AccountId: 011433970860
ContactId: efc371d6-4ceb-4b13-8b84-1acecf2ba600
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1326560 ms
Total Talk Time (AGENT): 311658 ms
Total Talk Time (CUSTOMER): 363986 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/efc371d6-4ceb-4b13-8b84-1acecf2ba600_20250515T19:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, ma'am. My name is [PII]. I'm calling from Jefferson Dental. How are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm good, ma'am. Thanks for asking. I'm calling to verify the eligible and benefit of the patient. Can you please help me?
[AGENT][POSITIVE] Happy to help on eligibility, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 0 00.
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] 02612405.
[AGENT][NEUTRAL] All right. Without the leaving zeros, can you start with the 2 and repeat that again, please?
[CUSTOMER][NEUTRAL] OK. 261-2405.
[AGENT][NEGATIVE] It's not pulling up anything.
[AGENT][NEUTRAL] What's the patient's first and last name?
[CUSTOMER][NEUTRAL] [PII] That is the first name and second name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me try by the patient's name and see what I find. One moment.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. So, patient is active. It looks like the effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK. Can you please help me with the deductibles and patient is a subscriber?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, yes, they are.
[CUSTOMER][NEUTRAL] OK. Can you please help me with the
[CUSTOMER][NEUTRAL] Deductibles and yearly max and coinsurance percentages.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Alright, so it looks like the deductible is going to be $50 per covered insured.
[AGENT][NEUTRAL] And the calendar year maximum is 500.
[AGENT][NEUTRAL] Patient has deductible in full calendar year amount remaining.
[CUSTOMER][NEUTRAL] Ma'am, family detectables, what about the family detectables?
[AGENT][NEUTRAL] Up to 150 per family.
[CUSTOMER][NEUTRAL] OK. And yearly max is 500 only?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh preventive basic and measure.
[AGENT][NEUTRAL] Preventative is covered at 100%. Basic is covered at 80%. Patient plan is preventative and basic coverage only.
[CUSTOMER][NEUTRAL] OK, Major is not there.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And can you please help me with the group number?
[AGENT][NEUTRAL] One moment, let me look that up for you.
[AGENT][NEUTRAL] Group number is 70,030.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] 070030, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what will be the
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Company name, ma'am? Group name.
[AGENT][POSITIVE] It's going to be creative circle.
[CUSTOMER][NEUTRAL] And the company name, American Public Life.
[AGENT][NEUTRAL] The company name for the insurance is American Public Life, yes.
[CUSTOMER][NEUTRAL] OK, American Public life.
[CUSTOMER][NEUTRAL] Ma'am, I need the completely full breakdown of the patient.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] And whatever the member ID you have given, that is correct only.
[AGENT][NEUTRAL] Yes, member ID was 2612405.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] What will be the full schedule for this, ma'am, plan start month of this patient?
[AGENT][NEUTRAL] The plan pays by UCR.
[CUSTOMER][NEUTRAL] No, when it started, uh, another year plan or physical year plan?
[AGENT][NEUTRAL] It's a calendar year plan.
[CUSTOMER][NEUTRAL] Yeah, OK. And uh what will be the insurance free schedule?
[AGENT][NEUTRAL] What will be the insurance, I'm sorry, what was that?
[CUSTOMER][POSITIVE] Insurance free schedule, ma'am, is scheduled.
[AGENT][NEUTRAL] It's paid by UCR usual customary fee.
[CUSTOMER][NEUTRAL] UCR
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I mean Carrington, we can use Carrington.
[AGENT][NEUTRAL] It does it does participate in the Carrington PPO network, yes.
[CUSTOMER][NEUTRAL] Reschedule.
[CUSTOMER][NEUTRAL] It is participate, correct? Yes or no?
[AGENT][POSITIVE] It participates, yes.
[CUSTOMER][NEUTRAL] Yeah, OK. And uh
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Authorization
[CUSTOMER][NEUTRAL] And what will be the pre-authorization amount, ma'am? Authorization amount dollars?
[CUSTOMER][NEUTRAL] Do we have any pre authorization.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Prior authorization is not required.
[CUSTOMER][NEUTRAL] Not required, OK.
[CUSTOMER][NEUTRAL] And uh is there any waiting period and uh
[CUSTOMER][NEUTRAL] Or the patient policy?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] And uh has it
[CUSTOMER][NEUTRAL] And does the patient has out network benefits also?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the student age limit up to?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Student age limit up to.
[AGENT][NEUTRAL] Dependent? Are you asking what the dependent age?
[CUSTOMER][NEUTRAL] No, no, ma'am.
[CUSTOMER][NEUTRAL] Full-time student age required up to.
[AGENT][NEUTRAL] Age requirement for what?
[CUSTOMER][NEUTRAL] Student age limit, ma'am.
[AGENT][NEUTRAL] The student
[CUSTOMER][NEUTRAL] Is there any student age limit?
[AGENT][NEUTRAL] The student age limit?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Full-time student required and specify age limit up to for the student.
[AGENT][NEUTRAL] OK. Well, this is an individual policy, but they can't carry coverage past the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, [PII]. OK. And uh is there any used amounts in the patient policy?
[CUSTOMER][NEUTRAL] No yearly max or anything.
[CUSTOMER][NEUTRAL] Ortho. Ortho is a covered benefit also?
[AGENT][NEUTRAL] No
[AGENT][NEGATIVE] There's no history on file and there's no or coverage.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] I don't know, let's see.
[CUSTOMER][NEUTRAL] And uh oral surgeries, ma'am?
[CUSTOMER][NEUTRAL] What is the percentage for the oral surgery for all codes?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Oral surgery is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. And uh 0140?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It's covered under basic at 80%.
[AGENT][NEUTRAL] It's limited to 2 oral evaluations in any 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am. 7953 and uh 9110 percentages.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 7953 is not covered. 9110 is covered at 80%.
[CUSTOMER][NEUTRAL] OK. And periodontic is a covered benefit?
[AGENT][NEUTRAL] No, we're just not
[CUSTOMER][NEGATIVE] No, it is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Ma'am, 6,106,010.
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEGATIVE] 610 also is not covered.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Iontic is a covered benefit.
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] It is not covered, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagno 600,220 frequency and percentage.
[CUSTOMER][NEUTRAL] Hello, ma'am.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] It's covered at 80%. I'm not showing any limitation.
[CUSTOMER][NEUTRAL] OK, no frequency and.
[CUSTOMER][NEUTRAL] And uh 0120, ma'am. And uh
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Covered at 100%, limited to 2 in a 12-month period.
[CUSTOMER][NEUTRAL] 2 to 12 months. OK. And all exams are sharing the frequencies?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I mean 0140 also sharing the frequency, ma'am.
[AGENT][NEUTRAL] 0140 shares frequency with 0120.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] Ma'am, what is the frequency, ma'am? 0?
[CUSTOMER][NEUTRAL] 0140
[AGENT][NEUTRAL] 2 for 12 months.
[CUSTOMER][NEUTRAL] OK, and it is covered up to 80%, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm 0150.
[AGENT][NEUTRAL] 100%, 2 for 12 months.
[CUSTOMER][NEUTRAL] And 111,110.
[AGENT][NEUTRAL] 100%.
[AGENT][NEUTRAL] One procedure for 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the 4346 and the 4910 also cover us.
[CUSTOMER][NEUTRAL] Are the
[CUSTOMER][NEUTRAL] Sharing frequencies 4346 and 4910 with that 710.
[AGENT][NEGATIVE] 4346 and 4910, I'm not showing listed. They're not covered.
[CUSTOMER][NEUTRAL] OK, not covered.
[CUSTOMER][NEUTRAL] OK, ma'am. And uh
[CUSTOMER][NEUTRAL] 0171.
[AGENT][NEUTRAL] Repeat that one more time.
[CUSTOMER][NEUTRAL] 01710351.
[AGENT][NEUTRAL] 0170 and 0351.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Are the covered benefits.
[AGENT][NEGATIVE] Don't show them listed, so they would not be covered.
[CUSTOMER][NEUTRAL] And 1510, 1510.
[AGENT][NEUTRAL] 1510.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You mean
[AGENT][NEUTRAL] So 1510 is covered at 100%. It looks like dependent children under the age of [PII] only, and it's a maximum of 1 per lifetime.
[CUSTOMER][NEUTRAL] OK, one for like 100%.
[CUSTOMER][NEUTRAL] And uh 0210.
[AGENT][NEUTRAL] Is covered at 80%.
[CUSTOMER][NEUTRAL] Forex and panel.
[AGENT][NEUTRAL] And it's limited to 1 X-ray procedure for 5 years.
[CUSTOMER][NEUTRAL] 1 to 5 years.
[CUSTOMER][NEUTRAL] OK. 0274 by 23.
[AGENT][NEUTRAL] Covered at 100%, limited to one bite X-ray per 12 months.
[CUSTOMER][NEUTRAL] 1 in 12 months, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ma'am, once in 12 months, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, 1351
[AGENT][POSITIVE] It's covered at 100%.
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months, limited to dependent children under the age of [PII], applications made to permanent teeth only, molar teeth.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Imola is covered only? Yes or no?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 3 molars covered.
[AGENT][NEUTRAL] Yes, they're covered. They're just have limitations.
[CUSTOMER][NEUTRAL] OK, they are covered. OK, 1208, frequency, percentage, and age limit.
[AGENT][NEUTRAL] 1208 is not listed.
[CUSTOMER][NEUTRAL] rates is not listed.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, one minute.
[CUSTOMER][NEUTRAL] And uh any down gets and feelings?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Hold on great so.
[CUSTOMER][NEUTRAL] 2391 frequency percentage.
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEUTRAL] OK, 2.
[CUSTOMER][NEUTRAL] And uh 2160.
[CUSTOMER][NEUTRAL] Frequency and percentage.
[AGENT][NEUTRAL] 80%.
[AGENT][NEUTRAL] Maximum of 1 tooth per 24 months.
[AGENT][NEUTRAL] And a replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh does missing tooth cloths apply for this patient? Yes or no?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And all major services are paid on proper seat.
[AGENT][NEGATIVE] It doesn't matter, but this plan has no major coverage.
[CUSTOMER][NEUTRAL] OK, ma'am. 4381.
[CUSTOMER][NEUTRAL] Ma'am, if it is covered, what will be that one? It is covered. The major services is covered, what will
[AGENT][NEUTRAL] It's not, it's not major, major services are not covered. 4381 is not listed.
[CUSTOMER][NEGATIVE] Not listed. OK.
[CUSTOMER][NEUTRAL] And uh 4355.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the 4267.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. Any downgrades in the crowns, ma'am?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And 2920?
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. And uh 6250?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] One minute updating.
[CUSTOMER][NEUTRAL] And 2920, 2930.
[CUSTOMER][NEUTRAL] And the crowns and witches are covered benefits.
[AGENT][NEUTRAL] 2930 is not.
[CUSTOMER][NEUTRAL] Um, ridges and dentures of the car.
[AGENT][NEGATIVE] No, they're not covered.
[CUSTOMER][NEUTRAL] 19 that is not covered.
[CUSTOMER][NEUTRAL] OK, not covered. OK. And 9945?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, I mean.
[CUSTOMER][NEUTRAL] Ma'am, 2950
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, if there is any history on the file, ma'am?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Sir, there is no yet.
[CUSTOMER][NEUTRAL] OK, one minute I'm updating.
[CUSTOMER][NEUTRAL] Whatever the member ID I have given, that is correct only.
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] I've given the member ID, you know, that is correct only.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what will be the call reference ID for the call, ma'am, for this patient?
[AGENT][NEUTRAL] That is my name with my last initial in today's date. My name is [PII], that's [PII], last initial, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is my yeah.
[CUSTOMER][NEUTRAL] And today's date, OK.
[CUSTOMER][NEUTRAL] Yeah, OK, mm.
[CUSTOMER][POSITIVE] [PII] OK, ma'am, I'm done with the patient. Thank you so much for your help. Thank you so much, ma'am. Bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.