AccountId: 011433970860
ContactId: dfefd0d8-1d03-44fd-aa4d-fcd271ec9629
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 935599 ms
Total Talk Time (AGENT): 316737 ms
Total Talk Time (CUSTOMER): 400267 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/dfefd0d8-1d03-44fd-aa4d-fcd271ec9629_20250411T14:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey how you doing?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you today?
[CUSTOMER][NEUTRAL] I'm good. I was calling. I just was on the phone with a rep, um, I got a patient in the office and we're needing to know, um.
[CUSTOMER][NEUTRAL] Fairly quickly if her feelings are covered and I haven't received the fax back so I kinda need to confirm like I need to go over benefits.
[AGENT][POSITIVE] Sure, I'll be happy to assist you. What is your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] Mr. [PII], could you bring me that card again?
[CUSTOMER][NEUTRAL] OK, I'm gonna get it. One second. Alright, I'll call you back up.
[CUSTOMER][NEUTRAL] It's 02599346.
[CUSTOMER][NEUTRAL] And name is [PII]
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] Date of birth [PII] no you're good, [PII].
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Now we have a different last name listed as well.
[CUSTOMER][NEUTRAL] What's that last name?
[CUSTOMER][NEUTRAL] Because I got, I, I, I got in with the other rep with that last name.
[AGENT][NEUTRAL] So we have [PII].
[CUSTOMER][NEUTRAL] She go by [PII]. OK, alright, well we would need to update that in our system then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me change it just to file that claim we will need that. OK, ma'am, um, could we start off with what's that group name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, and she sent that fax to [PII], is that correct?
[CUSTOMER][MIXED] Yes, that's correct, but I ain't got it.
[AGENT][POSITIVE] No problem. Sometimes it takes a minute to come through.
[CUSTOMER][NEGATIVE] Yeah, I'm still waiting on it and it just hasn't came through.
[AGENT][NEUTRAL] You know what?
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] I'm gonna send it again for you as well.
[AGENT][NEUTRAL] You just never know, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just tell her we have the patient in the chair.
[AGENT][NEUTRAL] Someone get that ready.
[AGENT][NEUTRAL] OK, so the group number is 26734.
[CUSTOMER][NEUTRAL] Hold on, let me get there and then I'm gonna ask you a question about the billing. Say that.
[AGENT][NEUTRAL] 26734.
[CUSTOMER][NEUTRAL] OK, yes ma'am. Alright, so, um, do you know the patient's maximum?
[AGENT][NEUTRAL] Yeah, so it all benefits given over the phone is a verification of coverage, not a guarantee of payment. She has a calendar year max of $1500.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, alright, and anything they use out of it?
[AGENT][NEUTRAL] There is
[AGENT][NEUTRAL] No, the effective date was [PII]. Now there is a $50 deductible.
[CUSTOMER][NEUTRAL] Is there a deductible?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That has not been met.
[CUSTOMER][NEUTRAL] OK, uh, uh, I'm pretty quick with questions. Um, do you know if feelings are covered on our policy? And if so, um, what percentage?
[AGENT][NEUTRAL] They are covered.
[AGENT][NEUTRAL] Um, what's the code?
[CUSTOMER][NEUTRAL] The 2330.
[AGENT][NEUTRAL] 2330.
[AGENT][NEUTRAL] Yeah, that's covered under basic at 80%. There's no network involvement, we pay a percentage of UCR.
[AGENT][NEUTRAL] Let me ask you, do you have an email?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do, um.
[AGENT][NEUTRAL] Would you like for me to email it to you?
[CUSTOMER][NEUTRAL] One second, how, how, what's the frequency for those feelings? I'm sorry, she's in a chair and they're kind of needing to know this.
[AGENT][NEUTRAL] Sure. So, um, fillings.
[AGENT][NEUTRAL] 2330.
[CUSTOMER][NEUTRAL] Um, I got into the next step I wanna come back.
[AGENT][NEUTRAL] I'm getting that. I'm sorry. It's maximum of 1 per 5 year period per tooth.
[CUSTOMER][NEUTRAL] No, it's fine.
[CUSTOMER][NEUTRAL] You said 1, so 1 in 1 in 60 months?
[AGENT][NEUTRAL] Right, and that's purchases.
[CUSTOMER][NEUTRAL] OK, let me place you on a brief hold if you don't mind.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright ma'am, can we finish going over that breakdown? I'm so sorry about that.
[AGENT][NEUTRAL] OK, so um.
[AGENT][NEUTRAL] This is a calendar year plan.
[AGENT][NEUTRAL] Now.
[CUSTOMER][NEUTRAL] OK, and I have specific questions if you don't mind.
[AGENT][NEGATIVE] Not at all, not at all.
[CUSTOMER][NEUTRAL] OK, alright, so let's see, got that. What's that, that group name? I didn't ever get that group name. I got the number but not the name.
[AGENT][NEUTRAL] Group name is Trucking, I mean sorry, Universal Trucking.
[AGENT][NEUTRAL] Evergreen.
[CUSTOMER][NEUTRAL] Alright ma'am, and do you know if it's a 18,050 breakdown?
[AGENT][NEUTRAL] It's 18,040.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEUTRAL] There is a missing tooth yes, there's one of those.
[CUSTOMER][POSITIVE] You, you, you're good, you, you're good. It's definitely OK. Alright, ma'am, and see, I got the, I, I just got that fax back. I just got it, but I just, I just got some of the, um, OK, I don't have to ask you about that. I'm just looking at things I don't have to ask.
[AGENT][POSITIVE] Oh, good.
[CUSTOMER][NEUTRAL] Some of this stuff don't be on here. OK, for the code D4341, do you know the frequency and what it's covered it?
[AGENT][NEUTRAL] So that is considered a major procedure. There is a 12-month waiting period for major procedures.
[AGENT][NEUTRAL] So she would not be eligible for any perioendo prostheonic repair, or uh or, or, I don't know, teeth, or oral surgery until for [PII].
[CUSTOMER][NEUTRAL] You know when it ends.
[CUSTOMER][NEUTRAL] So you said that's perioendo, oral surgery, and what else?
[AGENT][NEUTRAL] Perioendoprosthodontic repairs and oral surgery.
[CUSTOMER][POSITIVE] Prosthodontic repairs, correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, let's see here so.
[CUSTOMER][NEUTRAL] Oh, you said it was 1 in 24 months with D 4341?
[AGENT][NEUTRAL] Uh, D 4341, let me.
[CUSTOMER][NEUTRAL] And because some of like I see the facts that but it's not specific on.
[AGENT][NEUTRAL] 43, yeah.
[AGENT][NEUTRAL] It's 1 per quadrant per 24 months, and all 4 quadrants could be done in the same time.
[CUSTOMER][POSITIVE] So any problem, this is [PII]. How can I help you?
[AGENT][NEUTRAL] So on the limitation, the back page is the key for the limitations on that facts.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Yeah, I'm, it's just, it don't, it just don't make sense. Like I'm trying to, it's just a little weird looking, so.
[AGENT][NEUTRAL] Yeah, and you're trying to do it in a hurry too because she's in the chair, right?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, I, I am, yes. um.
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Do you know if let me just make sure I just I see this fact back so I'm trying not to ask you too many questions, um.
[CUSTOMER][NEUTRAL] Do you know if it's an age limit for sealants and fluoride because I'm not seeing it.
[AGENT][NEUTRAL] Mhm. There is an age limit. Um.
[AGENT][NEUTRAL] Fluoride is under the age of [PII] every 12 months.
[CUSTOMER][NEUTRAL] You said you have a your some therapy treatment, is that what you're looking at?
[AGENT][NEUTRAL] Seal lenses under the age of 14 permanent molars only every 3 years.
[CUSTOMER][NEUTRAL] Yes, the term that I gave you was for your gostairs.
[CUSTOMER][POSITIVE] I really appreciate you working with me because it's like the fact that doesn't give all the information sometimes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, we, and you have to look at it and go back to the key page and yeah.
[CUSTOMER][NEUTRAL] Yeah, I definitely understand like the basics are there, but
[AGENT][NEUTRAL] Sometimes what, what I would do.
[AGENT][NEUTRAL] Yeah, and you have to go through each code. It does have it broken down into preventive, basic and major expenses.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, OK, ma'am, I got another.
[AGENT][NEUTRAL] And sometimes what I would do is to print that last page with the key thing and then that way you can, you know, go through each page or.
[CUSTOMER][NEUTRAL] Yes ma'am. 40.
[AGENT][NEUTRAL] And look
[AGENT][POSITIVE] Just a little idea, but I'm I'm I'll be happy to help you.
[CUSTOMER][POSITIVE] I, I really appreciate it. Um, do you know, uh, for the code for build up the 2950 if it's what percentages covered it?
[AGENT][NEUTRAL] 2950 is
[AGENT][NEUTRAL] I'm checking I've got to look through this list of codes as well, so.
[CUSTOMER][POSITIVE] No, it's totally fine.
[CUSTOMER][NEUTRAL] Hey ma'am, I'm gonna put you on a brief hold, OK?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thanks
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, 25
[CUSTOMER][POSITIVE] Hey ma'am, I'm sorry, um.
[AGENT][NEUTRAL] Yeah you're fine. 2950 is, is not covered.
[CUSTOMER][NEUTRAL] And they.
[CUSTOMER][NEGATIVE] It's not at all OK. Uh, what about for per maintenance? Do you have the frequency and um, uh, what it's covered it? I don't see it, see like.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, so there's a 12 month, yeah, if you go like next to the last page, you just have to look for that code, the um 4910.
[CUSTOMER][NEUTRAL] 49.
[AGENT][NEUTRAL] Is 1 for 6 months, but that is listed under.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See, I, I'm trying to get what you're saying and, you know, trying to see it, but I
[CUSTOMER][NEUTRAL] I'm not seeing what you're talking about. Cause like it has like the key limitations, but it's not specifically stating like which like code is referring to. That's why I'm confused.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] What did you say about the 29 and 2950 is not covered, correct? OK, and what was the 4910?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4910. I'm wondering if you're not seeing I'm wondering if.
[AGENT][NEUTRAL] Was the fax pack 8 pages? I just wanna make sure you got the correct.
[CUSTOMER][NEUTRAL] 9
[AGENT][NEUTRAL] Yeah, OK, so you did, so 4910 is under basic, it's one for 6 months.
[AGENT][NEUTRAL] But I mean under major, I apologize, so that's that 12 month waiting period.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[CUSTOMER][NEUTRAL] No, it's OK. You said major.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh, no, not covered the 49 10 1 and 6 month period. OK, got that waiting period, yes ma'am. What about for D 4346?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4346, I don't see that listed as a covered benefit. If it's not on the um list.
[CUSTOMER][NEUTRAL] Back that
[AGENT][NEUTRAL] Yeah, it's not covered.
[CUSTOMER][NEUTRAL] OK, alright, ma'am, and I see 99. Did I see it? I'm sorry, I'm just, it's a little different.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For D 9944, I don't see it, but is the Closer guard covered on this policy D9944?
[AGENT][NEUTRAL] Yeah, it, it is now that 9940 was an old code and they just haven't updated, but the 9944 is covered again under major.
[AGENT][NEUTRAL] Under that 12 month waiting period.
[CUSTOMER][NEUTRAL] Alright ma'am.
[CUSTOMER][NEUTRAL] Here.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And for dentures, uh, dentures and parts, I do see it's covered in 1 in every 60 months, but OK, is there a waiting period for dentures or just the repair?
[AGENT][NEUTRAL] Yes, there would be a major, uh.
[AGENT][NEUTRAL] A waiting period for the crowns, bridges, dentures.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got I got all that in there just so we have a good idea of what's going on.
[CUSTOMER][NEUTRAL] OK, do you know if implants are covered on this policy D6010?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sounds good. Let's see, and I'm not showing ortho is there any ortho coverage? I'm just trying to make sure.
[AGENT][NEGATIVE] No or no coverage.
[CUSTOMER][POSITIVE] OK, awesome thank you so much for helping me with the policy.
[AGENT][POSITIVE] Oh, it's been my pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, um, there's no frequent no there's no history on file as well, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Alright ma'am, well I really appreciate it and could I get that reference number?
[AGENT][POSITIVE] Oh, it's been, it's my name in today's date and I spell my name [PII], and it's been a pleasure to assist you, [PII].
[CUSTOMER][NEUTRAL] You said,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You said [PII] and then what was it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK all right well thank you so much have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL [PII]. I hope you have a wonderful day as well and happy Friday.
[CUSTOMER][NEUTRAL] You too ma'am bye.
[AGENT][POSITIVE] Thank you. Bye-bye.