AccountId: 011433970860
ContactId: dad6ef43-4596-475e-993f-ef396466625c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 881239 ms
Total Talk Time (AGENT): 232229 ms
Total Talk Time (CUSTOMER): 203811 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/dad6ef43-4596-475e-993f-ef396466625c_20250311T13:04_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello there, [PII]. My name is [PII] checking for dental benefits.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with benefits. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] All right. Policy number, ID number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. That's 02596171.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's full name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. 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 fee schedule, I can fax that over to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But what can you help me with this verbally if it is all right?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Alright, thank you. So can I have the group number and group name?
[AGENT][NEUTRAL] Um, yes, the group number is.
[AGENT][NEUTRAL] 70,030.
[AGENT][NEUTRAL] And the group name is Creative Circle LLC.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And the group number again was 730, right? 70,030. Alright, got it. Thank you so much for that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Can I have the, also the individual max and um deductible?
[AGENT][NEUTRAL] Um, yes, let's see.
[AGENT][NEUTRAL] One moment, the benefits are coming up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. The calendar year maximum is 500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the annual deductible is $50.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEGATIVE] So individual deductible, it's $50 and nothing has been used?
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] No family deductible?
[AGENT][NEUTRAL] Um, no, no family deductible. And actually, she's the only one on the policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Alright, got it. Can I have the co-insurance for preventive, basic, and major?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] OK. For a preventative, we covered um 100% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For basic, we cover 80% of allowable.
[AGENT][NEUTRAL] And what was the other one? I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Major.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there's no major covered under this policy.
[CUSTOMER][NEUTRAL] Alright, major services is not covered.
[CUSTOMER][NEUTRAL] How about for endoperio oral surgery?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] They are under basic or major.
[AGENT][NEUTRAL] Oral surgery.
[AGENT][NEUTRAL] And do you have an individual code?
[CUSTOMER][NEUTRAL] Yes, uh, 3330 for endo 4341 for Pero.
[CUSTOMER][NEUTRAL] 7140 for oral surgery.
[AGENT][NEUTRAL] OK, 7140.
[AGENT][NEUTRAL] That's covered under the basic expenses.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Limited to 2 oral evaluation procedures and any combination per per year.
[CUSTOMER][NEUTRAL] So 2 per year for 7140.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] You said the other one was 3330?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that one on the fee schedule. It's not covered and what was the other code?
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] OK, I'm not showing any coverage for that one either.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Orthodontics is covered or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] Alright, no missing tooth gloss, no waiting period?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEGATIVE] Oh, actually, this policy does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] Oh alright, missing tooth lo applies. Yes, coordination of benefits, it's standard, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Are we following the uh denta Max?
[AGENT][NEUTRAL] Yes, we are. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Max, so Crons is not covered.
[CUSTOMER][NEUTRAL] Alright, hold on.
[CUSTOMER][NEGATIVE] Covered not covered.
[CUSTOMER][NEUTRAL] 4341. So I have um specific codes here. Do you need it all at once?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] 015.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And 0150.
[AGENT][NEUTRAL] Yes, those are covered under the preventative.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Preventative got it.
[CUSTOMER][NEUTRAL] All right, hold on.
[CUSTOMER][NEUTRAL] And what's the uh frequency?
[AGENT][NEUTRAL] OK. Limited to 2 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How about for 0274?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, that's covered is limited to one bite wing X-ray procedure per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1111
[AGENT][NEUTRAL] Maximum of 1 procedure every 6 months.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] OK. That one is limited to 1 X-ray procedure every 5 years.
[CUSTOMER][NEUTRAL] Mhm. Fluoride 1206.
[AGENT][NEUTRAL] OK, I'm not showing 1206. I'm showing 1205.
[CUSTOMER][NEUTRAL] Um, is that under fluoride?
[CUSTOMER][NEUTRAL] I think that's under Flori, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, topical application of fluoride for adults.
[CUSTOMER][NEUTRAL] Alright for adults and what's uh the frequency and age limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of one per calendar year and
[AGENT][NEUTRAL] Oh, this one is limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Next code 1351.
[AGENT][NEUTRAL] OK. Maximum of 1 per 36 months.
[AGENT][NEUTRAL] Limited to dependent children under age [PII] and see.
[AGENT][NEUTRAL] There's one more.
[AGENT][NEUTRAL] On applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2140.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months and maximum of 1 each tube for 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No downgrade?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Right, no downgrade.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2950.
[AGENT][NEUTRAL] OK. I only see a 2940 and a 2951.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] How about for 4346?
[AGENT][NEUTRAL] No, I don't see that one.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 4355.
[AGENT][NEUTRAL] No, that one isn't listed either.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4266.
[AGENT][NEUTRAL] No, sir. I'm not showing that one either.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 4381.
[AGENT][NEUTRAL] No, sir. I'm not showing that one.
[CUSTOMER][NEUTRAL] Um, last code 9944.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that one isn't listed either.
[CUSTOMER][NEUTRAL] Alright, so it's not covered as well. So is there any history and file for this patient?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, no, I'm not showing any.
[CUSTOMER][NEUTRAL] Alright, no history on file. What's your name again?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] [PII], can I have your call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] R
[CUSTOMER][POSITIVE] That would be all, thank you so much bye for now.
[AGENT][POSITIVE] OK. Thank you, [PII], for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.