AccountId: 011433970860
ContactId: f171f0fb-9148-4ed1-b97d-36fd770f1f87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479010 ms
Total Talk Time (AGENT): 205797 ms
Total Talk Time (CUSTOMER): 139638 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/f171f0fb-9148-4ed1-b97d-36fd770f1f87_20250610T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. Uh, I'm calling today to check on some codes as well as history on file, please.
[AGENT][NEUTRAL] OK, uh, dental procedures we're just needing to check those and then, uh, for history.
[CUSTOMER][NEUTRAL] Yes, both, please.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] Sure I could check all that for you um what was your name please?
[CUSTOMER][NEUTRAL] Uh, it's [PII]
[AGENT][NEUTRAL] Got it, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, thank you and then uh do you have that policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 00785013.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh, his name is, uh, [PII], uh, [PII].
[AGENT][NEUTRAL] OK perfect thank you for verifying that. OK, so this policy is active, uh, effective date was [PII] and now um I'm happy to answer any questions over the phone. Um, however, I can also send you a copy of this fax back that does show all of the covered procedures and benefit information if you'd like.
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, I believe I have a, uh, fax uh back in [PII] if nothing has been changed on the plan.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's correct, yes, it is the exact same.
[CUSTOMER][NEUTRAL] OK, great. And I just would like to confirm about some coverage for some codes, please.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Mm. Ready for all codes?
[AGENT][POSITIVE] Um, sure, however you'd like to do it, you can give them all at once or we could do one at a time, whatever is easier for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I can give it all, all at once, please. Uh, my first code, my first code is 2740.
[AGENT][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEUTRAL] 2950
[CUSTOMER][NEUTRAL] 674-062-45. And that's all.
[AGENT][NEUTRAL] OK, sure, give me just a moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] So 2740 is covered under this policy under major so that it's going to be at 40%. Uh give me just a moment, let me check those limitations.
[AGENT][NEUTRAL] That is gonna be a maximum of 1 per 7 year period.
[AGENT][NEUTRAL] And limited to patients age [PII] and over.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And over. OK. Yeah, got you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and then uh 2950 is covered under major as well, so that is at 40% and they have the exact same uh limitations, so, uh, one per seven year period and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6740.
[AGENT][NEUTRAL] That is also covered under major so at 40%.
[AGENT][NEUTRAL] Exact same limitations as well, maximum of 11 per 7 year period and dependence uh or patient [PII] and over.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] 6245.
[AGENT][NEUTRAL] Exact same as the others covered under majors 40%, same limitations, maximum of 1 per 7 year period and uh patient [PII] and over.
[CUSTOMER][NEUTRAL] OK, great. Thank you. And would you please, would you please confirm for me if the patient has any history on file for tooth number 31 as well as tooth number 23, and 4?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so that was two number 31, 23 and 4.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 23 and 4, yes.
[AGENT][NEUTRAL] OK, got it one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do have for 2 number 4, this was that date of service, um, [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Procedure code 2391.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Again, [PII] 7, 0, that one didn't pay. I apologize.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Bear with me just a moment. This policy goes back quite a ways.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and there was another one for tooth number 4 this was um.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, that was procedure code 2940.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it does not look like I have.
[AGENT][NEUTRAL] No, that's gonna be it for those teeth.
[CUSTOMER][POSITIVE] OK, so it's good for 31 and 2 and 3.
[AGENT][NEUTRAL] Right, I have no history on file for those particular teeth.
[CUSTOMER][POSITIVE] OK, that's great.
[CUSTOMER][NEUTRAL] All right. And um my last question, two questions please. I would like to confirm if the fillings has any frequency limitation.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What was that procedure code?
[CUSTOMER][NEUTRAL] Uh, um, 2391.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] 2391. Give me just a moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That is maximum of 1 each tooth per 24 months.
[AGENT][NEUTRAL] And replacement of existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] Oh, got you. Got you. All right. And the last question is regarding the missing tooth class policy. Do you have any, uh, missing tooth on the plan policy?
[AGENT][NEGATIVE] Yes, there is a missing tooth clause.
[CUSTOMER][NEUTRAL] Oh, OK, got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. I, uh, I appreciate your help, ma'am. Thank you for helping me.
[AGENT][NEUTRAL] I suppose
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Can I have a
[CUSTOMER][NEUTRAL] No, I just need the reference number, please.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initi[PII], and today's date. Uh, so my name is spelled [PII], last initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I appreciate it. Have a great day, ma'am.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thank bye bye.