AccountId: 011433970860
ContactId: c9e16567-b000-4a8b-b81f-ecff99c5b42d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622780 ms
Total Talk Time (AGENT): 114043 ms
Total Talk Time (CUSTOMER): 280897 ms
Interruptions: 4
Overall Sentiment: AGENT=-0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/c9e16567-b000-4a8b-b81f-ecff99c5b42d_20250430T16:02_UTC.wav
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[CUSTOMER][NEUTRAL] In that one or plastic surgery?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I just had a few questions about a patient's eligibility and benefits.
[AGENT][NEUTRAL] OK, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] and the number would be [PII]. [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you, [PII], and I can help you with eligibility and benefits. Do you have that policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah and just make 4.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] 02511246.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII]. Sorry. Yeah, we just need to go see her early in the morning or switch to a different day.
[AGENT][NEUTRAL] OK, and you need eligibility and benefits, is that right?
[CUSTOMER][NEUTRAL] Yes. Oh, OK. Just something of friend because um I just have a few specific questions.
[AGENT][NEUTRAL] OK, uh, effective date is [PII]. I can send a fax back that outlines everything that's covered under the policy. Um, would you like me to do that or do you need to go over something on the phone?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this policy a calendar or fiscal year?
[AGENT][NEUTRAL] That's calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, have they met their deductible?
[CUSTOMER][NEUTRAL] Alright, let me text [PII] and [PII].
[AGENT][NEUTRAL] And anything I quote is not a guarantee of payment, basic outline of the policy. Um, let me see my deductible.
[CUSTOMER][NEUTRAL] Yeah, just have her come back see if gonna leave to come back at one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] come at [PII].
[CUSTOMER][NEUTRAL] It's just been a change in the schedule where Doctor [PII] needs you to come at [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII] or a different day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Um, not met their $50 deductible this year. They have not.
[CUSTOMER][NEUTRAL] OK, um, can we downgrade to amalgam on posterior fillings?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] And for code 72,107,220 and [PII] is medical or dental primary preferred.
[AGENT][NEUTRAL] OK, so [PII], what were the other ones?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Um, no, primary is not required.
[CUSTOMER][NEUTRAL] So dental or medical?
[AGENT][NEUTRAL] Your medical.
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] It's, it's not required. This is under the policy. It's oral surgery expense.
[CUSTOMER][NEUTRAL] OK, so there's no medical or dental primary preferred.
[AGENT][NEUTRAL] No, I, I don't show, I show this is the only dental policy, so I don't know if there's another dental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for code 4341, what is the number of quads that can be done per day?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] 640949275
[AGENT][NEUTRAL] A maximum of 1 quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for code 4910 isn't in addition to pro fee?
[CUSTOMER][NEUTRAL] Or either or.
[AGENT][NEUTRAL] 4910. Is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's considered under Pero.
[AGENT][NEUTRAL] Um, which is major, I believe. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's in our major.
[CUSTOMER][NEUTRAL] So can it be done.
[CUSTOMER][NEUTRAL] OK, so can it be done in addition to pro fee?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long after deep cleanings caner maintenance be done?
[AGENT][NEUTRAL] You have a code?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Representative.
[AGENT][NEUTRAL] Uh, I don't see any specification, uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is the percentage that 4910 is covered at?
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] So even for 4910 that doesn't say how long after deep cleanings comparing maintenance be done.
[AGENT][NEGATIVE] No, it doesn't.
[CUSTOMER][NEUTRAL] Specific questions about a patient's eligibility and benefits.
[CUSTOMER][NEUTRAL] Um, what is the percentage that Ortho is covered at?
[AGENT][NEUTRAL] And there's no ortho coverage?
[CUSTOMER][NEUTRAL] Yes, it's 711 OK.
[AGENT][NEUTRAL] There's no ortho coverage?
[CUSTOMER][NEUTRAL] OK, and I have a few codes which I need the percentage at which they're covered at. Do you want them all at once or one at a time?
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Uh, one at a time.
[AGENT][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] Doctor [PII].
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] OK, what is his deductible applied to?
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] 6065.
[AGENT][NEGATIVE] Not covered, implants aren't covered.
[CUSTOMER][NEUTRAL] 7951.
[AGENT][NEUTRAL] And not covered?
[CUSTOMER][NEUTRAL] 5225.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 5226.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, how much after cleaning. And 9944.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Is there a missing two clause?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, now I just have to, I need that they're covered at you want me to give you and what is the replacement period?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] 5 years.
[CUSTOMER][NEUTRAL] So the first one is 6010 and then the next one is 6065.
[CUSTOMER][NEUTRAL] And can code 0140 be done in addition to treatment?
[CUSTOMER][NEUTRAL] But the question I asked.
[AGENT][NEUTRAL] It's just limited to two evaluations in a 12 month period.
[CUSTOMER][NEUTRAL] OK, is there a missing tooth cloth?
[CUSTOMER][NEUTRAL] Um, if an FMX is submitted, when is the next time a new pano can be submitted?
[CUSTOMER][NEUTRAL] 13175.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Could row 140 be done on the same day as treatment?
[AGENT][NEUTRAL] FMX or panos once every 5 years.
[CUSTOMER][NEUTRAL] Remaining from this patient's maximum.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What is the remaining from this patient's maximum?
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Eligibility
[CUSTOMER][NEUTRAL] No, I just need to answer the question.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I just wanted to do a double check.
[CUSTOMER][POSITIVE] Thank you very much for your time.
[AGENT][NEUTRAL] Uh, they haven't used anything this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this patient eligible for an exam prophy, bye wings, pano FMX?
[CUSTOMER][NEUTRAL] 961.
[AGENT][NEUTRAL] Yes, they are all of those.
[CUSTOMER][NEUTRAL] OK, and how about for code 0150?
[AGENT][NEUTRAL] They don't have any history at all. There's no claims on file.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I think that's all.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.