AccountId: 011433970860
ContactId: d39a56a2-e225-4a5b-8686-5cf51f5a586e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520299 ms
Total Talk Time (AGENT): 102633 ms
Total Talk Time (CUSTOMER): 226822 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/d39a56a2-e225-4a5b-8686-5cf51f5a586e_20250611T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] and I would like to verify patients dental benefits.
[AGENT][NEUTRAL] OK, [PII]. I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, I have [PII].
[AGENT][NEUTRAL] And what was the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, 01266497.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[CUSTOMER][NEUTRAL] 15 is on at [PII].
[CUSTOMER][NEUTRAL] Any
[AGENT][NEUTRAL] OK, I can send over, uh, it looks like the policy is active and effective [PII].
[AGENT][NEUTRAL] I can fax over a list of all of the codes that are covered in the frequency and duration, unless there's something you need on the phone.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, I do have the uh copy already. I only have uh something specific.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, um, are you able to check if the dentist considered in network or out of network?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, they don't have a network.
[AGENT][NEUTRAL] They can see any dentists they like.
[CUSTOMER][NEUTRAL] Oh there, uh, there is no network, OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, what's the group number for this plan?
[AGENT][NEUTRAL] Uh, group number is.
[AGENT][NEUTRAL] 17,970.
[CUSTOMER][NEUTRAL] 17,970. How about the employer name or group name?
[AGENT][NEUTRAL] Employer name is Universal Trucking.
[CUSTOMER][NEUTRAL] I think that [PII] they.
[CUSTOMER][NEUTRAL] Oh hold on here.
[CUSTOMER][NEUTRAL] Is this the uh correct one Universal Tracking XPO logistic?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what's the coordination of benefits?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Alright, and this plan runs on a calendar year from January to December?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um, I just wanna make sure for this policy there is no coverage for Ortho at all.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah, OK. And then the maximum deductible, the maximum applies to all services including preventative.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 7 period and then no missing insurance cost.
[CUSTOMER][NEUTRAL] Um, do you downgrade for billings composite?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] How about for a crown?
[CUSTOMER][NEUTRAL] You downgrade.
[AGENT][NEUTRAL] Yeah, there's no, there's no downgrades.
[CUSTOMER][NEUTRAL] OK, downgrade, um, for static data on prep date or seat date.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK and then how many quads are allowed for an SRP?
[CUSTOMER][NEUTRAL] So 11:30 to 1:30.
[AGENT][NEUTRAL] Um, you can do all the same quads on the same day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, period maintenance and.
[CUSTOMER][NEUTRAL] Cleaning, do they share frequency?
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] Do you have an age limit for 11:20 child cleaning?
[AGENT][NEUTRAL] I be to age [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Um, I don't see code 9223, is this covered.
[AGENT][NEGATIVE] Uh, the code's not listed, it's not covered.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Um, can you confirm 9230?
[CUSTOMER][NEUTRAL] Um, is this under major at 40%?
[AGENT][NEUTRAL] On a guarantee of payment basic outline of the policy, yes, it's under a major 40%.
[CUSTOMER][POSITIVE] OK, thank you so much um anything used or met from the annual max and deductible?
[AGENT][NEUTRAL] Uh, they used 100 for 2025.
[AGENT][NEUTRAL] And uh no deductibles been met yet.
[CUSTOMER][NEUTRAL] I'm sorry, hold on, no deductible in that.
[CUSTOMER][NEUTRAL] I'm sorry, out of 1500 patient use.
[AGENT][NEUTRAL] 100.
[CUSTOMER][NEUTRAL] 100.
[CUSTOMER][NEUTRAL] OK, so much.
[CUSTOMER][NEUTRAL] Remaining, do you have a history for this year?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Just to uh the only thing they've had is an exam.
[CUSTOMER][NEUTRAL] Last
[CUSTOMER][NEUTRAL] Do you have the date?
[CUSTOMER][NEUTRAL] Exam
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], do you have the uh specific code for that exam?
[AGENT][NEUTRAL] 15,000,150.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and no other history just exam.
[AGENT][NEUTRAL] Um, and they've had like a
[CUSTOMER][NEUTRAL] Uh, of [PII].
[AGENT][NEUTRAL] Full mouth, 00210 on the same date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Do you have the last paid cleaning and viling?
[AGENT][NEUTRAL] Uh, what, what is the code?
[CUSTOMER][NEUTRAL] Um, 11:10 and 0274.
[AGENT][NEUTRAL] I'm not pulling up those codes, so it doesn't look like you've got a history of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, just to confirm, patient is the subscriber, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] And can I get your claims mailing address and payer ID?
[AGENT][NEUTRAL] Claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And payer ID is 60801.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Alright, thank you so much. What was your first name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you have a reference number for this call?
[AGENT][NEUTRAL] That's just my name and today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, that would be all thank you so much.
[AGENT][POSITIVE] Thanks for calling ATL. Have a great day.