AccountId: 011433970860
ContactId: bcec550f-5f8c-4770-9a2e-3d94f531f505
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577789 ms
Total Talk Time (AGENT): 130556 ms
Total Talk Time (CUSTOMER): 121864 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/bcec550f-5f8c-4770-9a2e-3d94f531f505_20250326T19:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing? My name is [PII]. I'm calling from Raymond Cosmetic and Implant Dentistry, and I was calling to verify coverage on a patient.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] 02599345
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII]. The policy is still active and for a breakdown of benefits, I can fax that to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, we have that. It was, um, there were some questions on there that, um.
[CUSTOMER][NEUTRAL] On our breakdown that's not on the form, so I was trying to see if you can answer them for me.
[AGENT][NEUTRAL] OK. Yes, ma'am. Let me pull up that documentation.
[AGENT][NEUTRAL] OK, yes, ma'am. And your question?
[CUSTOMER][NEUTRAL] OK, is, um, is there a missing two calls or waiting period?
[AGENT][NEUTRAL] No, ma'am, there isn't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, there is a missing tooth cloth. I'm sorry, there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] Um, the replacement cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Is the includes the guard covered?
[AGENT][NEUTRAL] A crucial guard. Do you have a code for that?
[CUSTOMER][NEUTRAL] B 9944.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'm only showing the 9940.
[AGENT][NEUTRAL] Oh, yeah, I don't see the 9944, and if it's not on here, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, any downgrades on posterior composites or crowns?
[AGENT][NEUTRAL] Um, no, ma'am. There are no downgrades.
[CUSTOMER][NEUTRAL] You pay on pred or Ct date.
[AGENT][NEUTRAL] Either one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The replacement clause for crown bridges, dentures or partials.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I put you on a brief hold?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] No problem. And I'm still searching for that information. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, for those, I'm only showing the frequency, which is 1 every 7 years per tooth and 1 every 5 years for the partials and dentures. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is this, OK, he got a $1500 max and a $50 deductible.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And that's per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Uh, pre-authorizations required.
[AGENT][NEUTRAL] No, ma'am, there isn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's the frequency for uh SRPs?
[AGENT][NEUTRAL] OK and what's the code for that?
[CUSTOMER][NEUTRAL] If it's not on here.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, a maximum of 1 each quadrant for 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the Imperial Maintenance, the 4910.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's a maximum of one.
[CUSTOMER][NEUTRAL] All he says he does have a waiting period.
[AGENT][NEUTRAL] For 6 months.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] You, oh, you said the maintenance is 1 for 6 months?
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] OK, is that is that covered as preventative or major?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It's covered at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he has a waiting period on.
[CUSTOMER][NEUTRAL] Major procedures, endoperio and oral surgery.
[AGENT][NEUTRAL] Right, 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are implants covered?
[AGENT][NEGATIVE] No, implants are not covered.
[CUSTOMER][NEUTRAL] What about bone grass be 7953?
[AGENT][NEUTRAL] Um, no, I don't see that on the fee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the uh what um.
[CUSTOMER][NEUTRAL] What's the schedule do you all use?
[AGENT][NEUTRAL] Um, it's usual and customary, but we also use Carrington, but it's not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the timely filing?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the spelling of your name and the reference number for this call?
[AGENT][NEUTRAL] Um, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, in the state.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so very much, Ms. [PII].
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No ma'am, that'll be all.
[AGENT][POSITIVE] OK. I thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Same to you.
[AGENT][NEUTRAL] OK.