AccountId: 011433970860
ContactId: ee61f481-2130-4c1d-bf8a-83a227afeede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1516739 ms
Total Talk Time (AGENT): 429266 ms
Total Talk Time (CUSTOMER): 302320 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/ee61f481-2130-4c1d-bf8a-83a227afeede_20250327T15:03_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] Uh, hi, [PII]. This is [PII]. I'm calling you from Color office. I'm checking the eligibility and benefit of this discussion. How are you today, [PII]?
[AGENT][POSITIVE] OK. Well, I'm doing well. How are you?
[CUSTOMER][POSITIVE] Nice to hear. Yes me too I'm doing well. Excuse me for asking me, [PII].
[AGENT][POSITIVE] Well, I'll be more than happy to help you with the eligibility and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII]. This is direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is 183.
[CUSTOMER][NEUTRAL] 6257.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, for this patient,
[CUSTOMER][NEUTRAL] Give me the group number please.
[AGENT][NEUTRAL] The group number is 22215.
[CUSTOMER][NEUTRAL] 22215. And the group name?
[AGENT][NEUTRAL] Universal Trucking.
[AGENT][NEUTRAL] Nova Lines.
[CUSTOMER][NEUTRAL] U N I V E R.
[CUSTOMER][NEUTRAL] U N I V E R S, Universe tracking K R A E K I N G. And then universe tracking.
[AGENT][NEUTRAL] Nova, N O V A.
[AGENT][NEUTRAL] Lines
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] L I N E.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Do you have to pay your ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Right. And give me the claiming, uh, the claiming address.
[AGENT][NEUTRAL] Our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII], right.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] You probably is in the lock, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The provider it is in the work, right?
[AGENT][NEUTRAL] Is the provider in-network?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, let me, so this is a dental policy. Let me see if this policy has a network. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So this policy does not have a network?
[CUSTOMER][NEUTRAL] That's not happen.
[CUSTOMER][NEUTRAL] What about if his schedule?
[AGENT][NEUTRAL] Um, it's just a standard fee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, this plan type be is a calendar year or benefit year.
[AGENT][NEUTRAL] Um, calendar year.
[CUSTOMER][NEUTRAL] OK. So how much that will make?
[AGENT][NEUTRAL] $1500.
[AGENT][NEUTRAL] Per covered insured?
[CUSTOMER][NEUTRAL] And how much
[CUSTOMER][NEUTRAL] And how much use?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, they have not used any of their max or met the deductible.
[CUSTOMER][NEUTRAL] Mhm. So there is deductible or no deductible?
[AGENT][NEUTRAL] There's a $50 deductible up to $150 per family.
[CUSTOMER][NEUTRAL] 50,250, not use right deductible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, deductible it is applied for the preventative, yes or no.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] CUV type it is standard or no or no CUV?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] COB type, it is a standard or no loop or no COB.
[AGENT][NEUTRAL] There's no
[AGENT][NEUTRAL] There's no coordination benefits.
[CUSTOMER][NEUTRAL] No coordination, OK.
[CUSTOMER][NEUTRAL] All right. There is a waiting for missing tooth plus.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] There is a waiting for missing tooth plus.
[AGENT][NEUTRAL] Is there a waiting period or missing tooth louses? There is a waiting period for the major expenses, which is 12 months, um, from the day the policy became effective, um, but that has passed, and then, um,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] What was the second question?
[CUSTOMER][NEGATIVE] I missing the class.
[AGENT][NEGATIVE] No, missing tooth cloth, yes, there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] Mhm. And then pre-authorization, it is required, suggested.
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. So alternative ticket is covered or not covered?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Orthodontic. It is covered or not covered.
[AGENT][NEUTRAL] I can't. Can you repeat that, please?
[CUSTOMER][NEUTRAL] Sure, sure. Orthodontic, it is covered or not covered?
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] Or for lifetime max I mean in October.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Uh, uh, can you provide me the coinsurance percentage for preventative, basic endoreo and oral surgery?
[AGENT][NEUTRAL] Sure. So preventative is covered at 100% of UCI?
[AGENT][NEUTRAL] Radio graphs, FMX expenses are covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic expenses and basic restorative are covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Major expenses, which includes endodontic, periodontic, prosodontic, and oral surgery, is covered at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the uh adjunctive, it is 9110. It will be covered 80 or 40.
[AGENT][NEUTRAL] You said 9110?
[CUSTOMER][NEUTRAL] Yeah, the present it is covered 80 or 40.
[AGENT][NEUTRAL] I understand. Hold on one moment. I'm just searching for the code. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 9110 is not a code on this list, so it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] OK. All right. So, mhm, and the period and will be considered major, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So I have here this present code. So, can I give you one by one or do you need all at one of this present codes?
[AGENT][POSITIVE] Oh, we can do, you can give it to me all at once.
[CUSTOMER][NEUTRAL] Other ones. OK, let's start. It is 0150.
[CUSTOMER][NEUTRAL] 0140.
[CUSTOMER][NEUTRAL] 0160.
[CUSTOMER][NEUTRAL] 0180.
[CUSTOMER][NEUTRAL] 0220
[CUSTOMER][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] 0 to 10.
[CUSTOMER][NEUTRAL] 0431.
[CUSTOMER][NEUTRAL] 1110.
[CUSTOMER][NEUTRAL] 1206.
[CUSTOMER][NEUTRAL] 1351.
[CUSTOMER][NEUTRAL] 2140.
[CUSTOMER][NEUTRAL] 2391.
[CUSTOMER][NEUTRAL] 2740
[CUSTOMER][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] 2954
[CUSTOMER][NEUTRAL] 4341
[CUSTOMER][NEUTRAL] 4910
[CUSTOMER][NEUTRAL] 4355
[CUSTOMER][NEUTRAL] 5110.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] 6058
[CUSTOMER][NEUTRAL] 6056
[CUSTOMER][NEUTRAL] 6740.
[CUSTOMER][NEUTRAL] 7210.
[CUSTOMER][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] 9944. That's it.
[AGENT][NEUTRAL] OK, and do you have a copy of the member's fax back?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, do you mind if I place you on just a brief hold while I go through these codes for you?
[CUSTOMER][POSITIVE] Sure, sure. No problem.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 431.
[AGENT][NEUTRAL] OK, let me make sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I literally just saw 1351. Wait, let me refocus there we go.
[AGENT][NEUTRAL] How much these are um.
[AGENT][NEUTRAL] Like on base.
[AGENT][NEUTRAL] Um, what am I doing P 100 CD.
[AGENT][NEUTRAL] 2140.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] A major.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] 4341.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 5510. I don't see a 5110. I see 55.
[AGENT][NEUTRAL] 10.
[AGENT][NEUTRAL] 610.
[AGENT][NEUTRAL] 6010.
[AGENT][NEUTRAL] I see. OK, 06.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, but
[AGENT][NEUTRAL] 6740.
[AGENT][NEUTRAL] Major or.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Just have my eye on it here we go.
[AGENT][NEUTRAL] 2210.
[AGENT][NEUTRAL] 7140.
[AGENT][NEUTRAL] 7140, wait a minute.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] 7953.
[AGENT][NEUTRAL] 79.
[AGENT][NEUTRAL] OK, now.
[AGENT][NEUTRAL] 9944.
[AGENT][NEUTRAL] Oh, see, let me see if there's anything at the top.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 9944.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So for code 0150, um, that's preventative at 100% with a limitation of two or evaluations per
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 12 month period, um, 0 120, 140, 150, 60, and 80 are all paired together.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, code 014060 and 80, um, aren't covered, aren't on the policy 0150 is.
[AGENT][NEUTRAL] 0220 is basic at 80% with no limitation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0274 is preventative at 100%.
[AGENT][NEUTRAL] Limited to one bite wing um X-ray per twelve-month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0210 is 80% um basic.
[AGENT][NEUTRAL] Limited to 2 oral evaluations, um, and any combination for a 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0431 is not covered?
[AGENT][NEUTRAL] 1110 is preventative at 100%, 1 procedure max of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1206 is not covered?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1351 is preventative at 100%.
[AGENT][NEUTRAL] Um, limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh maximum 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2140 and 2391 are both basic at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Replace um replace the existing only if in place for 24 months.
[AGENT][NEUTRAL] A maximum of 1 per 5-year period per tooth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2740, 2950, and 2954 are all major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per 7 year.
[AGENT][NEUTRAL] And limited to patients um age [PII] and over.
[AGENT][NEUTRAL] 4341 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, 24 months. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 43 I'm sorry, 4910 is major at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Max 1 per 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4355 is major at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 51 1060 1060 58, 6056 are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6740 is major at 40%.
[AGENT][NEUTRAL] Maximum of 1 per 7-year period and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7210 is major at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7140, um 7953, and 9944 are not covered.
[CUSTOMER][NEUTRAL] 79539944 not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And 5410 also then surely it is not covered, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Then sure, so it's not covered, right?
[AGENT][NEUTRAL] Right, 5110 was not on this list.
[CUSTOMER][NEUTRAL] Oh, OK. So can you go ahead and check if there any history or no for this patient it might affect the frequency only for the pre.
[AGENT][NEUTRAL] Do you have particular codes that you'd like to check the history for?
[CUSTOMER][NEUTRAL] Sure, sure. It is D 0 to 10.
[CUSTOMER][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] 1110
[CUSTOMER][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] And 12 or 6. That's it.
[AGENT][NEUTRAL] OK, so there's no history on file for 00210?
[AGENT][NEUTRAL] 00274. Last day of service was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 01110 was also [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm the same for 00120.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 01206 is not a covered code.
[AGENT][NEGATIVE] And there's no history on file using that code.
[CUSTOMER][NEUTRAL] Mhm. And then
[CUSTOMER][NEUTRAL] OK. So, [PII], how do you spell your name?
[AGENT][NEUTRAL] My name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm, go I had to call her phone number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Today date [PII].
[CUSTOMER][POSITIVE] Thank you so much for this, OK, and I have a good day for you, OK? And bye for now.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, I'm not this patient. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.