AccountId: 011433970860
ContactId: b1b5bf1f-9624-4492-aa92-976e71ea10d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1349160 ms
Total Talk Time (AGENT): 488562 ms
Total Talk Time (CUSTOMER): 368150 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/b1b5bf1f-9624-4492-aa92-976e71ea10d6_20250311T21:50_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Recoin Dental. How are you doing today?
[AGENT][POSITIVE] I'm good. How about you, Miss [PII]?
[CUSTOMER][POSITIVE] Yeah, I'm doing good thank you. Thanks for asking. I'm calling to check eligibility and benefits. Can you please help me with that?
[AGENT][POSITIVE] Sure, I can assist you with eligibility and benefits. And may I have your callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] It's our callback number is [PII]. There's no extension.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It's a policy ID. It's D for Delta 43722698.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be our number.
[CUSTOMER][NEUTRAL] OK, can you please do name and date of birth search for this patient?
[AGENT][NEUTRAL] OK, what's the spelling of the last name?
[CUSTOMER][NEUTRAL] OK, the patients for last name it's spells with a [PII], and it's the date of birth is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What's the first name?
[CUSTOMER][NEUTRAL] It's a patient. First name is [PII]. It's spells with [PII].
[AGENT][NEUTRAL] [PII]. OK, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I have it pulled up and you say you need eligibility and benefits. You need, you need this information given to you verbally faxed over to you.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the call?
[AGENT][NEUTRAL] Over the phone. Do you have a specific question or you need a full breakdown?
[CUSTOMER][NEUTRAL] I have some specific questions. Can you please help me with the yearly max amount along with the coinsurance percentages like preventative to basic nature?
[AGENT][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] This is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And with this one, we have a calendar year maximum of $500 with the $50 deductible. This is one of our basic dental policies, so major is not included. So endoontics, periodontics, prostagonic, repair, and oral surgery are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for the percentages, we have, uh, preventative is cover 100%, radiograph FMXs cover 80%, basic expense and basic restorative expenses cover 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, can you please confirm with me the group name and group number?
[AGENT][NEUTRAL] Sure, OK, let's see.
[AGENT][NEUTRAL] OK, the group name is MAU, the number 70056.
[CUSTOMER][NEUTRAL] Oh, can you please repeat that? I could not capture the number.
[AGENT][NEUTRAL] The number is 70056.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] And it so can you please confirm with me the group name?
[AGENT][NEUTRAL] MAU.
[CUSTOMER][NEUTRAL] M
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any full form for the MAU?
[AGENT][NEUTRAL] A phone number?
[CUSTOMER][NEUTRAL] Uh-huh I'm asking the group name. You said that his full name.
[AGENT][NEUTRAL] Or a full name.
[AGENT][NEUTRAL] The, the full name, OK, it's Man.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Analysis.
[AGENT][NEUTRAL] And utilization.
[CUSTOMER][NEUTRAL] Universation.
[AGENT][NEUTRAL] Utilization. It's UTI.
[CUSTOMER][NEUTRAL] Utilize.
[AGENT][NEUTRAL] L I
[AGENT][NEUTRAL] ZA
[AGENT][NEUTRAL] T I O N.
[CUSTOMER][NEUTRAL] Management analysis utilization, right?
[AGENT][NEUTRAL] Manage management analysis and utilization, correct.
[CUSTOMER][NEUTRAL] OK. Uh, and you provided that you before called to that, uh, you said that the member ID is incorrect, right? Can you please provide me the correct member ID?
[AGENT][NEUTRAL] OK, yes. The correct member ID is 02.
[AGENT][NEUTRAL] 16
[AGENT][NEUTRAL] 26
[AGENT][NEUTRAL] 97.
[CUSTOMER][NEUTRAL] It's 02162697 is the correct member ID and it's a group name is Man analysis utilization and it's group number.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] It's 7056, right?
[AGENT][NEUTRAL] 70056.
[CUSTOMER][NEUTRAL] 100.
[CUSTOMER][NEUTRAL] 756.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK, can you please confirm with me the claim's mailing address?
[AGENT][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and it's a company name is American Public Life, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, is the patient is a subscriber holder for this policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is this calendar year or physical year?
[AGENT][NEUTRAL] It's a calendar year plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please help me with the uh payer ID?
[AGENT][NEUTRAL] Sure, that's 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what can be the free schedule?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Fee, insurance fee schedule.
[AGENT][NEGATIVE] I'm not understanding, you said insurance should do.
[AGENT][NEUTRAL] She
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] What's the they should do?
[CUSTOMER][NEUTRAL] I'm asking that is there in-network benefits, right? Is there any specific uh insurance fee schedule?
[AGENT][NEUTRAL] I don't know what we should do.
[CUSTOMER][NEUTRAL] OK, uh, just pause that question and, uh, can you please confirm with me that it's the individual deductible is $50 and it's EL max is $500 right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Hi, is there any family deductible?
[AGENT][NEUTRAL] Um, yes, the family deductible is 150 if it's a family plan. This one is an individual plan.
[CUSTOMER][NEUTRAL] OK. Is there any pre-authorized over dollar amount?
[AGENT][NEUTRAL] There's no pre-authorization.
[CUSTOMER][NEUTRAL] OK. Does deductibles apply to the preventative and diagnostics?
[AGENT][NEUTRAL] Not preventative, yes, diagnostic.
[CUSTOMER][NEUTRAL] OK. And is there any waiting period for this policy?
[AGENT][NEGATIVE] Not for this one.
[CUSTOMER][NEUTRAL] OK, can you please confirm with me the effective date?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, the effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And is there any used amount or deductibles met amount?
[AGENT][NEUTRAL] Not for [PII].
[CUSTOMER][NEUTRAL] OK, and is orthodontics a covered benefit for this policy?
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] OK, and as you mention that it's uh prevent it is covered at 100% and uh.
[CUSTOMER][NEUTRAL] Major basic is 80% and there is no major services, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I have some set of codes. Can you please provide me the frequency and percentage for that quote?
[AGENT][NEUTRAL] OK, um, and I need them one by one and give me just a second, let me pull the schedule benefits.
[CUSTOMER][POSITIVE] It's OK, no problem. Take your time.
[AGENT][NEUTRAL] Go ahead with the first one.
[CUSTOMER][NEUTRAL] It's the first code is 7140.
[AGENT][NEUTRAL] 7140 and that's gonna be under basic which is 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any frequency?
[AGENT][NEUTRAL] Maximum of one time per tooth.
[CUSTOMER][NEUTRAL] It's one per lifetime, right?
[AGENT][NEUTRAL] That's an extra. Yeah, that's the, yeah, that's an extraction, so yeah, it's just one time.
[CUSTOMER][NEUTRAL] OK. Next code is 7210.
[AGENT][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] That one is not covered.
[CUSTOMER][NEUTRAL] 7220.
[AGENT][NEGATIVE] That one is not covered.
[CUSTOMER][NEUTRAL] 4260.
[AGENT][NEGATIVE] That one is not covered.
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] That one is not covered?
[CUSTOMER][NEUTRAL] 5110.
[AGENT][NEGATIVE] That one is not covered.
[CUSTOMER][NEUTRAL] 5911.
[AGENT][NEUTRAL] That one is not covered?
[CUSTOMER][NEUTRAL] 6056.
[AGENT][NEUTRAL] That one is not covered?
[CUSTOMER][NEUTRAL] 6240.
[AGENT][NEUTRAL] That one is not covered?
[CUSTOMER][NEUTRAL] 3330.
[AGENT][NEUTRAL] You said 3313.
[CUSTOMER][NEUTRAL] I'm so sorry I could not hear you. Your voice is break down. Can you please repeat that 3330?
[AGENT][NEUTRAL] Can you, can you repeat?
[AGENT][NEUTRAL] Repeat that number again. 3330?
[CUSTOMER][POSITIVE] Yes, you're absolutely right.
[AGENT][NEUTRAL] OK, so 3330 is not covered?
[CUSTOMER][NEUTRAL] 3310.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 022 0
[AGENT][NEUTRAL] OK, so that one is going to be under basic which is 80%, no limitation.
[CUSTOMER][NEUTRAL] OK, 4381.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 4355.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] 9230 not covered?
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9945.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 0120
[AGENT][NEUTRAL] OK, so that one is going to be under the preventative, which is um 100%.
[AGENT][NEUTRAL] And that one has a limitation of let's see. So that is limited to two oral evaluation and any procedures, a combination of 120, 140, 150, or 160 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 1 in 12 months, right?
[AGENT][NEUTRAL] It's gonna be limited to two evaluation procedures in any combination of 120, 140, 150, or 160 for 12 months.
[CUSTOMER][NEUTRAL] OK, it's 212 months for the 0120 and 0140 and 0160, right?
[AGENT][NEUTRAL] 20,150. Correct, yes.
[CUSTOMER][NEUTRAL] OK, 0210?
[AGENT][NEUTRAL] 0210, that's going to be on the FM radiograph FMX which is 80% and that one is limited to one X-ray procedure in any combination of 210, 277, or 330.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 1 in 3 years or 1 in?
[AGENT][NEUTRAL] 1 in 5 years.
[CUSTOMER][POSITIVE] OK, thank you, thanks for repeating that. It's uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's shared with the panel, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. 0274.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] All right, so that one is the bite wing which is preventative, that's cover 100%, and that one is going to be limited to one bite weigh um X-ray procedure in any combination of 270, 272, or 274 for 12 month period.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it's one in one year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and let's share with the 0272 also?
[AGENT][NEUTRAL] Mm, go back to it one moment.
[AGENT][NEUTRAL] It's a combination 270, 272, and 274.
[CUSTOMER][NEUTRAL] OK, 0367?
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 1120.
[AGENT][NEUTRAL] OK, so that's a prophy and that's under preventative and that one is maximum of 1 procedures every 6 months and it looks like this is for a child, so it's going to be limited to dependent children age [PII].
[CUSTOMER][NEUTRAL] OK, and 1208?
[AGENT][NEUTRAL] 1208.
[AGENT][NEUTRAL] OK, so that's gonna be the fluoride.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's preventative, which is 100% and it's going to be maximum of 1 procedure for 12 months and limit it to depend on children age [PII].
[CUSTOMER][NEUTRAL] Mhm it's shared with the 1206 also?
[AGENT][NEUTRAL] We um uh no, 1206 is not covered, just 1208.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK 1351?
[AGENT][NEUTRAL] 1351 that's yins, which is 100%, that's under preventative and that one has an age limitation of under the age of [PII], and application made to the permanent molar teeth only, a maximum of 1 procedure for 36 months.
[CUSTOMER][NEUTRAL] 1516.
[AGENT][NEUTRAL] 1516 is not covered.
[CUSTOMER][NEUTRAL] 2331.
[AGENT][NEUTRAL] OK, so that one is under basic restorative, which is 80%, and that one is going to be replaced assisting if in place for 24 months.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Months and 24 months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, 4341.
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] 9310, that's gonna be the consultation that's on the basic which is 80%, no limitation.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] 2950 is not covered.
[CUSTOMER][NEUTRAL] 919,110.
[AGENT][NEUTRAL] 9110, that's uh palliative and that's under basic which is 80%, no limitation.
[CUSTOMER][NEUTRAL] 923 9
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 9243.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 2930.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] OK so that is a pro fee, um.
[AGENT][NEUTRAL] And that's gonna be 100% because it's on the preventative, it's once every 6 months.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEGATIVE] 2740 is not covered.
[CUSTOMER][NEUTRAL] 4342.
[AGENT][NEGATIVE] That's not coming.
[CUSTOMER][NEUTRAL] OK, and uh post your composite 2391 is downgrades for amalga.
[AGENT][NEUTRAL] We don't downgrade.
[CUSTOMER][NEUTRAL] OK, and uh 4910 and 1110 share the frequency?
[AGENT][NEUTRAL] 49 2011, 100 is not covered.
[CUSTOMER][NEUTRAL] OK, does missing tooth cloth apply?
[AGENT][POSITIVE] There's no um missing tooth cloth on this one.
[CUSTOMER][NEUTRAL] OK, I may be prep date or see date?
[AGENT][MIXED] There's no coverage for that, but it it's a if it's covered, but there's no coverage under this one. It's OK.
[CUSTOMER][POSITIVE] OK, I'm so sorry for that question.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any history which is effective for the frequency in this fine?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There's no history on file.
[CUSTOMER][NEUTRAL] OK, and uh I'm just uh can just reconfirm me the group name. It's last name, last word. It's utilization, right? It's [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] I'm so sorry for the delay, just give me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] American Public Life uh group number 400568 management analysis utilization could be I plan I will uh new plan pay karna.
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK, and just confirm me the, what is the plan type?
[AGENT][NEUTRAL] Um, this is a dental plan, basic dental.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So it's a PPO uh individual uh co-pay plan?
[AGENT][NEUTRAL] Commercial.
[CUSTOMER][NEUTRAL] It's a big ride.
[CUSTOMER][NEUTRAL] OK, I'm done with the questions in this patient. Can you please help me with the call reference number along with your good name?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. My name is [PII], that's [PII], last [PII].
[CUSTOMER][POSITIVE] OK, thank you. Thanks for assisting me. It's nice talking with you. Have a great day and bye for now.
[AGENT][POSITIVE] You as well thank you for calling [PII]. Mm bye bye.
[CUSTOMER][NEUTRAL] Bye bye.