AccountId: 011433970860
ContactId: ed238f13-ad10-488b-b416-c879795db76d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530119 ms
Total Talk Time (AGENT): 178072 ms
Total Talk Time (CUSTOMER): 128091 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/ed238f13-ad10-488b-b416-c879795db76d_20250520T14:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I need to verify a patient's dental insurance.
[AGENT][NEUTRAL] OK, I can help you with eligibility of a patient. May I please get your name and your callback number and the provider's office you're calling from?
[CUSTOMER][NEUTRAL] My name is [PII]. The callback number is [PII], and the dentist office is Penley Family Dentistry.
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. And then what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] [PII] 02623675
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] All right, I do show that [PII] does have an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And it is current.
[AGENT][NEUTRAL] And if you give me your fax number I can send you a fax back with a benefit breakdown and reschedule.
[CUSTOMER][NEUTRAL] I tried to get a fax earlier and I did not receive it so I was wondering if I could just ask a couple of questions and you can answer them for me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely. Let me get her um benefits pulled up real quick.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK just a second while I pull them in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's try it.
[AGENT][NEUTRAL] This first time I've looked one up this morning so it's uh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Being slow.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That's alright.
[AGENT][NEUTRAL] Once it wakes up though, it'll be fine.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, you're welcome. Alright, thank you.
[AGENT][POSITIVE] OK, I think I've got it pulled up.
[AGENT][NEUTRAL] Let me see what her maximum is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So looking at her policy.
[AGENT][NEUTRAL] I've got it's pulled up now. What are the questions that you have for us?
[CUSTOMER][NEUTRAL] Um, maximum deductible percentages on preventative, basic, and major.
[CUSTOMER][NEUTRAL] And if there's a missing tooth call, yeah, there's a couple questions.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] So maximum calendar year and this is just to verify her benefits it's not a guarantee of payment is $750.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has a $50 co-pay, um.
[AGENT][NEUTRAL] Which has not been met yet.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] For preventive, it's a 100% of allowable um we use the UCR fee fee schedule.
[AGENT][NEUTRAL] For basic is 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she does not have major on this policy.
[AGENT][NEGATIVE] She does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does she have a waiting period?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, she does not have a waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then I have a couple codes I need to check the frequencies on. Do you want all the codes at once or one at a time?
[AGENT][NEUTRAL] One at a time.
[CUSTOMER][NEUTRAL] OK, the first one is D1110.
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative and is
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next one is D0120.
[AGENT][NEUTRAL] Um, her oral evaluation.
[AGENT][NEUTRAL] Let me see, and that's also under preventative is 2 every 12 month period.
[CUSTOMER][NEUTRAL] OK, and the next one is D0274. I will also need to know if you have any history on this one.
[AGENT][NEUTRAL] Uh, the bite wing.
[AGENT][NEUTRAL] Is once every 12 month period.
[AGENT][NEUTRAL] And then let's look and see if she does not have any history at all, nothing's been turned in for claims for her.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK, alright, the next one is D0210.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] It goes by 80% of the allowable amount.
[CUSTOMER][NEUTRAL] OK, no frequency?
[AGENT][NEGATIVE] No frequency on this one.
[CUSTOMER][NEUTRAL] OK and the last one is D1208.
[AGENT][NEUTRAL] 1208.
[AGENT][NEUTRAL] OK, that's not pulling up on.
[CUSTOMER][NEUTRAL] The it's um for uh.
[AGENT][NEUTRAL] On the fax back so it's a non-covered service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and I have a group number of 70101.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, perfect. Alright, I believe that's it.
[AGENT][POSITIVE] OK, all right. Is there, that's everything I can help you with today, Ms. [PII]? You don't have any other questions?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, well, you have a blessed day and thank you for calling APL.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] Yes ma'am thank you you too.
[AGENT][NEUTRAL] Bye-bye.