AccountId: 011433970860
ContactId: b87d8b75-59a7-4735-a63a-b522efcac60e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442839 ms
Total Talk Time (AGENT): 218013 ms
Total Talk Time (CUSTOMER): 135147 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/b87d8b75-59a7-4735-a63a-b522efcac60e_20250304T16:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], uh, calling on behalf of the dental office to check eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and the benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's 02586391.
[AGENT][NEUTRAL] 02586391.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification.
[AGENT][NEUTRAL] Benefits, not a guarantee of payment, and I am showing call is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what benefits, um, what kind of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] All right. And so your line was going in and out. Uh, I didn't get the effective date.
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK. And is it a single or a family coverage?
[AGENT][NEUTRAL] This is the individual coverage.
[CUSTOMER][NEUTRAL] And what will be the group name and the group number?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The group number is 70044.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Group name is the Mega Force Staffing Group.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what will be the claim's mailing address?
[AGENT][NEUTRAL] [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And [PII], uh, do you accept assignment of benefits to a non-participating provider?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, there's no assignment of benefits, however, we received the claim, we'll process it.
[CUSTOMER][NEUTRAL] OK. And if benefits are exhausted, do in network providers discounts apply?
[AGENT][NEUTRAL] Yes, if benefits are exhausted, do the discounts apply on your end or ours? If the benefits are exhausted on our end, then we would send it back, um, usually with the patient responsibility or what the decision is, um, the discount would be on the provider's end.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. And is it a benefit your plan or a calendar year plan?
[AGENT][NEUTRAL] This is a calendar year.
[CUSTOMER][NEUTRAL] And uh what will be the uh sorry, what will be the deductible and maximum?
[AGENT][NEUTRAL] Um, the maximum is $500. The deductible is $50 per covered insured.
[CUSTOMER][NEUTRAL] All right. And anything been used on it?
[AGENT][NEUTRAL] Let's see. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] And so far I'm showing she has not used any of the benefits or met the deductible for [PII].
[CUSTOMER][NEUTRAL] OK. And uh what uh do we have any coverage for orthodontics?
[AGENT][NEUTRAL] Um, there is no orthodontic treatment on this policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And is there a waiting period or a missing tooth loss?
[AGENT][NEGATIVE] There is a missing tooth cloth. There is no waiting period. Um, the policy only covers preventative, basic, basic restorative and FMX and radiographs.
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Major expenses for us um at APL includes endodontic, periodontic, prosodontic, and oral surgery. Those are all not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh what will be the co-insurance for preventative and basic?
[AGENT][NEUTRAL] Preventative is covered at 100%. Basic is at 80%.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] For 49, 10 and 7140. Are those than the basic or major?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] 7140 is under basic and you said 4910?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 4910 must be under major because it's not on this list of cover codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And um
[CUSTOMER][NEUTRAL] We don't have any downgrade on this plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And lastly, I do have 4 codes to check. I only need the frequency. So do you need all the codes at once or one by one?
[AGENT][POSITIVE] Yes, we can do them all at once.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. So the first would be 0150.
[CUSTOMER][NEUTRAL] Then 0274.
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] And uh 1208.
[AGENT][NEUTRAL] 1208.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, so, um, 150 is under preventative at 100%. Um, it's two per twelve-month period.
[AGENT][NEUTRAL] Paired with 140, 50, I'm sorry, 120, 40 and 60.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 27, I'm sorry, 274. Let me see.
[AGENT][NEUTRAL] 0274.
[AGENT][NEUTRAL] It's under preventative at 100%?
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Limited to one bye bye wing X-ray per 12-month period. It is paired with two.
[AGENT][NEUTRAL] 70 and 272.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0210 is under radiograph um FMX, so that's 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's limited to one X-ray procedure per 5-year period. It's paired with um 277 and 0330.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1208 is not a covered code on this policy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh and I'm done with all my questions and uh you can provide me the reference number to our account.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Got it. All right, uh thank you so much for your assistance and have a wonderful day ahead.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day also.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.