AccountId: 011433970860
ContactId: f47ce2bf-a84a-4bb8-8c5c-ec8bc7ef1ee3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749559 ms
Total Talk Time (AGENT): 278305 ms
Total Talk Time (CUSTOMER): 257733 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/f47ce2bf-a84a-4bb8-8c5c-ec8bc7ef1ee3_20250213T16:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling on behalf of the dental provider's office to check eligibility and benefits for the patient on a recorded line.
[AGENT][POSITIVE] Good morning
[AGENT][NEUTRAL] OK, I can verify benefits for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02558867.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, this, this is the right direct line, no extension. The callback number is [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm showing an effective date of [PII], policy is active and what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Uh [PII] is the effective date and the policy is active, and what are, what benefits you're needing for this patient?
[CUSTOMER][NEUTRAL] OK, wait a second. OK. You said the effective date is [PII]. Is this a calendar plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there any group name group number?
[AGENT][NEUTRAL] Uh, yes. Group number is 70055.
[AGENT][NEUTRAL] Group num uh group name is TRC Staffing Services.
[CUSTOMER][NEUTRAL] TRC staffing service.
[CUSTOMER][NEUTRAL] OK. Is there any maximum for this patient?
[AGENT][NEUTRAL] What benefits are you needing for the patient?
[CUSTOMER][NEUTRAL] Like the maximum deductible or the coverage?
[AGENT][NEUTRAL] Well, I need to know what benefits you're needing. So is this for medical, for outpatient, in hospitals, dental is not covered under this plan. This is a medical policy only. They do have a dental plan, so when you're ready, I can give you that policy number.
[CUSTOMER][NEUTRAL] Delta, Delta.
[CUSTOMER][NEUTRAL] It's the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for this patient it's not a medic, it's not a dental, right?
[AGENT][NEUTRAL] Correct. And then when you're ready, I can give you the dental policy number.
[CUSTOMER][NEUTRAL] OK, could you please give me the dental policy number?
[AGENT][NEUTRAL] It's 255-8868.
[AGENT][NEUTRAL] Same effective date, same group number and name.
[CUSTOMER][NEUTRAL] The policy you said the number is 2558868, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so the policy number for this patient for the dental is 25566. OK.
[CUSTOMER][NEUTRAL] OK, so the effective date group number group name is the same right you said?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, is there a maximum for the patient?
[AGENT][NEUTRAL] Um, not a guarantee of payment, just a verification of coverage. The patient has benefit max up to $500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they have a $50 yes, per calendar year, and they have a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] 500, right?
[CUSTOMER][NEUTRAL] No family deductible?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, for the specific reason you some amount from the maximum deductible.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Is there any use amount from the family, from the maximum deductible?
[AGENT][NEUTRAL] No, the patient has not used the policy.
[CUSTOMER][NEUTRAL] OK, so is there any other coverage for this patient?
[AGENT][NEUTRAL] Or so it's not covered and the policy doesn't cover any major services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no major services for this patient. Is there a missing two class and waiting period?
[AGENT][NEGATIVE] Uh, there is a missing tooth clause.
[CUSTOMER][NEUTRAL] Uh, what will be the cultures of preventative and basic services?
[AGENT][NEUTRAL] Uh, preventive pays 100% of usual customers reasonable, basic, basic restorative FMX panoramic pays at 80. Major services are not covered.
[CUSTOMER][NEUTRAL] OK, so Clans fluoride, is it under the basic or major or under the basic or preventive?
[AGENT][NEUTRAL] sealants fluorides aren't uh uh preventative.
[CUSTOMER][NEUTRAL] OK, and only just FMX and panel and the basic, right?
[AGENT][NEUTRAL] FMX panel, PAs, fillings, those are considered basic.
[CUSTOMER][NEUTRAL] OK, for fillings is there already downgrade?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] For inlays, onlay, crowns, is it covered?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And for um endodontics, periodontics, oral surgery.
[AGENT][NEUTRAL] Not covered the policy does not cover any major services and that would include endo perio oral surgery, crowns, bridges, partials, and dentures.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for SRP for the Brightman.
[AGENT][NEGATIVE] Not cover that falls within periodontics, which is not covered.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, for implants also not covered, right?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Oral surgery also?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7953 bone grafting also.
[AGENT][NEGATIVE] Not covered.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And for the adjunctive anesthesia?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm 90,210 consultation.
[AGENT][NEUTRAL] Say again.
[CUSTOMER][NEUTRAL] 9310 consultation.
[AGENT][NEUTRAL] You said 9310?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] It falls under basic.
[CUSTOMER][NEUTRAL] No major services and the basic 9 to 10, what would be the frequency?
[AGENT][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] For the 9310?
[AGENT][NEGATIVE] There's no frequency.
[CUSTOMER][NEUTRAL] And for and for 4?
[AGENT][NEUTRAL] I'm sorry, what code?
[CUSTOMER][NEUTRAL] 9944
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for anesthesia 9223.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mm, let me check. OK.
[CUSTOMER][NEUTRAL] For this patient will be the frequencies of exam fluoride, sealants, FMX and panel and by wings.
[AGENT][NEUTRAL] Exams are 2 for 12-month period, cleanings once every 6 months, by wings 1 for 12 month period.
[AGENT][NEUTRAL] Um, fillings once every 24 months, sealants under the age of 14, once every 3 years, permanent molars only, fluoride under the age of [PII], and it's once every 12 months.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And for clinics again prophylaxis?
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] And for the FMX and panel.
[AGENT][NEUTRAL] Uh, FMX panel that is once every 5 years.
[CUSTOMER][NEUTRAL] Is there any history participation in the frequencies?
[AGENT][NEUTRAL] There's no history.
[CUSTOMER][NEUTRAL] OK, no history.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, [PII], can we move to the last question whenever you're ready?
[AGENT][NEUTRAL] Is it under the same policy number or a different policy number?
[CUSTOMER][NEUTRAL] Uh, it's on different.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] But same provider OK?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And what is the next policy number?
[CUSTOMER][NEUTRAL] The next policy number it's um.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 02518124
[AGENT][NEUTRAL] OK. Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name, date of birth, it's [PII]. OK, so sorry, so sorry. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, I'm showing her fixed date is [PII]. She is active on the policy.
[AGENT][NEUTRAL] And you need a general breakdown for her as well?
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK, for this patient, is it the group name Vella Aterra Services with the group number 70073?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So for this special is any coordination of benefits, is it standard or nonook?
[AGENT][NEUTRAL] Standard.
[CUSTOMER][NEUTRAL] OK, so, and also for the special is just the calendar plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I get, is it the maximum $500 deductible 50 family 150?
[AGENT][NEUTRAL] Uh, there's not a family deductible, uh, but yes, $500 total $50 deductible, everything but preventative services, major is not covered.
[AGENT][NEUTRAL] And it's 108
[CUSTOMER][NEUTRAL] OK. For the special,
[CUSTOMER][NEUTRAL] Uh, for this patient, is there like no family deductible, no or coverage, OK, got it. Is there any some from the maximum 500 and from the deductible 50?
[AGENT][NEUTRAL] No, not from this year.
[CUSTOMER][NEUTRAL] OK, there's a missing two class, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, no major service since you said right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, for this special, is there any history that may affect the frequencies?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Uh, showing the last bike wing.
[AGENT][NEUTRAL] And exam was [PII].
[CUSTOMER][NEUTRAL] [PII], right? For the bite wings or for the exam?
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] Yes, for the exam, for the bite wings and exam was [PII].
[CUSTOMER][NEUTRAL] For the bite wings and?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I don't and Pao, I'm showing [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I do not show any history of cleaning.
[CUSTOMER][NEUTRAL] Mm, OK, got it. So [PII] is an age limit for fluoride. What would be the age limit for fluoride for this patient?
[AGENT][NEUTRAL] The same, under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] And for [PII], 14, right?
[AGENT][NEUTRAL] Under, uh, correct, 14 permanent mos only once every 3 years.
[CUSTOMER][NEUTRAL] OK, and for students is it 100% right?
[AGENT][NEUTRAL] That falls under preventive, which is 100% of UCR, and she is too old for seance.
[CUSTOMER][POSITIVE] OK, got it. So, [PII], I think, yes, I'm done with this, with the patient. So thank you so much for assisting me today. I appreciated you a lot so much. Goodbye for now. Stay safe. Take care. Have a good day ahead. Stay healthy. God bless you and enjoy the rest of your day, OK?
[AGENT][NEUTRAL] Mhm. Thank you for calling APL Charlie. Bye.
[CUSTOMER][NEUTRAL] OK bye bye.