AccountId: 011433970860
ContactId: cb5533fa-7d38-40dd-9601-6953fe8b4247
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355190 ms
Total Talk Time (AGENT): 178522 ms
Total Talk Time (CUSTOMER): 94431 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/cb5533fa-7d38-40dd-9601-6953fe8b4247_20250331T14:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hello, I was calling to see if I can get a couple of questions answered for a um eligibility.
[AGENT][NEUTRAL] Sure, I can check eligibility for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then once I, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Callback number would be um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] It is 02607936.
[AGENT][NEUTRAL] OK, thank you and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] That'll be the patient will be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, uh, what was that fax number for you?
[CUSTOMER][NEUTRAL] Fax number would be [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was 770532-8835?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Got it. Alrighty, I will get that sent to you. I should get it here within about 10 minutes I would say. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I think that is all I needed to know, thank you.
[AGENT][POSITIVE] OK, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Well, can I, sorry, can I.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Um, can I please have a um.
[CUSTOMER][NEUTRAL] The frequency for the 1110.
[AGENT][NEUTRAL] 11:10. Give me just a moment, let me get that for you and of course I will let you know verification of coverage is not a guarantee of payment for claims.
[AGENT][NEUTRAL] Uh, alright. Code 11:10 is not going to be a covered procedure under this policy.
[CUSTOMER][NEUTRAL] 1110 not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What about the 0120?
[AGENT][NEUTRAL] Yes, um, the oral evaluation, yes, that's going to be covered under preventative, so that's 100%, um, let me check that limiting. I think it's once every.
[AGENT][NEUTRAL] OK, limited to two oral evaluation procedures in any combination, so 0120, 0140, 0150 and 0160 per 12 month period.
[AGENT][NEUTRAL] So any 2 of those per 12 months.
[CUSTOMER][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] Mm, and what about the 0274?
[AGENT][NEUTRAL] C274 is preventative, so that is at 100%.
[AGENT][NEUTRAL] Um, that is limited to one, per 12 month period and that can be 02700272, or 0274, so one of those per 12 month period.
[CUSTOMER][NEUTRAL] And what about the 0210?
[AGENT][NEUTRAL] 0210.
[AGENT][NEUTRAL] FMX that would be at 80% and that is limited to one X-ray procedure per 5 year period. That's uh 02 10, 02777 and then uh 0330.
[CUSTOMER][NEUTRAL] And you said at 80%?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So diagnostic, it could be 80 or 100%.
[AGENT][NEUTRAL] OK, so this, this policy in short does not offer any sort of major coverage um it offers preventative at 100% and then basic and FMX at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But this plan doesn't even have prophylaxis as a covered benefit.
[AGENT][NEUTRAL] Uh, prophylaxis is cleaning, yeah.
[CUSTOMER][NEUTRAL] What is covered on the preventative?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][POSITIVE] Oh hold on, I'm so sorry. I do see the 11:10. I apologize. I don't know why that didn't show up for me, um, that is covered under preventative. I am so sorry about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is fluoride a cover benefit for this plan?
[AGENT][NEUTRAL] Um, there are a few different ones. Uh, did you have a specific code?
[CUSTOMER][NEUTRAL] Um, specific for fluoride.
[CUSTOMER][NEUTRAL] 12:08.
[AGENT][NEUTRAL] I don't have 1208. I do have um 12:04 and 12:05.
[CUSTOMER][NEUTRAL] At 100%?
[AGENT][NEUTRAL] Yes, that is preventative.
[CUSTOMER][NEUTRAL] 100% and is there an age limit?
[AGENT][NEUTRAL] Let's see, give me just a moment.
[AGENT][NEUTRAL] Uh, yes, um, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, I think that is all. Then I'll just, uh, hopefully your fax will come in soon. Thank you.
[AGENT][POSITIVE] Yes, yes, of course. All right, thank you. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.