AccountId: 011433970860
ContactId: b5364204-8a2b-4672-ab5b-38149a2063a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511089 ms
Total Talk Time (AGENT): 151488 ms
Total Talk Time (CUSTOMER): 263923 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/b5364204-8a2b-4672-ab5b-38149a2063a8_20250203T23:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. I'm calling on behalf of the provider's office to check the eligibility and benefits for a patient on a recorded line. [PII], could you please help me with that?
[AGENT][NEUTRAL] I'm happy to check on benefits and eligibility, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It is 242-758-8.
[AGENT][NEUTRAL] Thank you for that. And then if I can get the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure, it is [PII], [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] So patient plan is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the
[AGENT][NEUTRAL] Would you like a fax back for a breakdown of benefits, or would you like to verbally go over them?
[CUSTOMER][NEUTRAL] Uh, yes, verbally, actually, I have only a few questions. So is the group name TRC Staffing Services Incorporated?
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the group number 70055?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Do you accept assignment of benefits?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, yes, we do, but it's not required.
[CUSTOMER][NEUTRAL] OK. So that means uh no assignment of benefits. I would say assignment of benefits not required.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I'll just update that. OK. And any waiting period, missing tooth cloths, UV standard or non-do?
[AGENT][NEUTRAL] Uh, no waiting period.
[AGENT][NEUTRAL] Uh, this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What were the other two questions? I'm sorry.
[CUSTOMER][NEUTRAL] COB is it standard or non-loop?
[AGENT][NEUTRAL] A standard
[CUSTOMER][NEUTRAL] OK. Standard COP.
[CUSTOMER][NEUTRAL] OK. Got that. And annual maximum, is it still the same $500?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Anything you out of $500?
[AGENT][NEUTRAL] Uh, let me check on that. One moment.
[CUSTOMER][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] 220.
[CUSTOMER][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] 426
[CUSTOMER][NEUTRAL] 9612.
[CUSTOMER][NEUTRAL] 1222.
[CUSTOMER][NEUTRAL] 7952.
[AGENT][NEUTRAL] Uh, patient still has the $500 left for the year.
[CUSTOMER][NEUTRAL] 231.
[CUSTOMER][NEUTRAL] OK, and individual and family deductible, are they still the same, 50 and 150?
[AGENT][NEUTRAL] Yes, correct. Patient has not met the deductible for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And or is not a covered benefit?
[AGENT][NEUTRAL] I'm so um ortho, let's see, uh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Orthodontic treatment is not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK, annual maximum does this applies to preventative services.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK. I actually have the previous plan of this patient. And as for that plan, the preventative basic, this is covered at 180 wherein measure is not covered. So, is it still the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and end of oral surgery not covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so is the plan still the same or any changes can you see?
[AGENT][NEUTRAL] No changes that I see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, OK, got that. OK, so 0140, do they share frequency and can the treatment be done on the same day?
[AGENT][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So please notify.
[AGENT][NEUTRAL] Uh, 0140 is not listed. 0150 is listed. It does share the same frequency with 0140.
[CUSTOMER][NEUTRAL] OK, but 0140, is it 80% twice in a calendar year?
[AGENT][NEGATIVE] 0140 is not listed on the fax back that I see therefore it would not be covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, just so, so I think so that's the change then. Mhm mhm.
[AGENT][NEUTRAL] Oh, hold on.
[AGENT][NEUTRAL] 1 2nd.
[AGENT][POSITIVE] It is actually, I apologize I missed it. It is listed under basic, so yes, it is covered at 80%.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Twice per calendar year, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so they do share frequency?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK. And can the treatment be done on the same day?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh, yeah, I don't show any limitation with that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so, and 2391 are they downgraded?
[AGENT][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] OK, got that. And the patient is the subscriber, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And this is a single or a family or an individual plan?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is just single.
[CUSTOMER][NEUTRAL] OK, so any history for this patient, [PII], that might affect the frequency in terms of proofy exams, FMS panel, right wings, SRP crowns, so the patient is good to go.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Last exam that the patient had 0120 was data of service of 11424.
[CUSTOMER][NEUTRAL] OK, so he's eligible, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Anything for FMX panel?
[AGENT][NEUTRAL] Not that I see, no.
[CUSTOMER][NEUTRAL] OK. 2740.
[AGENT][NEUTRAL] Let me double check my procedure code. One moment.
[CUSTOMER][NEUTRAL] that's
[CUSTOMER][NEUTRAL] Just to make sure filling is 11.
[CUSTOMER][NEUTRAL] So the thing I that letter.
[AGENT][NEUTRAL] Not that I see in the history, no.
[CUSTOMER][NEUTRAL] OK. What about 4341?
[AGENT][NEUTRAL] 4341.
[AGENT][NEUTRAL] I don't see any of that in the history.
[CUSTOMER][NEUTRAL] OK, and white wings?
[AGENT][NEGATIVE] The last day of service patient had bite wings. One moment.
[CUSTOMER][NEGATIVE] It doesn't.
[AGENT][NEUTRAL] Last day of service bye wings were performed was 114 of 24.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And what was the code? Is it 0274 or 77?
[AGENT][NEUTRAL] 77.
[CUSTOMER][NEUTRAL] OK and 0274 no history [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so any carry over or roll over amount for this patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And the patient would be the subscriber as you told me. OK, got it. Thank you so much. So just to confirm the claims mailing address, is it [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And 60801 the payer ID?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, so my all questions are answered.
[CUSTOMER][POSITIVE] And thanks so much for your help. Please help me with the call reference number.
[AGENT][NEUTRAL] Absolutely, [PII], call reference is my name with my last initial in today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], and wonderful day to you. Thank you. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye, [PII].