AccountId: 011433970860
ContactId: f8dd1582-3abb-45e9-a94e-389df9609dc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437130 ms
Total Talk Time (AGENT): 202254 ms
Total Talk Time (CUSTOMER): 127775 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/f8dd1582-3abb-45e9-a94e-389df9609dc5_20250513T18:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office. I would like to verify the eligibility and benefits of one of our patients.
[AGENT][NEUTRAL] OK, I could check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02361937.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you so much for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] I have some specific questions to ask. Can I?
[AGENT][NEUTRAL] Of course, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before that, could you please confirm me the policy holder [PII] date of birth [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the group number 13611.
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And the group name Universal Trucking.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please confirm me the coverage percentage for preventive basic and major service are 180 and 40.
[AGENT][NEUTRAL] Yes, Preventive 100, um, FMX and basics are at 80, and all majors at 40.
[CUSTOMER][NEUTRAL] OK. And there is a 12 month waiting period, right? And what is the waiting period and date? Is it [PII]?
[AGENT][NEUTRAL] Yes, so they are currently not under a waiting period.
[CUSTOMER][NEUTRAL] OK, uh, could you please provide me the annual maximum amount, the deductible amounts and the remaining amounts?
[AGENT][NEUTRAL] Of course, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so annual, uh, calendar year maximum is $1500 per covered insured calendar year deductible is $50 per covered insured up to $150 per family, and that does not apply to preventative expenses. And if you give me one moment, I can go ahead and check to see if any of that has been used or met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was just for um Porsche correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Got you. OK, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so Porsha has met that uh $50 deductible and so far for the year of [PII], she has used $1,464 of that benefit.
[CUSTOMER][NEUTRAL] So the remaining is just $36 right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] What's the family could be reminding, is it $100?
[AGENT][NEUTRAL] Yes, uh, Porsche is the only one who has used any of that or met that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please confirm me there is no all benefits in this plan?
[AGENT][NEUTRAL] Correct. And no orthodontic treatment is covered.
[CUSTOMER][NEUTRAL] What is the assignment of benefits, the payment goes to the provider or the patient?
[AGENT][NEUTRAL] It depends on who files the claim. So if the provider files the claim, we send that information to them. If the patient files the claim we send it to the patient.
[CUSTOMER][NEUTRAL] So your signature on file, the payment goes to provider, right?
[AGENT][NEUTRAL] If the provider is the one to file the claim, yes, then we would send that payment to the provider.
[CUSTOMER][NEUTRAL] OK, could you please tell me if there's any patient dental history that will affect the frequency services.
[AGENT][NEUTRAL] Let's see one moment.
[AGENT][NEUTRAL] OK, were there particular codes you were looking at [PII]?
[CUSTOMER][NEUTRAL] I, I need the diagnostic preventive and period history like exam FMX and panel bittings, gray, uh and SRP 4910 and 4346.
[AGENT][NEUTRAL] I'm sorry, what were those codes you said 4910?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the other?
[CUSTOMER][NEUTRAL] 43 46 43 41 43 40.
[AGENT][NEUTRAL] 43, 46, and
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Can I give you all the codes at once?
[AGENT][NEUTRAL] Oh, we're just needing to check the history for these codes. Is that correct?
[CUSTOMER][NEUTRAL] I need, if there is any patient dental history for exam, FMX and panel, biting, trophy, and other video services that will affect the fren services.
[AGENT][NEUTRAL] Sure, OK, so I can tell you um that she did have an evaluation on, let's see that was [PII].
[AGENT][NEUTRAL] And she did have let's see uh 0220 uh that was also on [PII]. It looks like everything else she had was for um they were extractions bear with me just a moment.
[AGENT][NEUTRAL] Yes, so it was all, um, and none that seems to would have, um, affect any sort of um routine frequency. So 2393 2 23 35, 2331, um, she had all of that in April. So before that, um, again she had the 0140 and 0220 on [PII]. Prior to that she hasn't had anything since [PII].
[CUSTOMER][NEUTRAL] OK. So, there is no diagnostic, preventive and period history that will affect the frequency services, right? Everything is good to go. Everything is
[AGENT][NEUTRAL] Right. The only
[AGENT][NEUTRAL] The only one that I see again is that 0140 that was on [PII].
[CUSTOMER][NEUTRAL] There is no history for SRP and other video services as well, right? Just to confirm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, that's the only other history I have, uh, for this year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you, [PII]. Thanks for the help. That's all I need for today. Could you please tell me the reference number for this call?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, [PII]'s date. Uh so my name is spelled [PII], last initial [PII]
[AGENT][NEUTRAL] And there wasn't anything else I could help you with?
[CUSTOMER][POSITIVE] Uh no, thank you so much have a great day bye bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.