AccountId: 011433970860
ContactId: b80468ed-f731-4a7f-8a32-28659e371bf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 939330 ms
Total Talk Time (AGENT): 257339 ms
Total Talk Time (CUSTOMER): 275350 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/b80468ed-f731-4a7f-8a32-28659e371bf6_20250326T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Good afternoon. I'm sorry. My name is [PII]. My name spelled [PII], calling directly from the provider's office. Can you help me get the full breakdown of this dental benefit plan today, please?
[AGENT][NEUTRAL] Um, yes, ma'am. I can fax that information to you. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Can you, can you, can I speak to you instead if that's OK with you?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] Uh, would you mind if you could provide me the information over the phone instead of providing me the fax? because apparently I spoke to the previous representative and um there's no any fax that has been delivered to us yet. I spoke to her almost 10 minutes ago.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you over the phone. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, definitely. It's gonna be [PII]. And how do you spell your name, ma'am, so I can address you properly, please?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, Ay.
[AGENT][POSITIVE] OK, no problem. You're welcome.
[CUSTOMER][NEUTRAL] Would you like me to provide you the codes?
[CUSTOMER][NEUTRAL] Mm, uh, would you like me to provide you the membership number?
[AGENT][NEUTRAL] Well, first, um, I'll need the.
[AGENT][NEUTRAL] Yes, I need the policy number.
[CUSTOMER][NEUTRAL] Yep, the policy number is 02585551.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I'm showing that this policy has an annual maximum benefit amount of $500 but there is a $50 co-pay that needs to be met first, and let's see have any of that been met yet.
[AGENT][NEUTRAL] Um, no, none of that has, have been met yet.
[AGENT][NEUTRAL] And what are the benefits do you need to verify?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I have here like more than 20 codes. Would you like me to provide them to you all at once or one by one?
[AGENT][NEUTRAL] 20 codes.
[CUSTOMER][NEUTRAL] Yes, because I haven't received the fax yet. I'm afraid that the patient will come in and have it verify the patient yet we haven't verified it yet, so I'm just calling.
[AGENT][NEUTRAL] OK. What's the first code? We'll try to do as many as we can. What's the first code?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You have the 1st 1, D0150 or exams. The second one?
[AGENT][NEUTRAL] OK, then we'll go, we have to.
[CUSTOMER][NEUTRAL] Would you like me to provide them to you all at once or what?
[AGENT][NEUTRAL] One by one. OK, that one is um covered under preventative.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] And for preventative, that's covered at 100%.
[CUSTOMER][NEUTRAL] What's the frequency limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limit to one.
[AGENT][NEUTRAL] Per lifetime, per quadrant arch.
[CUSTOMER][NEUTRAL] Once per lifetime?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Thank you. How about 0140?
[AGENT][NEUTRAL] OK, that's limited to 2 oral evaluation procedures and any combination for 12-month period. And that's also the same for the previous um code that I gave you.
[CUSTOMER][NEUTRAL] This was for lifetime, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Does it share frequency with each other? Does exams share frequency?
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][POSITIVE] Thank you so much. Also, can you provide me the frequency limited coverage for prophylaxis or D1110, please?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Maximum of 1 procedure every 6 months.
[CUSTOMER][POSITIVE] Alright, got it, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Also 0274.
[AGENT][NEUTRAL] Limited to one bite wing X-ray per twelve-month period.
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] OK, I'm still waiting on my system. One moment please.
[CUSTOMER][POSITIVE] Please take your time. Thank you.
[AGENT][POSITIVE] Mm, thank you.
[AGENT][NEUTRAL] OK, I'm showing that that's covered under basic and 80% of allowable.
[CUSTOMER][NEUTRAL] What is the frequency limit?
[AGENT][NEUTRAL] Um, it's not showing a frequency limit under that one.
[CUSTOMER][NEUTRAL] So there's no frequency, right? At 80% basic. Thank you. How about FMX or 0210, please? 0210.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, limited to one X-ray procedure for five-year period.
[CUSTOMER][NEUTRAL] How many percent are you covering for this? Is it also under preventive?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's on the radiation and FMX and that's one every 5 years.
[CUSTOMER][NEUTRAL] How about 1351?
[CUSTOMER][NEUTRAL] Reience.
[CUSTOMER][NEUTRAL] 1351 or Cents.
[AGENT][NEUTRAL] Yeah, I found it. Um, it's a maximum of 1 procedure every 36 months.
[AGENT][NEUTRAL] And also, it's limited to, yeah, it's limited to dependent children under age [PII]. And you said BD and what was the other one? I'm sorry, I'm looking at something. Hold on.
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] It's, it's OK, it's OK. Um, how about 1206 or fluoride?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You said 1306?
[CUSTOMER][NEUTRAL] 1206.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it not covered?
[AGENT][NEUTRAL] Um, I see a 1201, 1203, 1204, and a 1205.
[AGENT][NEUTRAL] These are fluorides.
[AGENT][NEUTRAL] Um, the 1204 and the 1205 are for adults.
[CUSTOMER][NEUTRAL] Mm. How about
[CUSTOMER][NEUTRAL] How about 1206? Is it, is it covered or not?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] No, I don't see the 1206 on here.
[CUSTOMER][NEUTRAL] Is it not covering?
[AGENT][NEGATIVE] Right, if it's not on here, it's not covered.
[CUSTOMER][POSITIVE] Alright, got it, thank you. Also, 2393 or?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2393, please? Or fillings.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, a maximum of 1 each tooth for 24 months and replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] How many are you covering for this?
[CUSTOMER][NEUTRAL] Code
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so it's on basic.
[AGENT][NEUTRAL] Yes, it's covered under basic.
[AGENT][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] Is there any downgrade for filling? Does it have any downgrade code or does it have any alternate benefits? All right, got it. Thank you. How about and the down take are 33,330.
[AGENT][NEUTRAL] Um, no, there
[AGENT][POSITIVE] Um, no, there are no downgrades.
[CUSTOMER][NEUTRAL] I don't think it's covered. It's not covered, isn't it?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it the, you said 330?
[CUSTOMER][NEUTRAL] 3330.
[AGENT][NEUTRAL] Um, no, that's not covered.
[CUSTOMER][NEUTRAL] How about 7240? Is it also not covered?
[AGENT][NEGATIVE] Not covered. There's a 7140 but not a 7240.
[CUSTOMER][NEUTRAL] Yeah, how about 7, I'm sorry, 4341.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] No, ma'am, not covered.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] Um, Ey, also, can you tell me the frequency limit for 9944?
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, there's no coverage for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 7311.
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEUTRAL] No coverage?
[CUSTOMER][NEUTRAL] 9110.
[AGENT][NEUTRAL] That's covered under basic.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And what is the
[AGENT][NEUTRAL] Minor procedure basics.
[CUSTOMER][NEUTRAL] Can you tell me the frequency limit? Yeah.
[CUSTOMER][NEUTRAL] Is there I don't think there's frequency limit, right?
[AGENT][NEUTRAL] Right, there isn't one.
[CUSTOMER][NEUTRAL] All right. How about 6010?
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] 6057
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] And 6058.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEGATIVE] Mm, no coverage.
[CUSTOMER][POSITIVE] All right, got it. Thank you so much for all of this information. Basically, you don't cover or out of network or benefits, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] You don't cover or benefits. Thank you so much for that. You've been a great help for me today. Thank you.
[AGENT][NEUTRAL] Right, or those not covered. And could I get your fax number? I can also try to fax it to you again.
[CUSTOMER][POSITIVE] Actually, you received it just now. You don't have to do that. Thank you so much.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] OK. Anything else I can assist you with?
[CUSTOMER][NEGATIVE] I'm sorry for, I'm sorry for wasting your time, by the way.
[AGENT][NEGATIVE] Oh, no, you didn't waste my time.
[CUSTOMER][NEUTRAL] Yeah, I just need to know um.
[CUSTOMER][POSITIVE] Thank you so much for being so helpful. Does this policy has a future termination date?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, no, I'm not showing one. I'm showing that it's still active.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. Also, yep, I think that's it. Thank you so much for your time today. What is your reference number?
[AGENT][NEUTRAL] It'll be my name and today's date. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Oh thank you so much. That's it. I'll take it from me. I won't take much for your time. You've been a great help for me. I hope you have a great day. Enjoy the rest of your shift and take care, OK? Bye for now.
[AGENT][NEUTRAL] You do the same. Thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] I'll drop the call for you, OK? Thank you.
[AGENT][POSITIVE] Mhm. Thank you.