][NEUTRAL] Uh, Clans under the age of [PII], once every 3 years, permanent molars online.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Once every 3 years.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And what's the age limit again?
[AGENT][NEUTRAL] Under [PII].
[CUSTOMER][POSITIVE] Under [PII], thank you so much. 4355 which is uh uh full mouth department.
[AGENT][NEGATIVE] Uh, once every 24 months and it falls under major.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] Uh, it's once every 6 months. Is major.
[AGENT][NEGATIVE] And it does not share frequency with the regular cleaning.
[CUSTOMER][NEUTRAL] Um, and what's the limitation after an SRP? How many days?
[AGENT][NEUTRAL] Uh, there's no limitation.
[CUSTOMER][NEUTRAL] Uh, 4341.
[AGENT][NEUTRAL] Uh, once every 24 months.
[CUSTOMER][NEUTRAL] And how many uh calls could be done on the same day?
[AGENT][NEUTRAL] All 4 can be done on the same day.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] How many days apart from the.
[CUSTOMER][NEUTRAL] Oh, never mind. That doesn't go to that 4381 is it the Rustin.
[AGENT][NEUTRAL] Said 4381.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Uh, I don't show a frequency, but it does fall on a major.
[CUSTOMER][NEUTRAL] Major 4 to 12.
[AGENT][NEUTRAL] 42
[AGENT][NEGATIVE] I don't show it's being covered.
[CUSTOMER][NEUTRAL] OK 4249.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] See 249 falls under major and it shows it's.
[AGENT][NEUTRAL] One each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK and uh fillings?
[AGENT][NEGATIVE] Uh, fillings are once every 24 months and they fall on our basic.
[CUSTOMER][NEUTRAL] Are they downgrading?
[AGENT][POSITIVE] Uh, there are no downgrades for fillings or for crowns.
[CUSTOMER][NEUTRAL] OK, what is the um 2740 frequency?
[AGENT][NEUTRAL] 27.
[AGENT][NEUTRAL] Uh, it's once every 7 years.
[CUSTOMER][NEUTRAL] Um, is the build up, um, covered, and is, uh, is it available on the same day as the crown?
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] Uh, let's see. So it's 1 for 7 years, but it doesn't have any stipulation of time before or after or during a crown.
[CUSTOMER][NEUTRAL] Do you guys pay on seat date or prep date for crowns?
[AGENT][NEUTRAL] Uh, either or.
[CUSTOMER][NEUTRAL] OK, 2620.
[AGENT][NEUTRAL] C 2620.
[AGENT][NEUTRAL] Uh, once every 7 years is considered major.
[CUSTOMER][NEUTRAL] Um, dentures.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 5110.
[AGENT][NEUTRAL] Dentures are partials and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] Um, and implants.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] Is that Closer guard?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it is considered major and it is once every.
[AGENT][NEUTRAL] Let me double check
[AGENT][NEUTRAL] Oh, once every 7 years.
[CUSTOMER][NEUTRAL] It's every 7 years.
[CUSTOMER][NEUTRAL] Um, bone grass 7953.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] And is there an ortho coverage under this plan?
[AGENT][NEUTRAL] Uh, no, ma'am. Ortho is not covered.
[CUSTOMER][NEUTRAL] I just need a reference number for this call and.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, what's your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] OK, and when your is your appointment, ma'am?
[CUSTOMER][NEUTRAL] And is there a payer ID to this plan?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And is there anything else I, oh, I'm sorry, say again.
[CUSTOMER][NEUTRAL] 608.
[CUSTOMER][NEUTRAL] What was that thing?
[AGENT][NEUTRAL] Uh, the payer ID is 60801.
[CUSTOMER][NEUTRAL] The pay ID again?
[CUSTOMER][POSITIVE] Yeah perfect thank you so much for your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that'll be it thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.