AccountId: 011433970860
ContactId: d05cfc60-0ab7-4fda-ab6c-807034bbd614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622510 ms
Total Talk Time (AGENT): 186465 ms
Total Talk Time (CUSTOMER): 195360 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/d05cfc60-0ab7-4fda-ab6c-807034bbd614_20250206T16:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with Family Dental Health at Bruss Creek. How are you?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] I'm doing good thank you. I am calling to um check and see if we, if a patient we have um if yeah, if we accept y'all's insurance and are we in network.
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] It is 02594573.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And thank you so much [PII] for verifying the policy. With this policy, it is not considered in or out of network. You will be able to verify based off of our their contract or policy that they have with us.
[AGENT][NEUTRAL] It has the dollar amount listed on there.
[CUSTOMER][NEUTRAL] Say that last part one more time.
[AGENT][NEUTRAL] There is a dollar amount that is listed on the fax back that we have.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so there's no.
[CUSTOMER][NEUTRAL] In or out of network there's just a certain dollar amount that you pay.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And that that'll be plainly listed.
[AGENT][NEUTRAL] Yes, it's listed on the fax back.
[CUSTOMER][NEUTRAL] OK, so they can be seen by anyone.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, do y'all pay the patient or do you pay the office?
[AGENT][NEUTRAL] If the provider submits the claim in, we will submit the payment to the provider.
[CUSTOMER][NEUTRAL] I'll get you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And would you like to receive a fax back?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] May I have that fax number please?
[CUSTOMER][NEUTRAL] Yes ma'am 864.
[CUSTOMER][NEUTRAL] 268.
[CUSTOMER][NEUTRAL] 3993.
[AGENT][NEUTRAL] Into the attention of Latoya.
[CUSTOMER][NEUTRAL] Say that one more time.
[AGENT][NEUTRAL] To the attention Latoya.
[CUSTOMER][POSITIVE] Yes ma'am, I'm sorry.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, just a couple of random questions. How does their benefit year run?
[AGENT][NEUTRAL] It's a per calendar year.
[CUSTOMER][NEUTRAL] OK, and then do they have a yearly max?
[AGENT][NEUTRAL] They do have a per calendar year mix.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm pulling that up for you now, in which that will be listed on the fax back as well.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is showing.
[AGENT][NEUTRAL] So for this member verification coverage does not guarantee the payment of the claim. The member has up to $500 per calendar year. They also have a $50 deductible, which the deductible does not apply to the preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and what are your percentages for.
[CUSTOMER][NEUTRAL] Preventative, basic, and major.
[AGENT][NEUTRAL] For the preventative, it is showing that it's 100% allowable. For the basic basic expenses and basic restorative expenses, the member has up to 80%.
[CUSTOMER][NEUTRAL] OK, what about major?
[AGENT][NEUTRAL] The member does not have major expenses.
[CUSTOMER][NEUTRAL] OK, do you do any downgrades for like composites?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] In the molars, no downgrades. Is there a waiting period?
[AGENT][NEUTRAL] It's based off of which services you're questioning.
[AGENT][NEUTRAL] Would you like me to give you all the waiting period?
[CUSTOMER][NEUTRAL] Is it a long list?
[AGENT][NEUTRAL] Well, for this member, since they only have preventative and basic, they have zero waiting period.
[CUSTOMER][NEUTRAL] OK 04.
[AGENT][NEUTRAL] Which that is listed on the fax back as well.
[CUSTOMER][NEUTRAL] OK thank you um last question I won't go through all the codes but fluoride.
[CUSTOMER][NEUTRAL] Does that cover up to a certain age?
[AGENT][NEUTRAL] May I have the code, please?
[CUSTOMER][POSITIVE] Yes ma'am, give me 2 seconds and I'll find it.
[CUSTOMER][NEUTRAL] D 1206.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Now, would this include prophylaxis and is this for an adult or a child?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It would be for an adult and for a child. So I know how sometimes they would cover up to but not including age [PII].
[CUSTOMER][NEUTRAL] So I'm trying to see if.
[AGENT][NEUTRAL] But does it include prophylaxis or without?
[CUSTOMER][NEUTRAL] It would be included with I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking that for you now.
[CUSTOMER][POSITIVE] You're fine thank you.
[AGENT][NEUTRAL] So for the child, it is up to age [PII].
[AGENT][NEUTRAL] And for the adult, it is up to age [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so when you say um.
[CUSTOMER][NEUTRAL] For an adult, it would have to, the actual prophylaxis would have to say adult prophylaxis, and then it would go up to 19, but if it's a child, it would say um child prophylaxis up to 14.
[AGENT][NEUTRAL] Yes, if the child is up to the under the age of [PII], if they're over if they're [PII] [PII], that is considered an adult. So they only
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] And then with that number.
[CUSTOMER][NEGATIVE] Oh sorry.
[AGENT][NEUTRAL] They only have a maximum of 1 per 12 months for both of them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 14 per 12 months, how many cleanings are they allowed to have a year?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] And is there a specific code on that one as well?
[CUSTOMER][NEUTRAL] Um, D1110.
[AGENT][NEUTRAL] And that's for both as well?
[CUSTOMER][NEUTRAL] This would be for an adult.
[CUSTOMER][NEUTRAL] The child, let's see.
[CUSTOMER][NEUTRAL] Let's look at [PII].
[AGENT][NEUTRAL] Well, both of them only get one procedure for 6 months.
[CUSTOMER][NEUTRAL] 1 per 6 months.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] As far as let's say D 0272, those are bite wings.
[CUSTOMER][NEUTRAL] Um, how many can they have per?
[CUSTOMER][NEUTRAL] Calendar year.
[AGENT][NEUTRAL] 1
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think that's it. Do they have any history on file?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just for [PII] or, or is there someone else as well?
[CUSTOMER][NEUTRAL] We'll just go with [PII].
[AGENT][NEUTRAL] So for this member, it is not showing that the member had used any of their benefits.
[CUSTOMER][NEUTRAL] OK, so y'all don't draw from previous insurances, it's just whatever.
[CUSTOMER][NEUTRAL] Happened with y'all?
[AGENT][NEUTRAL] Yes, it's per calendar year, so since this is a new year, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, I think that's all. Can I get a call reference number?
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much for your help, [PII].
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.