AccountId: 011433970860
ContactId: ec337ae8-52eb-4cc2-910c-78bb4c13b42c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391980 ms
Total Talk Time (AGENT): 164429 ms
Total Talk Time (CUSTOMER): 169796 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/ec337ae8-52eb-4cc2-910c-78bb4c13b42c_20250115T15:19_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, [PII]. This is [PII] and I'm calling on behalf of the provider's office to check on dental, uh, dental eligibility and benefits on a recorded line. Could you help me with that, [PII]?
[AGENT][NEUTRAL] Did you say dental eligibility or eligibility and benefits?
[CUSTOMER][NEUTRAL] Yeah, eligibility in the benefits, yeah.
[AGENT][NEUTRAL] OK. And is this your service in a doctor's office?
[CUSTOMER][POSITIVE] Mostly benefits
[CUSTOMER][NEUTRAL] Uh, doctor's office, yes.
[AGENT][NEUTRAL] OK, and we can help you. What's the policy number?
[CUSTOMER][NEUTRAL] Um, that would be 02521252.
[AGENT][NEUTRAL] Did you say 02521252?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that's gonna be [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That is correct, [PII].
[AGENT][NEUTRAL] OK. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]. [PII], date of birth, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Spell the patient's first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And you are a dental provider or medical?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] A dental.
[AGENT][NEUTRAL] OK, do you want to schedule of benefits faxed over to you?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and what is your fax number?
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So you'll receive the schedule within the next 5 to 7 minutes. Um, there is no history for this patient. The calendar year maximum is $1500 per covered person per calendar year, and there is a $50 calendar year deductible under this policy.
[AGENT][NEUTRAL] Um, the schedule will include the frequencies, common limitations, exclusions, um, it'll list, um, each procedure code that's covered under the policy as well. And did you have any additional questions regarding this?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Starting off with the group name and the group number, what the, what would it be?
[AGENT][NEUTRAL] OK, this is also on the identification card. um, the group number is 12028. Group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Universe, so wait, give me a second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Any personal tracking you said.
[CUSTOMER][NEUTRAL] Could you spell the last word?
[AGENT][NEUTRAL] A truck?
[AGENT][NEUTRAL] ING on the end trucking trucking.
[CUSTOMER][POSITIVE] Thank you. Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And the group number you said it was 12028 correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you very much and what would be the effective date at the coordination of benefit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The coordination of benefits is standard, the policy effective date.
[AGENT][NEUTRAL] It's [PII]. Uh, the policy is active.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] At this time.
[CUSTOMER][POSITIVE] Thank you very much and and it does run in the calendar year, right?
[AGENT][NEUTRAL] It's per calendar year and that information is on the schedule.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you very much, [PII]
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So and this is the first time I'm receiving fax for this insurance so I don't really know which or what the benefits which are the benefits which are like that are available. So, um, yeah, could you also uh check out if the providers in that in or out of network for this patient.
[AGENT][NEUTRAL] There's no network affiliated with this policy, it's provider of patient's choice.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Mhm. We've just faxed over the schedule. Mhm.
[CUSTOMER][NEUTRAL] Uh, could you check if.
[CUSTOMER][POSITIVE] Thank you. And what would be the orthodontics lifetime amount special?
[AGENT][NEGATIVE] So orthodontics is not covered. Uh, the exclusions is on the schedule. Um, there is a missing tooth cloth, um, implants, placement, removal of those items are not covered. TMJ is not covered. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you, and no waiting period, right?
[AGENT][NEUTRAL] There is a 12 month waiting period that's listed on the schedule as well and that's for major services.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Wonderful. And for the fillings in the Quran, are there any alternate benefits? Are they gonna be down with it?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][POSITIVE] Oh, the downgrades. Wonderful. And it's paid on sea date, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It, it cedar prep, either or.
[CUSTOMER][POSITIVE] Oh, thank you very much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I think that's most of it and could you maybe check for the code um.
[CUSTOMER][NEUTRAL] 4381, Harrison.
[AGENT][NEUTRAL] And what is that for?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] That is Arston.
[AGENT][NEUTRAL] And what is that?
[CUSTOMER][NEUTRAL] Uh, it's, it doesn't list that here. It just says Arin and the code for this procedure would be 4381.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's considered major, so it's reimbursed at 40%, mhm.
[CUSTOMER][NEUTRAL] Matrix.
[CUSTOMER][NEUTRAL] OK, frequency would be.
[AGENT][NEGATIVE] There's no frequency for this code.
[AGENT][NEUTRAL] And you did say D 4381?
[CUSTOMER][POSITIVE] Wonderful. Uh.
[CUSTOMER][NEUTRAL] That is correct, [PII], it is.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] I think that would be it then. We just let me give me a moment just to confirm things yeah.
[AGENT][NEUTRAL] OK, you
[AGENT][NEUTRAL] You should receive the schedule within the next 5 to 7 minutes. It's already been sent.
[CUSTOMER][POSITIVE] Thank you very much [PII] and yeah, that'll be it. And could you provide me the reference number?
[AGENT][NEUTRAL] My name in today's date, [PII].
[CUSTOMER][POSITIVE] Thank you very much, [PII], and yeah that will be it. Thank you for your service and you have a wonderful day and take care, [PII]. Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a great day thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] But