AccountId: 011433970860
ContactId: ef555adb-cfa3-410c-aa42-677598dccf39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419820 ms
Total Talk Time (AGENT): 189621 ms
Total Talk Time (CUSTOMER): 136816 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/ef555adb-cfa3-410c-aa42-677598dccf39_20250318T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. I'm calling from a provider's office to verify benefits and eligibility.
[AGENT][POSITIVE] All right. I'm happy to verify benefits and eligibility today, [PII]. Can I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um, 023-71714.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, thank you. So the patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and this is for dental?
[AGENT][NEUTRAL] Um, actually, this is not. Let me double check. You need dental benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. Patient is active for dental, same effective date, [PII]. It is a different policy number. Do you need that?
[CUSTOMER][NEUTRAL] I do, please.
[AGENT][NEUTRAL] OK, it's gonna be 0237.
[AGENT][NEUTRAL] 1658.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you tell me um what the fee schedule would be?
[AGENT][NEUTRAL] Yeah, let me pull that.
[CUSTOMER][NEUTRAL] In or out of network.
[CUSTOMER][NEUTRAL] And would the group number be different as well?
[AGENT][NEUTRAL] Shouldn't be. Let's see here, one moment.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Group number should be 16068 for universal trucking.
[CUSTOMER][NEUTRAL] OK, you said 16068?
[AGENT][NEUTRAL] Sorry, I need to go back. I apologize.
[CUSTOMER][NEUTRAL] That's OK, sorry.
[AGENT][NEUTRAL] Yes, 116068. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, Universal trucking, OK.
[AGENT][NEUTRAL] Um, it looks like the plan pays by UCR, um, and it does participate, um, in the Carrington PPO network. however, it's not required for usage. And then if you guys need [PII], we can also send a fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That would be that would be great.
[AGENT][POSITIVE] Yeah, absolutely. That's a good fax number.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And um I'm I'm not sure if all the questions I have on here are gonna be on that fax back um as far as like downgrades for um posterior composites, crowns um and frequencies as well as percentages.
[AGENT][POSITIVE] No problems.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there is no downgrade um as far as percentages and frequencies that will that is listed on the fax back.
[CUSTOMER][NEUTRAL] OK, um, is there any history on file?
[AGENT][NEUTRAL] Uh, let me double check that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] All right, looks like no history on file. Hm.
[CUSTOMER][NEUTRAL] OK, and so the max and deductible, um, would be on the fax back?
[AGENT][NEUTRAL] They are, if you need that though, the uh calendar year maximum is gonna be 1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then their calendar year deductible is $50 per covered and then $150 up to family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can I ask about two separate codes, um, D7953 and D9944 please?
[AGENT][NEUTRAL] 9753 and I apologize, the other one was D 9.
[CUSTOMER][NEUTRAL] I'm sorry, 7953 and then 9944.
[AGENT][NEUTRAL] Alright, let me double check those two codes. Give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 7953 is not listed on the fax back so therefore it would not be covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then 9954.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] Oh, sorry, 9944.
[CUSTOMER][NEUTRAL] That's OK, mhm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] on the.
[AGENT][NEUTRAL] I do not see 9944 listed so.
[CUSTOMER][NEUTRAL] OK, that's the Clozal guard.
[AGENT][NEUTRAL] Yeah, it wouldn't be covered. It looks like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They have 9940, 9951 and 52.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, are there any, is there a missing tooth claws or waiting periods for this?
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the waiting period applies to major endoperio and oral surgery and that waiting period is 12 months.
[CUSTOMER][NEUTRAL] Yes, your schedule
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So he's probably exhausted that since it was started in [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so all those endoperio oral surgery, that's all major?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do the exams share frequency?
[AGENT][NEUTRAL] Uh yes, it looks like they do. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK and probably everything else I can get on that fax back.
[AGENT][NEUTRAL] Yeah, I'll have payer ID claims mailing address, um, it does have frequency like I said, and percentages but the waiting periods as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK awesome thank you so much and what was your name?
[AGENT][NEUTRAL] My name is [PII] and the fax is on its way, so it should be there momentarily.
[CUSTOMER][POSITIVE] Perfect and I just need a reference number.
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial in today's date. My last initial to my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Today's date, OK, and is this, uh, [PII]?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, ma'am. [PII], yeah.
[CUSTOMER][POSITIVE] Perfect, alrighty thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye bye.