AccountId: 011433970860
ContactId: e5a0be0f-2c94-47a5-ae6f-dae547556140
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519989 ms
Total Talk Time (AGENT): 166154 ms
Total Talk Time (CUSTOMER): 254870 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/e5a0be0f-2c94-47a5-ae6f-dae547556140_20250218T17:45_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from the provider's office. I'm just calling, um, to verify if a code is covered under the policy plan.
[AGENT][POSITIVE] I'll be happy to assist with benefits today, [PII]. If I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy 02.
[CUSTOMER][NEUTRAL] 346-815
[CUSTOMER][NEUTRAL] Turn it down.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII].
[CUSTOMER][NEUTRAL] I don't know the last name. It's pretty long. It's [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active with an effective date of [PII]. And what is the code?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said the original effective date was [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] OK, I'm not showing that's on the fax but.
[AGENT][NEGATIVE] So that wouldn't be covered.
[CUSTOMER][NEUTRAL] It's not covered. OK, just wanted to make sure because we have a fax, but it, it wasn't included on there, so assuming it was not covered.
[AGENT][NEGATIVE] Yeah, anything that's not on the fax back means it's not covered.
[CUSTOMER][NEUTRAL] OK, I just wanted to not assume that's why I rather call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just double check.
[AGENT][NEUTRAL] Well, was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Mm, there was another code that wasn't on there, but it does say at the top, so it's a little misleading. So code 0330.
[CUSTOMER][NEUTRAL] It shows radiographs FMX expense is 80%, but then on the chart of the code it doesn't show that code on the chart.
[AGENT][NEGATIVE] Then it's not covered.
[CUSTOMER][NEUTRAL] OK, so it's not if it's not under a schedule of coverage dental services and procedures under that part, if the code is not on there, it's not covered even though at the top it says of the next expenses, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] That means we have, we may um have it coded differently and you would need to find the code that's the closest to it.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] I don't see one though. I just see one.
[AGENT][NEUTRAL] But the FMX, if you look on there under the preventative, those are the FMX expenses that are covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The 00330.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 100 and then the 00210, those are the only two FMX expenses that we cover.
[AGENT][NEUTRAL] So it's not misleading, it's just not maybe the cold that you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the code we have, but it's not showing here in the fax. Maybe it cut off.
[AGENT][NEUTRAL] That's the code that you have 00330?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEGATIVE] 0 that's the same code we use 0330 and 0210 for the FMX or panel, which sometimes is downgraded, but on the fax, the first page it says preventative expenses. It only gives us code 00120 all the way to 1525, but in between there it should be code 0330 and it's not on there.
[AGENT][NEUTRAL] Look, look, look, look below that. Keep going.
[AGENT][NEUTRAL] Because if you can see that you have to be able to see 0330 but look, look under the service column. Don't look on look under the service column. Do you see where it says preventative expenses?
[CUSTOMER][NEUTRAL] Mm, yes, uh-huh.
[AGENT][NEUTRAL] Now scan down in that same column and then in bold letters, you should see radiographs and FMX expenses. Do you see that?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] But it doesn't have the code right next to it. It just says radiograph FMX expense.
[AGENT][NEUTRAL] OK. Now, now go back to the other side where you see all the other codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see? It's right under. If you can see radiographs, FMX expenses, then you should see intraoral complete series, including bye wings. You don't see that?
[CUSTOMER][NEUTRAL] No, ma'am, it's not on here. I think our fax might have cut off maybe when it was sent that first time around. We got one in [PII], so maybe it cut off then when somebody sent it to us.
[AGENT][NEUTRAL] So what do you see under radiographs and FMX expenses?
[CUSTOMER][NEGATIVE] There's nothing. There's a line that's black, so that's why I'm saying it's probably the fax was sent and it cut off.
[CUSTOMER][NEUTRAL] There, there's just black lines on there, so I think it was cut off when it was sent the first time around. So that's why I'm saying it's not on there. So that's why I called to verify because it's not on here. So I'm thinking it was cut in half.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Like when I was processing.
[CUSTOMER][NEUTRAL] So that's why I wanted to make sure that panel code was covered.
[AGENT][NEUTRAL] Yeah, that's covered.
[CUSTOMER][NEUTRAL] OK, and it's covered under 80%?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, and I think that's all if you can just send me a new fax um.
[CUSTOMER][POSITIVE] For the patient, that would be great.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] What was that first cold?
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] Oh, they have that under basic that's an extraction.
[CUSTOMER][NEUTRAL] Yes, it's an extraction.
[AGENT][NEUTRAL] That's covered. I'm sorry, they had it under basic and I was going in order with the other codes that were.
[AGENT][NEUTRAL] The 7, the 7 codes. OK, yeah, they have it under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause then they're not.
[CUSTOMER][NEUTRAL] So that would be 80%.
[AGENT][POSITIVE] Yes, that'll be 80%. Yes, I'm glad I saw that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's good then.
[AGENT][NEUTRAL] Cause I was looking under the major.
[AGENT][NEUTRAL] Because that's where the majority of the, the seven codes are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Extractions are usually, yeah, yeah.
[AGENT][POSITIVE] OK. All right, good.
[CUSTOMER][NEUTRAL] So then I think our fax was cut off the first time around because I don't see it anywhere in here. I searched the whole fax for 7140. I searched in the race.
[AGENT][NEGATIVE] You should have a total of 8 pages.
[CUSTOMER][NEUTRAL] Yes, I do have the 8 pages, but like I said, there's like some weird lines at the bottom, so I think that's where the codes that I'm needing were cut off.
[AGENT][NEUTRAL] OK, what's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Alright, you should receive that fax in the next 5 to 7 minutes.
[CUSTOMER][NEUTRAL] OK, yes ma'am, and can I have a reference number for today's call, please?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK, all right, thank you so much ma'am.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.