AccountId: 011433970860
ContactId: f19d432a-f752-45d4-869e-11c310c1ed44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645900 ms
Total Talk Time (AGENT): 260331 ms
Total Talk Time (CUSTOMER): 246583 ms
Interruptions: 8
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/f19d432a-f752-45d4-869e-11c310c1ed44_20250624T19:35_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling from a provider's office. I had a few questions about one of our patients benefits.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, that would be [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from, Miss [PII]?
[CUSTOMER][NEUTRAL] I'm calling from Family Dental care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] That would be 02355973.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And I barely
[CUSTOMER][NEUTRAL] I didn't even, I didn't
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] That would be [PII] I believe.
[CUSTOMER][NEUTRAL] No, it's actually [PII]. I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So this is for which member? What's the name?
[CUSTOMER][NEUTRAL] Um, it would be the dependent for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Thank you. All right. And how may I assist you with the benefits on this number, Miss [PII]?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So I just had a few questions. What would be her group name? and then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, let's see. Let me go ahead and pull that information.
[AGENT][NEUTRAL] OK, this is under Guru Universal Trucking Altum Transport. Altum is A L T O M.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is this a calendar year plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like that was just like
[CUSTOMER][NEUTRAL] Are there any waiting periods?
[AGENT][NEUTRAL] Um, it looks like they're out of the waiting period. Um, there was a 12 month waiting period, but it looks like this policy has been effective since [PII], so they're out of the waiting period.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would be the annual maximum for in and out of network?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] A calendar year maximum and this is not a guarantee of payment, just a verification of coverage. We have a 1500 per cover person per cover insured.
[AGENT][NEUTRAL] And a $50 deductible or $150 per family, and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this would be for out of network as well, correct?
[AGENT][NEGATIVE] Yes, yeah, there's no network on this one.
[CUSTOMER][NEUTRAL] OK, and has any of the maximum been used?
[AGENT][NEUTRAL] I can check on that. Let's see one moment.
[AGENT][NEUTRAL] Excuse
[AGENT][NEUTRAL] OK, as of today for [PII], she has not used her benefits. She still have the full amount available.
[CUSTOMER][NEUTRAL] OK, and can I get the coinsurances for preventative restorative and major services, please?
[AGENT][NEUTRAL] Sure, OK, so preventative is cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered 80%.
[AGENT][NEUTRAL] Basic expense and basic restorative expenses cover 80%.
[AGENT][NEUTRAL] Major services including endodontics, periodontics, and oral surgery, they're covered at 40%.
[CUSTOMER][NEUTRAL] OK, and now can I get the most recent history for three codes as well? Those codes would be 02 1011 10, and 4341.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Looking for
[CUSTOMER][POSITIVE] Alrighty, question for you, [PII] over.
[AGENT][NEUTRAL] OK. I don't see anything for 0 to 10, but that one shares frequency, so let me check the panel. One moment.
[CUSTOMER][NEUTRAL] a bell for you, um, I see it might have been like the last time you had signed in something like that, but basically.
[AGENT][NEUTRAL] OK, there's no panel either um let's see.
[CUSTOMER][NEUTRAL] a detailed narrative for the fillings that she got done. Who did you give that to and that you want.
[AGENT][NEUTRAL] 01110.
[AGENT][NEUTRAL] The last profi [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the last code.
[CUSTOMER][NEUTRAL] Uh [PII] and then just dashes to pop up first name [PII].
[AGENT][NEUTRAL] 341.
[AGENT][NEUTRAL] And there is no nothing for 04341 um let me make sure that one doesn't share frequency nowhere.
[AGENT][NEUTRAL] No, it doesn't. So yeah, that one is not listed on their history.
[CUSTOMER][NEUTRAL] OK, and I also need the frequency for a few codes as well. Would you like them all at once or one at a time? I need the the frequency for a few codes.
[AGENT][NEUTRAL] What kind of cos I'm sorry.
[AGENT][NEUTRAL] Uh, the frequency for a few calls, one at a time, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first one is 0120.
[AGENT][NEUTRAL] OK, so that one is limited to two or evaluation procedures in any combination of 120, 140, 150, 160, and 180 for 12 month period.
[CUSTOMER][NEUTRAL] So, OK, next time I, um, whenever you.
[CUSTOMER][NEUTRAL] Uh, [PII], she's in charge of like this sort of stuff, so what she'll do right in in her office.
[CUSTOMER][NEUTRAL] OK, the next one would be 0272.
[AGENT][NEUTRAL] OK, 0272 that is going to be bear with me OK, limited to one by win X-ray procedure and any combination of 270, 272, or 274 for 12 month period.
[CUSTOMER][POSITIVE] Thank you [PII] bye bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The next one would be 11:10.
[AGENT][NEUTRAL] OK, so that one is once every 6 months.
[CUSTOMER][NEUTRAL] The next one would be 2740.
[AGENT][NEUTRAL] OK, so that's the crown, um, bear with me, let me pull that one.
[AGENT][NEUTRAL] Maximum of 1 per 7 year period limited to the to children aged [PII] and over.
[CUSTOMER][NEUTRAL] OK, the next one is 4341.
[AGENT][NEUTRAL] OK, so that one is going to be maximum of 1 in quad for 24 months.
[CUSTOMER][NEUTRAL] And would this be covered under major?
[AGENT][NEUTRAL] Yes, that one is under major.
[CUSTOMER][NEUTRAL] OK, the next one is 49 cents.
[AGENT][NEUTRAL] So it's 40%.
[AGENT][NEUTRAL] OK, 4910 is going to be once every 6 months.
[CUSTOMER][NEUTRAL] OK, the next one is 4260.
[AGENT][NEUTRAL] 4260.
[AGENT][NEUTRAL] OK, so that one is also under major and for that one we have.
[AGENT][NEUTRAL] But for 36.
[CUSTOMER][NEUTRAL] The next one.
[CUSTOMER][NEUTRAL] That would actually be a.
[CUSTOMER][NEUTRAL] Um, are implants covered as well or no?
[AGENT][NEGATIVE] No, no, implants are not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And would you be able to check if 3 of our providers are in or out of network and the few schedule that they follow?
[AGENT][NEGATIVE] There's no network on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So would you still be able to access the fee schedule or no?
[AGENT][NEUTRAL] There's no network we pay, uh, we pay on the us showing customary rate UCR.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And since this is a member's secondary insurance, do you follow the birthday rule?
[AGENT][NEUTRAL] I'm not sure what is that. Can you elaborate?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So benefits on this plan coordinate?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And do benefits downgrade to primaries allowable fee?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Do you pay the difference from what primary pays?
[AGENT][NEUTRAL] Um, this is a regular dental and we don't coordinate. So we're gonna pay based on what's the payable amount under the code.
[AGENT][NEUTRAL] In the percentage.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] And is there a missing tool clause on this plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then can I just have a reference number for this call please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][POSITIVE] No, that would be all thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling ATL. Have a good afternoon, Miss [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome. Thank you