AccountId: 011433970860
ContactId: d78ebec1-401b-4d51-a8e6-c3b4fcf3ee56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1029838 ms
Total Talk Time (AGENT): 271635 ms
Total Talk Time (CUSTOMER): 215701 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d78ebec1-401b-4d51-a8e6-c3b4fcf3ee56_20250625T21:18_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the dental provider office and need the patient's eligibility benefit detail. Can you please help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can verify eligibility for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 02361939
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And what is the callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] She's [PII].
[AGENT][NEUTRAL] OK, and you say you're needing benefits and eligibility for the patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Uh, let's see. I'm showing an effective date of [PII], policy is active. And you need general benefits or I can send you a fax back?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, you can send me that back, but uh I also need the verbal benefit breakdown.
[AGENT][NEUTRAL] OK. What is the fax number first, please?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1500 per calendar year, and they have a $50 deductible that is applied to everything but preventative services.
[AGENT][NEUTRAL] Policy pays by usual customary reasonable for preventative service pays 100% of UCR.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Basic services pay at 80 and major pays at 40% of UCR.
[CUSTOMER][NEUTRAL] OK, uh, firstly, the provider is in-network or also network with this policy?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] The providers network in or out?
[AGENT][NEUTRAL] We do not have a network. Uh, the policy is open to where you can go to any provider.
[CUSTOMER][NEUTRAL] OK. Uh, what is the group name, group number?
[AGENT][NEUTRAL] Group number 18528.
[CUSTOMER][NEUTRAL] And the group number name?
[AGENT][NEUTRAL] Universal Trucking United Petroleum.
[CUSTOMER][NEUTRAL] Thank you. Uh, it is a calendar policy?
[AGENT][NEUTRAL] Say again.
[CUSTOMER][NEUTRAL] Uh, is it a current policy?
[AGENT][NEUTRAL] It is calendar year.
[CUSTOMER][NEUTRAL] Thank you. And uh any waiting period or missing tooth class?
[AGENT][NEUTRAL] Uh, they've already passed their waiting period and there is a missing, there is a missing tooth clause.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, as you told me, the annual max is 1500, deductible is 50. Uh, anything used on me?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, no, I don't show the patient that user benefits or met the deductible for the year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, nothing, nothing is OK. Uh, I do some specific course. Can you please tell me the coverage percentage frequency for those courses.
[AGENT][NEUTRAL] And how many cos do you have?
[CUSTOMER][NEUTRAL] Uh, around 15.
[AGENT][NEUTRAL] OK, what are the codes?
[CUSTOMER][NEUTRAL] Uh, all at once?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. [PII], sorry, [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Tomorrow [PII]. OK. Hold one moment, please.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, are you ready?
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] OK. For code 11:10 is preventative, once every 6 months.
[AGENT][NEUTRAL] 120, 140 share frequency of 2 for 12 month period, the 120 is preventive, the 140 is basic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1351 is preventative under the age of [PII], once every 3 years, permanent molars only.
[AGENT][NEUTRAL] Uh, fluoride is once every 6 months, I'm sorry, once every 12 months and it's preventative.
[AGENT][NEGATIVE] 220 is basic, no frequency.
[AGENT][NEUTRAL] 274 is preventative and it's once every 12 months.
[AGENT][NEUTRAL] 210 is basic, once every 5 years.
[AGENT][NEGATIVE] 23.95 not covered, 2745 not covered. 4910 is major and it's once every 6 months, 4341 is major, once every 24 months. All four quads can be done on the same day.
[AGENT][NEUTRAL] 9943, um.
[AGENT][NEUTRAL] I didn't see that one. What is that code for?
[CUSTOMER][NEUTRAL] It's for official adjust.
[AGENT][NEUTRAL] And what was 99434?
[CUSTOMER][NEUTRAL] Oh, usual or just?
[AGENT][NEUTRAL] What did you say? I'm sorry. What was that code for?
[CUSTOMER][NEUTRAL] Occasion, occasion or just?
[AGENT][NEUTRAL] OK, it's major once every 7 years, 923, uh 9230 is major, no frequency, 9222 is major, no frequency, 5212 not covered, 2950 is major, once every 7 years, 4346, and 6057 not covered.
[CUSTOMER][NEUTRAL] OK. I think you smashed the two ports for fillings, 2391 and for crown 2740.
[AGENT][NEUTRAL] Uh, crowns are once every 7 months, and they are major fillings are once every 24 months, and they're basic.
[CUSTOMER][NEUTRAL] OK. Uh, downgraded or not?
[AGENT][POSITIVE] There are no downgrades.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No downgrades. Be on see data update program.
[AGENT][NEUTRAL] Either or.
[CUSTOMER][NEUTRAL] OK. Uh, for fluoride, is there any age limit?
[AGENT][NEUTRAL] Florida is under the age of [PII], once every 12 months.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, and the oral period and extractions falls under the basic or major?
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] All of them
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Is there coverage for also?
[AGENT][NEGATIVE] Or there is not covered.
[CUSTOMER][NEUTRAL] OK, uh, for payroll maintenance, uh, does it start frequency with profit?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, uh, official guards are covered or not?
[AGENT][NEUTRAL] Occlusive guard so once every 7 years and it's major.
[CUSTOMER][POSITIVE] Thank you and uh
[CUSTOMER][NEUTRAL] Implants are not covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and benches and bridges are basic, uh, I'm sorry, major?
[AGENT][NEUTRAL] They are major.
[CUSTOMER][POSITIVE] Thank you. Um
[CUSTOMER][NEUTRAL] TMZ covered or not?
[AGENT][NEUTRAL] Say again.
[CUSTOMER][NEUTRAL] TMJ covered or not?
[AGENT][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] It's TMJ 7880.
[AGENT][NEGATIVE] No, not covered.
[CUSTOMER][NEUTRAL] OK. Full mouth.
[AGENT][NEUTRAL] Major once every 24 months.
[CUSTOMER][NEUTRAL] OK, bone graft.
[AGENT][NEUTRAL] What's the code?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Thank you. Uh, crown repair.
[CUSTOMER][NEUTRAL] Uh, for the major.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the core buildup?
[AGENT][NEUTRAL] Sir, say that again.
[CUSTOMER][NEUTRAL] Core build up, uh, I think the code is 2950.
[AGENT][NEUTRAL] Yes, it's covered as major and it's one moment.
[AGENT][NEUTRAL] Did you ask about this code?
[CUSTOMER][NEUTRAL] Uh, no, I don't think so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, she is 40, 2940 or 2950. Like I said, it's major once every 7 years.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, uh, two more quotes covered are not, uh, 4266 and 4381.
[AGENT][NEUTRAL] Yes, they are major.
[CUSTOMER][NEUTRAL] Thank you. Uh, is there any history on file that can affect frequency?
[AGENT][NEUTRAL] There is no history.
[CUSTOMER][POSITIVE] I'm sorry, no issue on file at all?
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, and is there any history on file that can affect you can see like FM or in the last 5 years?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, thank you. Can you please spell your name for me, then you call the number.
[AGENT][NEUTRAL] [PII] and for reference, you can use my name in today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much and have a wonderful rest of your day. Bye-bye.
[AGENT][NEUTRAL] Mhm. Bye. Thank you for calling APL.