AccountId: 011433970860
ContactId: ca1fcaed-c08c-497e-a249-852d8d6c5f2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858419 ms
Total Talk Time (AGENT): 239984 ms
Total Talk Time (CUSTOMER): 223964 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/ca1fcaed-c08c-497e-a249-852d8d6c5f2b_20250324T13:10_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the dental office to check the eligibility and benefit for them. I'm on a recorded line. Could please know that.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with benefits. Um, first, can I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02.
[CUSTOMER][NEUTRAL] 502895
[AGENT][NEUTRAL] OK, thank you and I'm waiting on my system.
[AGENT][NEUTRAL] OK. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And for a list of the benefits and the breakdown of the fee schedule, I can fax that to you.
[CUSTOMER][NEUTRAL] Alright, so, but I'm having a few questions before you fax down the benefit to me. So what kind of plan is?
[AGENT][NEUTRAL] It's a dental plan?
[CUSTOMER][NEUTRAL] Is it a
[CUSTOMER][NEUTRAL] OK. Is it a routine dental plan?
[AGENT][NEUTRAL] Um, yes, routine is covered, is included. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is the member the subscriber on this plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], um, yes, sir. He's a subscriber.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What about the group name on this plan?
[AGENT][NEUTRAL] The group name is?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Quest liner.
[CUSTOMER][NEUTRAL] And the group number.
[AGENT][NEUTRAL] The group number is 17238.
[CUSTOMER][NEUTRAL] And is it a family plan or a single coverage?
[AGENT][NEUTRAL] A family plan.
[CUSTOMER][NEUTRAL] And what about the provider network status?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, I'm showing that this actually isn't run by network. We work with all providers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And it works like a PPO plan. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it works like a PPO plan. So what's going to the fee schedule like? is it through Carrington, Data Max, something like that?
[AGENT][NEUTRAL] Um, as usual and customary, yes, sir.
[CUSTOMER][NEUTRAL] OK, usually in customary. Alright, uh, what about the claiming advice?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Amazing. What about the deductible, the max on this plan?
[AGENT][NEUTRAL] OK, the deductible?
[AGENT][NEUTRAL] There's a $50 annual deductible.
[AGENT][NEUTRAL] Per family member.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the calendar year maximum is 1500 per family member.
[CUSTOMER][NEUTRAL] OK, and the deductible applies to its services.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It applies to all services.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Alright, and anything used to me on this plan?
[AGENT][NEUTRAL] OK, let's see one moment.
[AGENT][NEGATIVE] Um, no benefits have been used so far this year.
[CUSTOMER][NEUTRAL] And it's a calendar plan, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Is autotoponic service covered?
[AGENT][NEUTRAL] Orthodontic services, let's see.
[AGENT][NEUTRAL] It's not covered. No, sir.
[CUSTOMER][NEUTRAL] What about the coverage for preventative and basic images, are they covered on this plan?
[AGENT][POSITIVE] Yes, they are covered.
[CUSTOMER][NEUTRAL] So endo period oral surgery, are they covered on this plan?
[AGENT][NEUTRAL] Yes, I'm showing that there is some coverage covered at 40% with the 12 month waiting period.
[CUSTOMER][NEUTRAL] So for which service there is a 12 month waiting period?
[AGENT][NEUTRAL] For major endodontic, perdontic.
[AGENT][NEUTRAL] Prosthetic repair expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And oral surgery.
[CUSTOMER][NEUTRAL] So for all of the services there is a waiting period right of 12 months?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And which still hasn't been met right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is implant service covered?
[AGENT][NEUTRAL] What type of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Implant.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] No, implants are not covered.
[CUSTOMER][NEUTRAL] And crown residentials are under major right.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Can I get the frequency for preventative services?
[AGENT][NEUTRAL] For what sizes, I'm sorry?
[CUSTOMER][NEUTRAL] Can I get the frequency for preventative services?
[AGENT][NEUTRAL] Preventative services, let's see.
[AGENT][POSITIVE] OK. Preventative is covered at 100%. There's no waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, for exam, what's the frequency for that for cleaning, what's the frequency?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing that it is limited to 2.
[AGENT][NEUTRAL] In a twelve-month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So exam is in 2 in a 12 month period. What about cleaning and lighting?
[AGENT][NEUTRAL] That's the same, yes, sir.
[CUSTOMER][NEUTRAL] OK. For by doing also it's the same.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What about FMX panel?
[AGENT][NEUTRAL] OK, do you have a um a code for that?
[CUSTOMER][NEUTRAL] Sure, 0210 and [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the 03110, that's 40% with a 12-month waiting period. And what was the other one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The postcode was [PII], not [PII].
[AGENT][NEUTRAL] OK, I'm still [PII]ng on my system. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, for the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's limited to 1 X-ray procedure every 5 years.
[CUSTOMER][NEUTRAL] And does it share it 0330?
[AGENT][NEUTRAL] Yes, sir. Yeah, that, that is included.
[CUSTOMER][NEUTRAL] What about 1208?
[AGENT][NEUTRAL] OK, I'm not showing that on the fee schedule.
[CUSTOMER][NEUTRAL] OK. What about 4910?
[AGENT][NEUTRAL] Maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Under which category?
[AGENT][NEUTRAL] Under basic.
[CUSTOMER][NEUTRAL] What about 7140?
[AGENT][NEUTRAL] OK, on this one, it just says there's an X-ray and pathology report required.
[CUSTOMER][NEUTRAL] And under which category it is covered?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And the oral surgery expenses. Mhm.
[CUSTOMER][NEUTRAL] Is it on the basic major?
[CUSTOMER][NEUTRAL] Uh, OK, oral surgery. All right. And is there a missing tooth clause on this plan?
[CUSTOMER][NEUTRAL] Yeah yeah that.
[CUSTOMER][NEUTRAL] ID or not.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEGATIVE] Yes, there is a missing tooth cause.
[CUSTOMER][NEUTRAL] OK, what about 4341, the frequency for that?
[AGENT][NEUTRAL] How many more codes do you have?
[CUSTOMER][NEUTRAL] Just 2 more calls.
[CUSTOMER][NEUTRAL] OK I already got my card.
[AGENT][NEUTRAL] OK, that's covered on periodontic expenses and the frequency is
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] What about 0431?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm still looking. One moment.
[AGENT][NEUTRAL] OK, I'm not showing 0431 on the fee schedule.
[CUSTOMER][NEUTRAL] All right, great. Now, what about the replacement cost for denia beds and crowns?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] The replacement clause for dentures and crowns.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I'm showing for crowns and bridges, 1 every 7 years per tooth.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what were the other one? What was the other one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Potential.
[CUSTOMER][NEUTRAL] Beer.
[CUSTOMER][NEUTRAL] Really.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah so I.
[AGENT][NEUTRAL] Partials and dentures 1 every 5 years.
[CUSTOMER][NEUTRAL] Any downgrade of this plan?
[AGENT][NEUTRAL] Repeat the question, please.
[CUSTOMER][NEUTRAL] Any downgrade on this plan?
[AGENT][POSITIVE] No, there are no downgrades.
[CUSTOMER][NEUTRAL] And could you please help me with your name and the reference number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII]. It's spelled [PII] My last initial is [PII], and today's date is the reference number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] And it's the authorization mandating on this plan.
[AGENT][NEUTRAL] No, there isn't.
[CUSTOMER][POSITIVE] OK, good, thank you for the information thank you for your help.
[AGENT][POSITIVE] Thank you, [PII], for calling ATL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You go.