AccountId: 011433970860
ContactId: c99c936c-7b37-44e0-83ee-10a308643634
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 985669 ms
Total Talk Time (AGENT): 357630 ms
Total Talk Time (CUSTOMER): 309510 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c99c936c-7b37-44e0-83ee-10a308643634_20250211T20:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling on behalf of provider office. Could you please help me with the patient dental eligibility and benefits?
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Mhm. Uh, policy number is gonna be 614247.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mhm, I do have it's gonna be [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth [PII].
[AGENT][NEUTRAL] OK. And this is for dental. So you're wanting to verify benefits and eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes, then the eligibility and benefits.
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. He is active under the policy.
[AGENT][NEUTRAL] And we can send a fax back if you like, or you need in general benefits.
[CUSTOMER][NEUTRAL] OK, so the fact
[CUSTOMER][NEUTRAL] Uh, yes, I will be needing general benefit, but the effective date was uh.
[CUSTOMER][NEUTRAL] July
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Is there any future cancellation date?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there any future cancellation date?
[AGENT][NEUTRAL] Not that I'm aware of, no, ma'am. I'm sure the policy is just active.
[CUSTOMER][NEUTRAL] OK, and this plans runs in the calendar year or a fiscal year?
[AGENT][NEUTRAL] Calendar
[CUSTOMER][NEUTRAL] Uh, what about the group number and the group name?
[AGENT][NEUTRAL] Uh, it's an individual policy. There's no group number or name.
[CUSTOMER][NEUTRAL] OK. And yes, what about the timely filing limit? Is there any?
[AGENT][NEGATIVE] Uh, no, ma'am. There's no timely following.
[CUSTOMER][NEUTRAL] No time is filing, OK.
[CUSTOMER][NEUTRAL] And you said it's an individual plan, right?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] OK. And what about the plan maximum deductible for the used amount?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification of coverage. Insured has or the patient has a benefit max up to $1000 per calendar year and there is a $50 deductible that is that is applied to exam and profy.
[AGENT][NEUTRAL] Everything but the examine prophy, I'm sorry, and I don't show he's used any benefits for this year, so it is available, nor has he met his deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about rollover benefit? Is there any?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] A rollover benefit, is there any?
[AGENT][NEUTRAL] No, we don't do rollover benefits.
[CUSTOMER][NEUTRAL] OK. And the fee schedule is gonna be?
[AGENT][NEUTRAL] Uh, it pays by their policy fee schedule.
[AGENT][NEUTRAL] Uh, they have a fee schedule under their plan that lists the codes, description, and the amount that is payable under from our company. Would you like me to fax that to you?
[CUSTOMER][NEUTRAL] Um, no, actually I will not be needing the entire detail. I just need the name whether it's a connection Dental or Unit Concordia.
[CUSTOMER][NEUTRAL] Or Carrington
[AGENT][NEUTRAL] Uh, they can go to a Carrington provider, but we pay by their policy with our company. If you're a Carrington provider, then I guess you will go by uh charge what you have with Carrington.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Yes, we do have Carrington. And yes, what about the co-insurance for preventive basic and major services?
[AGENT][NEUTRAL] It doesn't pay by a percentage. It doesn't pay by UCR. It pays by their policy fee schedule.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this is based on the schedule?
[AGENT][NEUTRAL] By their policy. They have a policy and in the policy, there's uh some amount that we will pay. We don't go by a Carrington or how much the provider charge, we go by what's allowed in their policy for certain procedures.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, uh, and, yes, what about, uh, OK, so here I do have quotes. Will you be able to provide me the frequency for those quotes?
[AGENT][NEUTRAL] OK, and how many coats do you have?
[CUSTOMER][NEUTRAL] I have around 20 quotes.
[AGENT][NEUTRAL] Ma'am, it will be a lot easier for me to send you a fee schedule. I can give you the general frequency and then on the fee schedule, it does have the code, the description and how much we will pay.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Uh, so, uh, will you be able to assist me with the
[CUSTOMER][NEUTRAL] Codes, like half of the codes on call. And for the rest, we can do the fax.
[CUSTOMER][NEUTRAL] Is it OK with you?
[AGENT][NEUTRAL] OK. Sure. What are the codes?
[CUSTOMER][NEUTRAL] OK. Uh, so the first one would be 2391.
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 4341.
[CUSTOMER][NEUTRAL] OK, uh, I forgot to ask you, uh, can I give you all at once or one by one?
[AGENT][POSITIVE] All at once it's fine.
[CUSTOMER][NEUTRAL] OK. Uh, so we were on 4342, uh sorry, 4341, and the next one is 43554346.
[CUSTOMER][NEUTRAL] 274-051-110.
[CUSTOMER][NEUTRAL] 795360106058.
[CUSTOMER][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] 91,102,950
[CUSTOMER][NEUTRAL] 0364.
[CUSTOMER][NEUTRAL] And 0431.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, for the 2391, there's not really a frequency.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Uh, the 4910 is once every 3 months. The 4341.
[AGENT][NEUTRAL] It's once every 12.
[AGENT][NEUTRAL] 4355, once every 1243 46 not covered.
[AGENT][NEUTRAL] 2740.
[AGENT][NEUTRAL] It's once every 5 years.
[AGENT][NEUTRAL] Uh 5110.
[AGENT][NEUTRAL] Um, every 5 years.
[AGENT][NEUTRAL] 7953.
[AGENT][NEGATIVE] Not covered.
[AGENT][NEUTRAL] 6010.
[AGENT][NEGATIVE] Not covered, 6058, not covered.
[AGENT][NEUTRAL] 9944.
[AGENT][NEUTRAL] It's once every 12 months.
[AGENT][NEUTRAL] Um, 9110.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, no frequency for the 9110, 2950, or is that 2950 or 58? I can't read my own handwriting.
[CUSTOMER][NEUTRAL] No, it's uh 2930.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] No frequency.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0364.
[AGENT][NEGATIVE] It's not covered.
[AGENT][NEGATIVE] And 40, um sorry, 0431 not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and under this plan, I posted the downgrade amalgam, the code 2391 do the downgrade to algam.
[AGENT][POSITIVE] Uh, there are no downgrades.
[CUSTOMER][NEUTRAL] No downgrade for ground sir, sir?
[AGENT][NEUTRAL] Uh, correct, we don't do downgrade. There is no downgrades on the policy.
[CUSTOMER][NEUTRAL] OK, and for SRP can we we can do all four quarter at once?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And yes, uh, is starting an X-ray required for peru claim?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Is charting an X-ray required for perio claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh yes, uh, can 4342 can be done in conjunction with 11:10?
[AGENT][NEUTRAL] I'm sorry, say that one more time.
[CUSTOMER][NEUTRAL] 4342 can be done in conjunction with 11:10.
[AGENT][NEUTRAL] Uh, yes, 43.
[CUSTOMER][NEUTRAL] OK, got it. And yes, 4910 is an addition with 1110.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, either or. OK got it and mhm.
[CUSTOMER][NEUTRAL] An oral surgery will be billed to medical or dental first?
[AGENT][NEUTRAL] Uh, it doesn't have to be billed to Medical first.
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] So it doesn't have to be billed to medical first.
[CUSTOMER][NEUTRAL] OK, doesn't have to. OK.
[CUSTOMER][NEUTRAL] Got it. And yes, under this plan, is there any missing toothpas or waiting period?
[AGENT][NEUTRAL] There is a missing tooth cloth, but they've already passed their waiting period.
[CUSTOMER][NEUTRAL] Got it. And is pre-authorization mandatory or suggested?
[AGENT][NEUTRAL] Uh, neither. It's not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And now can I get the order down to flat time next month with the used amount?
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][NEUTRAL] Got it?
[CUSTOMER][NEUTRAL] And what about the uh history? Does this patient have any history, large date of service?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm showing, are you wanting what history are you needing?
[CUSTOMER][NEUTRAL] I travel the needing basically for uh any history the last date of service for preventive perio and crowns.
[AGENT][NEUTRAL] I don't show any history of periodontics, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, say the last FMX was [PII] or [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, there's no history of a panoramic.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Last exam and cleaning was, well, last exam was [PII], last cleaning was uh [PII].
[AGENT][NEUTRAL] And last flight when was [PII].
[CUSTOMER][NEUTRAL] Mhm. Any history for SRP 4341?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] What about Crowns 2740 or 2750?
[AGENT][NEUTRAL] What was that number again? 2740 and what else?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 2750.
[AGENT][NEUTRAL] Uh, what is the tooth number? Because they have a couple, uh, they have one for the 2750 and the 2740, but they are on a different tooth number. So what tooth number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, uh, not a problem then. And yes, what about the, uh, OK, and what about the mailing address with the payer ID?
[AGENT][NEUTRAL] Uh, payer ID is 6060801, mailing address [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. So it's uh [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the payer ID is 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And for the timely finding you said there is no timely finding, OK, and would you mind spelling out your name for me?
[AGENT][NEUTRAL] Sure, [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, nothing [PII]. I actually I do have only this patient, but [PII], I do have a few quotes, few preventive quotes for which I will be reading their frequency. So would you mind sending me a fax for this patient?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so fax number [PII].
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, I will fax this over. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, OK, how long it will take for, for the arrival of the fax?
[AGENT][NEUTRAL] In a few moments.
[CUSTOMER][NEUTRAL] OK. And lastly,
[CUSTOMER][NEUTRAL] Did you get the uh
[CUSTOMER][NEUTRAL] OK, I'm really sorry. Just hold on a second. OK, and lastly, can I get the call reference number, [PII]?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name of today's date.
[CUSTOMER][POSITIVE] OK. So yes, that's for all the information I needed. Thank you very much for your time and assistance. Have a wonderful day.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] Bye bye and take care.