AccountId: 011433970860
ContactId: db443ae5-1fc8-43b4-b485-9e8d8e1f8ec2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 673280 ms
Total Talk Time (AGENT): 312226 ms
Total Talk Time (CUSTOMER): 197264 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/db443ae5-1fc8-43b4-b485-9e8d8e1f8ec2_20250324T15:20_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi, my name is [PII]. I'm calling from Century Dental, and I was, um, wondering if you could help me with benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with that there. Could I get a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The policy number you're calling on?
[CUSTOMER][NEUTRAL] Um, you know what he gave me was 02584613.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, his date of birth is [PII].
[AGENT][NEUTRAL] And his name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thank you
[AGENT][NEUTRAL] OK, thank you for that and you did say you were calling for benefits today?
[CUSTOMER][NEUTRAL] Yeah, I, I just wanna make sure that we're in network with you or what for schedule you follow because I haven't seen you come up in my office before.
[AGENT][NEUTRAL] OK, so this is a non-contracted policy, so he can go to any provider. Um, we have a fee schedule. I can, uh, well, the procedures that are covered frequencies, information that I can fax to you as far as payment, we pay a percentage of the of usual and customary.
[CUSTOMER][NEUTRAL] OK, so you don't follow a certain fee schedule?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, um, and so he can go to any dental office?
[AGENT][NEUTRAL] He can as long as they accept the insurance, um, there is no list of providers. It just pays based uh on the procedures covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we've never seen this insurance our in our office before, so, um.
[CUSTOMER][NEUTRAL] I don't know if we accept it, um, so, so tell me again you don't follow up the schedule, but you do what now it's a non-contracted schedule?
[AGENT][NEUTRAL] Yes, so, uh, like for instance, please be advise verifying benefits is not guaranteed payment. Uh, it looks like, uh, his policy has a $500 calendar year maximum. He does have a $50 deductible, uh, for preventative, uh, we pay 100% of the allowable, and that allowable is based on you showing customary.
[CUSTOMER][NEUTRAL] OK, so what, so what do you cover for cleanings, you know, preventive, basic and major?
[AGENT][NEUTRAL] Uh, so as I can, I mean, there's a list of procedures you can either give me codes or I can send you over a full, um,
[AGENT][NEGATIVE] It shows you all procedures that are covered. The frequency, if it's preventative, basic, or um I don't think this policy covers major. No, there is no major coverage on this um policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about for like um work canals for 3330?
[AGENT][NEUTRAL] 3330, let's see.
[AGENT][NEUTRAL] OK. I don't show 3330 as a cover procedure.
[CUSTOMER][NEUTRAL] What about 4341?
[AGENT][NEUTRAL] 4341 is not a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about, uh, 4342?
[AGENT][NEUTRAL] 4342 is not a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about like 4910 for period maintenance?
[AGENT][NEUTRAL] 4910 is not a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about, um.
[CUSTOMER][NEUTRAL] Like 443 55.
[AGENT][NEUTRAL] 4355 is not a covered procedure.
[CUSTOMER][NEUTRAL] What about um 9944?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 9944 is not a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about for crowns 2740?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I do not show 2740 as a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about, uh, dennters 5110?
[AGENT][NEUTRAL] That is not a covered procedure.
[CUSTOMER][NEUTRAL] Bridges 6240.
[AGENT][NEUTRAL] That is not a covered procedure. I stated, this policy has no major
[AGENT][NEUTRAL] Um, coverage.
[CUSTOMER][NEUTRAL] OK, so this is all what about for like um extraction 70 to 10?
[AGENT][NEUTRAL] 7822.
[AGENT][NEUTRAL] So I don't show 7210 as a covered uh extraction. I show 7140.
[CUSTOMER][NEUTRAL] OK, um, and then what about implant supported crown 6058? I'm sure that falls on major, so.
[AGENT][NEUTRAL] Correct, and it's not a covered procedure.
[CUSTOMER][NEUTRAL] Um, what about 4346?
[AGENT][NEUTRAL] 4346 is not a covered procedure.
[CUSTOMER][NEUTRAL] OK, um, do you guys cover, um, fillings 2392?
[AGENT][NEUTRAL] 223
[AGENT][NEUTRAL] 2392 is covered.
[CUSTOMER][NEUTRAL] And then what do you pay? What's the co-pay on that?
[AGENT][NEUTRAL] And let me look at that. That is basic 2.
[AGENT][NEUTRAL] So that would be covered under his basic expenses, paying 80% of the allowable.
[CUSTOMER][NEUTRAL] OK, and then so you said he has an annual max of 500 and individual deductible about 50, um, what would the frequencies be for exams for him?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Do you have a code, um, that you would use?
[CUSTOMER][NEUTRAL] Um, 010120.
[AGENT][NEUTRAL] 0120 that's under preventive and the frequency is.
[AGENT][NEUTRAL] Uh, that is limited to 2 oral evaluation procedures, um.
[AGENT][NEGATIVE] And and per 12 months and I show at this time, uh, he has not used any of his benefits.
[CUSTOMER][NEUTRAL] OK, what about for profi 1110?
[AGENT][NEUTRAL] Uh, 1110 is, let's see under preventative paid at 80%, uh.
[AGENT][NEUTRAL] Frequency is 1 per every 6 months.
[CUSTOMER][NEUTRAL] What about for buying 0274?
[AGENT][NEUTRAL] 0274 uh is.
[AGENT][NEUTRAL] Let's see, under preventative at 100% frequency on that is uh limited to one bite wing X-ray procedure.
[AGENT][NEUTRAL] In 12 month period.
[CUSTOMER][NEUTRAL] What about FMX 0210?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 0210.
[AGENT][NEGATIVE] I do not show 0210 covered.
[CUSTOMER][NEUTRAL] OK, what about, um, fluoride coverage to what age? [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 1208 is not a covered procedure.
[CUSTOMER][NEUTRAL] What about um 1351?
[AGENT][NEUTRAL] 1351 is not a covered procedure. I'm sorry, it is. Uh, so that is covered under the preventative.
[AGENT][NEUTRAL] Um, let me look.
[AGENT][NEUTRAL] One per every 36 months.
[AGENT][NEUTRAL] Um, limited to, uh, so this is limited to, uh, dependent children under [PII].
[CUSTOMER][NEUTRAL] OK, um, what about 9110?
[AGENT][NEUTRAL] And it's
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9110 is covered.
[AGENT][NEUTRAL] Uh, and that is covered under the basic, uh, benefit of
[AGENT][NEUTRAL] Let's see, 80% of the allowable.
[CUSTOMER][NEUTRAL] Is there a frequency for that at all?
[AGENT][NEGATIVE] There is no frequency.
[CUSTOMER][NEUTRAL] And then what about 2980?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, 2980 is not a covered procedure.
[CUSTOMER][NEUTRAL] OK, um, and then, so what was the effective date for this then?
[AGENT][NEUTRAL] I showed that this policy has been effective since [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII] you said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then what would be the payer ID for this?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] And then your claims address please?
[AGENT][NEUTRAL] Mailing address for claims is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] so [PII] you said?
[AGENT][NEUTRAL] Yes, and that's [PII].
[CUSTOMER][NEUTRAL] [PII] and then who would be his employer or group name?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, the group name is Oxford Global Resources LLC.
[CUSTOMER][NEUTRAL] Oxford is O X F O R D.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So Oxford Global, I'm sorry, what was the rest?
[AGENT][NEUTRAL] Resources LLC.
[CUSTOMER][NEUTRAL] OK and then so is this insurance um then called American Public Life?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, and so what would be his group number?
[AGENT][NEUTRAL] Group number is 70052.
[CUSTOMER][NEUTRAL] OK, um, and you said he hasn't had any history of, um, FMX panel or by wings, correct?
[AGENT][POSITIVE] Correct, that is correct.
[CUSTOMER][NEUTRAL] And then can I just get a reference number please?
[AGENT][NEUTRAL] Yes, ma'am, to reference our call, you'll use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you for helping me.
[AGENT][POSITIVE] You're welcome you have a wonderful day. Thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.