AccountId: 011433970860
ContactId: b2153315-abe5-4893-bdca-857f1640225d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500989 ms
Total Talk Time (AGENT): 201577 ms
Total Talk Time (CUSTOMER): 182595 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/b2153315-abe5-4893-bdca-857f1640225d_20250213T16:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with the dental office, and I was just calling to get a patient's breakdown of benefits, please.
[AGENT][NEUTRAL] OK, I can verify benefits for you. Uh, Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Yes, I have 02441140.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Um, yes, it is [PII] Last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy, and I just need a general breakdown or I can send you a fax back.
[CUSTOMER][NEUTRAL] Yes, I do need a general breakdown.
[AGENT][NEUTRAL] OK, not a guarantee of payment, just verification of coverage. She has a benefit max up to $1500 per calendar year and a $50 deductible, excuse me, that is applied to everything but preventative.
[AGENT][NEUTRAL] Uh, preventative pay is 100% of UCR.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80% and major services pay at 40%, and they are eligible for major. They passed the waiting period.
[CUSTOMER][NEUTRAL] OK, and then what are endoperio and oral surgery? Are they basic or major?
[AGENT][NEUTRAL] Um, major.
[CUSTOMER][NEUTRAL] Major, OK.
[CUSTOMER][NEUTRAL] OK, and then what is the um PO box for claims?
[AGENT][NEUTRAL] PO Box 248,950.
[AGENT][NEUTRAL] Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and can you give me the group name and the group number?
[AGENT][NEUTRAL] Sure, give me a moment.
[AGENT][NEUTRAL] Uh, group number 14585.
[AGENT][NEUTRAL] You know, uh, group name Universal Trucking, Anderson Van.
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Alright, and have they, have they used any of their benefits this year or met their deductible?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and the um pro fee, how what is the frequency on that?
[AGENT][NEUTRAL] Uh, cleanings are once every 6 months.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and does it share frequency with the um with the perio maintenance?
[AGENT][NEGATIVE] Uh, it does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then exams.
[AGENT][NEUTRAL] Uh, exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And a panoramic or FMX.
[AGENT][NEUTRAL] Oh, once every 5 years.
[CUSTOMER][NEUTRAL] OK, and do they have history of that?
[AGENT][NEUTRAL] Um, not for panel or FMX, but they do have a history of bite wings, which are once every 12 months and an exam, and both of those were on [PII] or [PII].
[CUSTOMER][NEUTRAL] OK, and then are uh are sealants covered under this plan?
[AGENT][NEUTRAL] Uh, ceilings are under the age of [PII], once every 3 years, permanent molars only.
[CUSTOMER][NEUTRAL] And are those at 100 or 80%?
[AGENT][NEUTRAL] Uh, they fall on their preventive, so it's 100% of UCR.
[CUSTOMER][NEUTRAL] OK, and fluoride.
[AGENT][NEUTRAL] Uh, Florida is under the age of [PII], once every 12 months, and they also follow on the preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um a gingival scaling with inflammation or D4346.
[AGENT][NEUTRAL] Get that one more time. D43. OK.
[CUSTOMER][NEUTRAL] Yep 46.
[AGENT][NEUTRAL] 3434.
[AGENT][NEGATIVE] I do not show that it's covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then Aperio Maintenance D4910.
[AGENT][NEUTRAL] Uh, it falls under major, so it pays at 40% and it's once every 6 months.
[CUSTOMER][POSITIVE] Perfect and then a full mouth debridement D4355.
[AGENT][NEUTRAL] Um, that is once every 24 months, and it is major.
[CUSTOMER][NEUTRAL] And then a SRP or scaling and root planning D4341.
[AGENT][NEUTRAL] Uh, 1 for 24 months per quadrant, all four quads could be done on the same day.
[CUSTOMER][NEUTRAL] OK, and is there a healing period or waiting period between period maintenance after SRP?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then um what is the frequency for a crown?
[AGENT][NEUTRAL] Uh, crowns are once every 7 years.
[CUSTOMER][NEUTRAL] OK, and are they paid on prep or seat date?
[AGENT][NEUTRAL] Uh, either it or.
[CUSTOMER][NEUTRAL] OK, and do they downgrade, um, posteriors?
[AGENT][NEUTRAL] Uh, no, ma'am. There are no downgrades.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then for composite fillings, what would the frequency on those be?
[AGENT][NEUTRAL] Uh, once every 24 months and there is no downgrade.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then denture frequency, is it the same as the crown frequency?
[AGENT][NEUTRAL] Um, dentures, uh, dentures and partials are once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then for an accrual guard D9944, are those covered under this plan?
[AGENT][NEUTRAL] It is covered as major and it is once every, I think it's.
[AGENT][NEUTRAL] Mm. It's once every 7 years.
[CUSTOMER][NEUTRAL] OK, and is it for breaks only?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and let's take a look here.
[CUSTOMER][NEUTRAL] Just double checking everything that we got everything. And was there any other histories on file besides that exam and bite lien?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, nothing that would affect their frequency.
[CUSTOMER][NEUTRAL] OK, and then do they have a missing tooth cloth?
[AGENT][NEUTRAL] Uh, yes, there is a missing tooth clause.
[CUSTOMER][NEUTRAL] OK, is there any implant coverage or orthodontic coverage?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and can I just have a reference number for this call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, and can you repeat your name for me please?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Perfect, thank you so much for all your help today, [PII]. I really appreciate it.
[AGENT][POSITIVE] Uh, you are welcome, Ms. [PII], and thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Alright, have a wonderful day. bye bye.
[AGENT][NEUTRAL] You too. Bye.