AccountId: 011433970860
ContactId: eec4b4af-1b73-4923-8bd1-c76f4c121c38
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420250 ms
Total Talk Time (AGENT): 149422 ms
Total Talk Time (CUSTOMER): 170558 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/eec4b4af-1b73-4923-8bd1-c76f4c121c38_20250423T14:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII] and I'm calling from All in the Family dental to verify the eligibility of a patient.
[AGENT][NEUTRAL] Yeah, I can check eligibility for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] ID number is 02594428.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Alright, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII], and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] I actually got the fax back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I just, I, I still have some additional questions. That's right.
[CUSTOMER][NEUTRAL] Um, before that, could you confirm?
[AGENT][NEUTRAL] Sure, what, what kind of questions do you have for me?
[CUSTOMER][NEUTRAL] Before that, could you confirm if the patient is the subscriber?
[AGENT][NEUTRAL] Yes, uh, [PII] is the only member active under this policy.
[CUSTOMER][NEUTRAL] And just the group number 70054 with the group name innovative t solutions.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] This is the calendar year plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and any pre-authorization required in this plan?
[AGENT][NEUTRAL] No pre-authorization is not required.
[CUSTOMER][NEGATIVE] And I missing class or waiting period.
[AGENT][NEGATIVE] There is a missing tooth cloth and uh no eating period.
[CUSTOMER][NEUTRAL] You said no missing tooth class, right? Oh, you said there is a missing tooth class, uh.
[AGENT][NEGATIVE] There is a missing tooth cloth.
[AGENT][POSITIVE] Correct and then no waiting period.
[CUSTOMER][NEUTRAL] Can you tell
[CUSTOMER][NEUTRAL] Can you tell me the duration for missing this class?
[AGENT][POSITIVE] Uh, could you repeat that? I'm so sorry.
[CUSTOMER][NEUTRAL] Is it for like
[CUSTOMER][NEUTRAL] Can you tell me the duration for missing tooth class? Is it for lifetime?
[AGENT][NEUTRAL] Yes, for the lifetime of this policy, as long as I have this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Can you tell me the remaining uh amount of the individual maximum for the patient and the deductibles also the remaining for that.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] Yeah, let me see if any of that has been used so far.
[CUSTOMER][NEUTRAL] The remaining
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so she has not used any of that benefits for this year and not yet met the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Can you check if fluoro 1206 and 1208 is covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was 1206 and 1208, uh, 1 moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So neither of those codes are uh covered procedures under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What do you know if all exams share their frequencies 01200140 and 01500180?
[AGENT][NEUTRAL] So 0180 is not going to be a covered procedure. uh 012001400150 and 0160 uh all share frequencies.
[CUSTOMER][MIXED] OK, but 0140 it's considered as basic right.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Yes, that is basic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But these, uh, all of these codes are.
[CUSTOMER][NEUTRAL] The frequency is 2 for 12 months, right?
[AGENT][NEUTRAL] What was that? I'm sorry?
[CUSTOMER][NEUTRAL] For exam, the frequency is 2 for 12 months, right?
[AGENT][NEUTRAL] Uh, for those, uh, codes that I just listed, they do share frequency, yes.
[CUSTOMER][NEUTRAL] And the frequency is 2 for 12 months, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And does SMX and panel share the frequencies?
[AGENT][NEUTRAL] Yes, uh, so those are gonna be uh 02100277 and 0330.
[CUSTOMER][NEUTRAL] OK, can you also check if uh 2740 is covered from?
[CUSTOMER][NEUTRAL] And 2750.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] So, uh, 2740 is not covered. Um, in short, this policy does not offer any basic or excuse me, any major coverage. It's only going to be preventative radiographs and basic.
[CUSTOMER][POSITIVE] Fair enough.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And maximum does not apply to preventive services, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there was no history for this patient at all?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There is no coverage for anontic, periodontics, oral surgery, or implants, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Um, well then I guess that's all I need today. Thank you so much for all that information.
[CUSTOMER][NEUTRAL] Uh, [PII], could you provide me with the call reference number? 01 more question.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Sure, that would
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, can you check, uh, 9110 have any frequency?
[AGENT][NEUTRAL] That was 9110?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that is covered under basic uh and does not have any limitations or frequencies.
[CUSTOMER][NEUTRAL] And 1352, is it covered?
[AGENT][NEUTRAL] 352. That is not a covered procedure under this policy.
[CUSTOMER][NEUTRAL] But 1351 is covered, right?
[AGENT][NEUTRAL] Yes, correct, under preventative.
[CUSTOMER][NEUTRAL] OK, thank you. uh call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last initial is [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] Um, thank you so much and have a great day.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.