AccountId: 011433970860
ContactId: f269c484-13b1-4982-ab0d-191872a12cd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1077489 ms
Total Talk Time (AGENT): 304571 ms
Total Talk Time (CUSTOMER): 568386 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f269c484-13b1-4982-ab0d-191872a12cd6_20250117T18:16_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I am calling with Shawny Modern Dentistry. I'm just trying to locate if a patient has a dental policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, I'd love to help you with that today, [PII], and do you mind if I snag a really quick callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, of course, uh, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and what's the member ID today?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Um, she, I was just able to obtain her social. The one I have is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. Let me try searching for her through that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yep, it's gonna be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect. And I do see Ms. [PII] right here. Hold on one second, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome I love that.
[AGENT][NEUTRAL] All right. And
[AGENT][NEUTRAL] [PII], um, would you like me to go ahead and get together a, a fax back of benefits for you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, I have her coming in in like 10 minutes. Do you know how long a fax back takes?
[AGENT][NEUTRAL] I mean, I can also email it to you if you want um.
[CUSTOMER][NEUTRAL] Maybe email just because I'm, I think email would probably be a lot faster.
[AGENT][POSITIVE] Yes, OK, perfect. Let me fill this out for you.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see 02.
[AGENT][NEUTRAL] 16.
[AGENT][NEUTRAL] And our email is not secure, so I'm just gonna put her first and last initial instead of her name on it. Is that OK?
[CUSTOMER][POSITIVE] Yeah, no, that's totally fine.
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] It will still have like her effective date and her policy number written down for you though.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][POSITIVE] thank you
[CUSTOMER][NEUTRAL] How are you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] That is you.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] All right, and what is an email address I can make this out to for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so it's gonna be my [PII] name, [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it should be [PII].
[AGENT][POSITIVE] Perfect, thank you so much.
[CUSTOMER][POSITIVE] Yeah definitely.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Alright, I am hitting send on that. It should be coming your way in just a second, but let me know if you get it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, let's take a look.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I haven't gotten it yet.
[AGENT][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Mhm, yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, OK, let me see.
[CUSTOMER][NEUTRAL] Um, I can wait a couple more minutes just to see if we get it.
[CUSTOMER][NEGATIVE] I just don't wanna keep you too long.
[AGENT][POSITIVE] That's OK. I get paid by the hour. You just take your time.
[CUSTOMER][NEUTRAL] I hear that the same.
[AGENT][NEUTRAL] Um, if you end up like.
[CUSTOMER][NEUTRAL] When people are like I don't wanna uh-huh.
[AGENT][POSITIVE] Oh, I was about to say if you need like I can start giving you verbal benefits too.
[CUSTOMER][NEUTRAL] Um, maybe just like a couple of important ones. Um, what is her effective date?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, is it a calendar year policy or?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK perfect and I would assume that we're in network, but I just wanna make sure.
[AGENT][NEUTRAL] Uh, we don't have a network we're gonna honor it no matter where she goes.
[CUSTOMER][POSITIVE] Oh perfect OK.
[CUSTOMER][NEUTRAL] Um, what else, what else? What is her plans maximum?
[AGENT][NEUTRAL] Yes, absolutely. I do want to let you know if I'm giving dollar amounts any information I could use the verification of coverage, not a guarantee of payment. Um, her calendar year maximum is $1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, has any been used?
[AGENT][NEUTRAL] And she has
[AGENT][NEUTRAL] Uh, not for this calendar year, no.
[CUSTOMER][POSITIVE] Oh perfect.
[CUSTOMER][NEUTRAL] OK, um, so, as, um, does that mean you guys also pay out of network like technically, right, yeah, I would assume.
[AGENT][NEUTRAL] Yeah, technically.
[CUSTOMER][NEUTRAL] And then does she have a deductible on the plan?
[AGENT][NEUTRAL] Um, yes, she does. It's a $50 deductible. It's not a family plan, but there's also a $150 deductible for family.
[CUSTOMER][NEUTRAL] For family, OK.
[CUSTOMER][NEUTRAL] Um, I'm.
[CUSTOMER][NEUTRAL] Have either been met.
[AGENT][NEGATIVE] Not for this calendar year.
[CUSTOMER][NEUTRAL] Perfect. And then is there a missing tooth cloth?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][POSITIVE] Perfect. OK, so I have her coming in for like an emergency exam, um.
[AGENT][NEUTRAL] I can check codes for you if you need.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, what?
[CUSTOMER][NEUTRAL] Mm I'm trying to figure out like what question I wanna ask first.
[CUSTOMER][NEUTRAL] What is um endodontics covered at?
[AGENT][NEUTRAL] OK, endodontics, um.
[CUSTOMER][NEUTRAL] Um, let me think of a call.
[AGENT][NEUTRAL] So, unfortunately, she does have a twelve-month waiting period for um endodontics, periodontics, oral surgery, and other major expenses.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You said endo oops pero crowns as well.
[AGENT][NEUTRAL] Um, I think we do have some crowns that are covered. Let me check right away, um.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It looks like the
[CUSTOMER][NEUTRAL] Do.
[AGENT][NEUTRAL] The 02782.
[CUSTOMER][NEUTRAL] What that was.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me give me one second, I'm so, so sorry, [PII].
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um, do you mind if I just put the phone down? I need to go see if I have a package to get FedEx.
[AGENT][NEUTRAL] Yes, you're fine.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] No, but do you have one
[AGENT][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] So they called me and said that you guys had.
[CUSTOMER][NEUTRAL] I double check.
[CUSTOMER][NEUTRAL] Sorry we did not
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] We know yesterday they they uh.
[CUSTOMER][NEUTRAL] They gave it to one of our other carriers, uh, in [PII], which is not us, so that's why if, uh if you're waiting for us we're apologize oh no no no no no you guys are fine, um.
[CUSTOMER][NEUTRAL] I just don't want to get dinged for not picking up the package. Well, um, I'll see if they send it over to me.
[CUSTOMER][NEUTRAL] Um, they just did it to me.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Doesn't have a time. Well, it says from [PII] to [PII], but it says be here before [PII] because I guess you guys close at [PII]. I was looking to read that we're just double checking I lot, yeah.
[CUSTOMER][NEUTRAL] So the contact is [PII]. I don't know if that.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Um, OK, thank you so much, Miss [PII], sorry about that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Um, OK, OK.
[CUSTOMER][NEUTRAL] Oh, I see right here. So major endoerio prostateontics and oral surgery, I think I just got it.
[AGENT][POSITIVE] Oh, perfect.
[CUSTOMER][NEUTRAL] 12 months, uh, oops, just getting 1212.
[CUSTOMER][NEUTRAL] So basically what is um.
[CUSTOMER][NEUTRAL] And then that way
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Is major I'm guessing crowns.
[AGENT][NEUTRAL] Um, so the crowns, there are some covered under, uh, yeah, they're all covered under major.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK. And then are they, do you know if there's any downgrades for composites and crowns, are they covered?
[AGENT][NEGATIVE] Unfortunately, we don't downgrade.
[CUSTOMER][NEUTRAL] Who was
[CUSTOMER][NEUTRAL] The no downgrades you said they're both covered?
[AGENT][NEUTRAL] Yes, well, I don't know as far as the coverage, I do know that we don't do any downgrades, um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Um, do you pay on seat date?
[AGENT][NEUTRAL] Um, either or.
[CUSTOMER][NEUTRAL] OK, so either prep or receipt doesn't matter. So no waiting period for that, no deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's go to 100, um, do you, is there any implant coverage?
[AGENT][POSITIVE] Um, that is such an excellent question, my friend.
[AGENT][NEUTRAL] Um, I could look with the individual code.
[CUSTOMER][NEUTRAL] Code, uh.
[CUSTOMER][NEUTRAL] It would be 6010.
[AGENT][NEUTRAL] All right, I'm not showing any coverage for that code. No, I'm sorry.
[CUSTOMER][NEGATIVE] No coverage awesome.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] 222
[CUSTOMER][NEGATIVE] Oral surgery 40% of UCR, um, 4040 0 my gosh, my brain's not functioning today. I'm so sorry. 40%, does that mean you've covered 40% of patients responsible for 60 or do you guys cover 60 and the patients responsible for 40?
[AGENT][POSITIVE] You're OK.
[AGENT][NEUTRAL] We'll cover 40% of that, the usual and customary rate.
[CUSTOMER][NEUTRAL] OK, so they're responsible for 60.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is what's 9222 covered that I'm.
[CUSTOMER][NEUTRAL] He doesn't have a
[AGENT][NEUTRAL] 9222 you said?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] want
[AGENT][NEUTRAL] I'm actually not showing 9222 on here. Hold on.
[CUSTOMER][NEUTRAL] You said no coverage for 9222.
[AGENT][NEUTRAL] I don't, no, I'm not seeing any. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, no, you're totally fine. What about 9310?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 9310.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that one's covered under basic.
[CUSTOMER][NEUTRAL] You said it's gonna covered under basic so 80% 9944. 0 wait, before we move on, I'm so sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For 9310, is there a waiting period on that one or no? I guess not for basic, huh?
[AGENT][NEGATIVE] It doesn't show there is, no.
[CUSTOMER][NEUTRAL] OK, um, is there a frequency for that?
[AGENT][NEGATIVE] There was not a frequency on that one either, no.
[CUSTOMER][POSITIVE] Awesome and then 9944 for like an accrual card.
[AGENT][NEUTRAL] OK, so we have on there, um, we have a convert under a 9940 on the occlusal guard, but not the 44, um, but I do think that is listed under a major, so I don't know if, I mean, I believe that would be that 12 month waiting period for that one.
[CUSTOMER][NEUTRAL] I know what can do
[CUSTOMER][NEUTRAL] Every 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can put at 0 then.
[CUSTOMER][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, um, yes, yes, deductible for scaling and ro planning, can they do 4 quads same day or does it have to be 2 quads in one day?
[AGENT][NEUTRAL] So, my understanding for the quads is they just have to be a maximum of one quadrant per so many months, but not so many quadrants per visit.
[CUSTOMER][NEUTRAL] do you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, totally OK. I was just trying to get you scheduled back for.
[AGENT][NEUTRAL] So I believe you can do all 4 at the same day, but you can't, you have to wait um before you go back into each one of them.
[CUSTOMER][POSITIVE] Got all that, OK, OK, perfect, um, cleaning like one every 6 months.
[CUSTOMER][NEUTRAL] That's OK. I'm all for fluoride, is there an age restriction.
[AGENT][NEUTRAL] Um, let me double check. Do you have the code for the fluoride treatment?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Uh huh, it's uh 12:06. Awesome.
[AGENT][NEUTRAL] I don't sure that's gonna be a covered procedure for them.
[CUSTOMER][NEUTRAL] Uh, so my Crown and bridges is 7 years.
[CUSTOMER][NEUTRAL] OK, I want to say is that only needed basic is covered.
[CUSTOMER][NEUTRAL] Uh, probably 1 for 6 months. Oh my gosh.
[CUSTOMER][POSITIVE] Yeah, I enjoy it. I know it for sure.
[CUSTOMER][NEUTRAL] OK, so there's this one now. Sorry, I'm like talking to myself, Miss [PII].
[AGENT][POSITIVE] You're fine. I'm not worried about it. I'm here to help when you need it.
[CUSTOMER][NEUTRAL] Um, for thank you for 4341, is there a frequency on that one?
[AGENT][NEUTRAL] 341 um let me see, there is one limitation OK it says a maximum 1 each quadrant per 24 months.
[CUSTOMER][POSITIVE] OK perfect that's what I figured.
[CUSTOMER][NEUTRAL] Uh, what about 4355?
[AGENT][NEGATIVE] 4355. I'm not showing any coverage for 40 hold on it's taking its time to load um same 11 each quad quadrant for 24 months, but that one's also in um this major expenses that wait the 12 months.
[CUSTOMER][NEUTRAL] Major
[CUSTOMER][POSITIVE] OK perfect um.
[CUSTOMER][NEUTRAL] For 4910 is that one every 6 months?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ta da da da.
[AGENT][NEUTRAL] I do, yes, one every 6 months.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] And then I think I have it. Let me just make sure dentures do I have every 5 years.
[CUSTOMER][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] I think we are good to go, Miss [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Appreciate you so much. So when does her um waiting period satisfied?
[AGENT][NEUTRAL] Um, it will be the mark from her effective date, so November of this year, yep.
[CUSTOMER][NEUTRAL] But November of this year.
[CUSTOMER][NEUTRAL] OK, that is [PII]. OK, perfect, um, and then is there a reference number?
[AGENT][NEUTRAL] Yeah, it's just my name, [PII], first initial, last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] Oh we are yeah we got that.
[CUSTOMER][POSITIVE] Perfect, I appreciate you so much, Miss [PII]. I hope you have a great, great weekend.
[AGENT][POSITIVE] Thank you. I hope you have a great weekend as well, [PII], and thank you so much for um your kindness today.
[CUSTOMER][POSITIVE] Thank you, yeah.
[CUSTOMER][POSITIVE] Oh thank you so much I appreciate it um you have a good rest of your day thank you bye bye.
[AGENT][POSITIVE] You too, take care.
[AGENT][NEUTRAL] Bye bye.