AccountId: 011433970860
ContactId: f32e816f-d592-47de-91c7-320c67b68b49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 953340 ms
Total Talk Time (AGENT): 270031 ms
Total Talk Time (CUSTOMER): 194405 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/f32e816f-d592-47de-91c7-320c67b68b49_20250506T17:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII]. I'm calling from a dental office to check on a patient's dental plan, please.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with benefits for a patient. May I please get your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is Dangerous Plus Implant and Dental Center. Number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[CUSTOMER][NEUTRAL] Member ID is 02596982.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] I do show that [PII] does have an active policy with us. The effective date of the policy is [PII], and if you can give me your
[AGENT][NEUTRAL] Uh, fax number, I'll send you a fax back with the benefit and breakdown and fee schedule.
[CUSTOMER][NEUTRAL] OK, can I get that over the phone with you right now?
[AGENT][NEUTRAL] Yes, you can get it over the phone. Hold on, let me pull up that fax back.
[CUSTOMER][NEUTRAL] OK, and I just want to know if.
[CUSTOMER][NEUTRAL] OK, if we are in network.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, absolutely, this, um, policy they can use any, um, provider or they want to use.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with, Ms. [PII], before we go?
[CUSTOMER][NEUTRAL] Yes, what fee schedule do we follow?
[AGENT][NEUTRAL] UCR
[CUSTOMER][NEUTRAL] UCR.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, I do have a few other questions and maybe a few codes I want to provide you to check coverage.
[CUSTOMER][NEUTRAL] If we can do that at the end.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, excuse me?
[AGENT][POSITIVE] Yes, ma'am. I can go over codes with you and um answer your questions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so annual max, um, and then deductible.
[AGENT][NEUTRAL] OK, and this is just to verify benefits it's not a guarantee of payment. He has a calendar year maximum of $1500 and the deductible is $50 per covered insured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to 150 for the family.
[CUSTOMER][NEUTRAL] Uh remaining max.
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] Remaining max still 1500.
[AGENT][NEUTRAL] Yes ma'am, let me look real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He still has his um.
[AGENT][NEUTRAL] Calendar year maximum left and he still has left to pay his deductible.
[CUSTOMER][NEUTRAL] OK. Preventive, basic and major. What's the percentage?
[AGENT][NEUTRAL] Uh, preventive is 100% of UCR. Basic is 80% of UCR, and major is 40% of UCR.
[CUSTOMER][NEUTRAL] OK, can I provide you with a few codes?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you. 0274.
[AGENT][NEUTRAL] 0274. Let me look that up.
[AGENT][NEUTRAL] That is gonna be the bite wing.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me see what it says for.
[AGENT][NEUTRAL] Fight wings.
[AGENT][NEUTRAL] But wings are once every 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] Uh, let me look at that one.
[AGENT][NEUTRAL] Maximum of one time per tooth.
[CUSTOMER][NEUTRAL] OK, at 80%?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] The Basic is at 80, yes.
[CUSTOMER][NEUTRAL] OK. 4341 SRP.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, I do not see that on the patient's fax back which means it's a non-covered service.
[CUSTOMER][NEUTRAL] OK. 4910.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] That is not on the patients. Wait a minute, let me go one more space real quick.
[AGENT][NEUTRAL] As perontal and it has an exclusion, let me tell you the exclusion maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] OK, so it is a covered services at 80 for basic.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. 2740 Crown Bridge.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, it has exclusions. Let me get the excursion, exclusions.
[AGENT][NEUTRAL] Maximum of 1 per 7 year period and limited to patients aged [PII] and over.
[CUSTOMER][NEUTRAL] OK, 6010.
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] That is not on the facts back, therefore, it's not covered.
[CUSTOMER][NEGATIVE] OK. 5110 dangerous.
[AGENT][NEGATIVE] Dentures are not covered.
[CUSTOMER][NEUTRAL] Oh, not?
[CUSTOMER][NEUTRAL] OK, no dangers. OK. Um 7310.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that one is on the fax back, but it has an exclusion. Let me look at the exclusion.
[AGENT][NEUTRAL] Maximum of one per lifetime per quadrant or arc.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, at 40%?
[AGENT][NEUTRAL] And what was the code again?
[CUSTOMER][NEUTRAL] 7310.
[AGENT][NEUTRAL] OK, let me keep looking. 7310.
[AGENT][NEUTRAL] is considered.
[AGENT][NEUTRAL] Oral surgery expenses. Oral surgery is under its own category. So let me go up here and look.
[AGENT][NEUTRAL] At 40%.
[CUSTOMER][NEUTRAL] OK. Last 1, 7473.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] There's no cover.
[AGENT][NEUTRAL] That is covered and it has an exclusion.
[AGENT][NEUTRAL] A maximum of one per lifetime.
[CUSTOMER][NEUTRAL] OK. Is there a waiting period and a missing tooth cloth?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[AGENT][NEUTRAL] And major expenses.
[AGENT][NEUTRAL] Endoonic, periodontic, prosthodontic, and oral surgery have a twelve-month waiting period.
[CUSTOMER][NEUTRAL] 12 months, OK.
[CUSTOMER][NEUTRAL] Timely filing limit?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] 12 months doesn't apply to 72. Oral surgery. Yes, it does.
[CUSTOMER][NEUTRAL] OK and then um is there a group name?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is.
[AGENT][NEUTRAL] Universal Trucking Western Flyer.
[CUSTOMER][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] Just say that last part again please.
[AGENT][NEUTRAL] Western Flyer.
[CUSTOMER][NEUTRAL] I flyer.
[CUSTOMER][NEUTRAL] Thank you. PO Box mailing address for dental claims.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] OK and last question, is it possible to um fax that fee schedule over to us?
[AGENT][NEUTRAL] Yes, I asked you that at the beginning of the call.
[CUSTOMER][NEUTRAL] UCR
[AGENT][NEUTRAL] If you wanted me to do that, OK, what is your fax number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get this fax back ready for you and I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Miss [PII]. I have that faxed back on its way to you now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so so much I appreciate it.
[AGENT][POSITIVE] It's no problem at all. Is there anything else that I can help you with before we go?
[CUSTOMER][NEUTRAL] That's, that's all for now.
[AGENT][POSITIVE] OK, well, you have a wonderful day and thank you for calling APL Miss [PII].
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Uh bye-bye