AccountId: 011433970860
ContactId: fa8c3d1f-1a06-40a6-8a71-dc1187a54eae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667010 ms
Total Talk Time (AGENT): 235274 ms
Total Talk Time (CUSTOMER): 242767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/fa8c3d1f-1a06-40a6-8a71-dc1187a54eae_20250521T22:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling on behalf of the provider's office to check on dental eligibility and benefits for a, for one patient here. Actually, could you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check eligibility for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, um, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's going to be [PII], with no extension.
[AGENT][NEUTRAL] Thank you, and then did you have the policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number I got here is going to be um 02365891.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and then if you'd like I can send you a fax back showing all of the covered, uh, procedures and benefit information.
[CUSTOMER][NEUTRAL] Oh, I just have a few specific questions, this patient here.
[AGENT][NEUTRAL] Um, specific questions regarding benefits?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Oh yes. Uh, you said if I date is [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. And just confirm the plan on the can the coordination and standard.
[AGENT][NEUTRAL] It is on a calendar year there is no coordination of benefits.
[CUSTOMER][NEUTRAL] No cos, and can I have the unemployed maximum and the deductibles?
[AGENT][NEUTRAL] Of course, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Calendar year maximum for this plan is $1500 with a $50 deductible that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] All right. Nothing has been used and nothing has been met, right?
[AGENT][NEUTRAL] Oh, let me verify that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for this year that deductible has been met. Give me just a moment because he has used some of that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so again that $50 be or deductible has been met, um, of the $1500 he has used $312.40 so far this year.
[CUSTOMER][NEUTRAL] 3, 12 and 40 cents. Thank you. And how about the um uh how about the uh missing the class and waiting period?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] There is a missing tooth claws, um, and they are no longer within a waiting period.
[CUSTOMER][NEUTRAL] All right, there so close but no waiting period. OK, I wait for that one. And for the fillings and crow, I mean, sorry, for the, um, yes, fillings and crowns to the downgrade or not.
[AGENT][NEGATIVE] No, they do not.
[CUSTOMER][NEUTRAL] All right. And for the, uh, I believe there are no orthodontic coverage, right?
[AGENT][NEUTRAL] Correct. No orthodontic treatment is covered.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right. And uh how about implants? Are there any implants coverage?
[AGENT][NEUTRAL] Implant placement, removal and all related services are not going to be covered under this policy.
[CUSTOMER][NEUTRAL] OK, time for that one. And just confirm the coverage presented for preventative is 100, basic at 80, and major at 40%.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, so implants is not coverage. OK. Let me put that. And, uh, by the way, uh for the um police and plans you said is down they are downgrade, right?
[AGENT][NEGATIVE] They do not, no.
[CUSTOMER][NEUTRAL] Oh, they do not downgrade, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, let me put that one. And uh yes, uh, for the FMX and panel, do they share frequency or not?
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][NEUTRAL] All right. And the frequency of those?
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] Once every 5 years. Thank you. And just confirm the frequency of the period exam. It's 2 for 12 months.
[AGENT][NEUTRAL] Yes, that is, uh, for exams, uh, cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] Oh thank you. And what about the age limit of the rate?
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] Oh, what about the age limit of fluoride?
[AGENT][NEUTRAL] The age limit of what? I'm sorry?
[CUSTOMER][NEUTRAL] Uh, fluoride, H of fluoride.
[AGENT][NEUTRAL] Oh, fluoride, um, do you have that, uh, procedure code by chance?
[CUSTOMER][NEUTRAL] Sure. It's uh uh sorry, 1206.
[AGENT][NEUTRAL] 1206. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1206 is not going to be a covered procedure under this policy.
[CUSTOMER][NEUTRAL] OK, and the black wings, is it 2 per calendar, yeah?
[AGENT][NEUTRAL] Yeah, uh, once per 12 month period.
[CUSTOMER][NEUTRAL] Uh, once for 12 months for buy drinks, uh, right, time for that. And for the uh-huh, and for the SRP can all the four class perform on the same day?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, either one.
[CUSTOMER][NEUTRAL] 0, 11. OK, thank you for that. And I believe for my department and they are not covered benefits.
[AGENT][NEUTRAL] Uh, what was not a covered benefit? I'm sorry?
[CUSTOMER][NEGATIVE] Uh, for multi bribing and arresting, they are not covered benefits, right?
[AGENT][NEUTRAL] Do you have those uh procedure codes?
[CUSTOMER][NEUTRAL] Oh, sure. 4355 and 4381.
[AGENT][NEUTRAL] So 4355 is covered under periodontic, so that is uh 40%. And what was the other procedure code, I'm sorry?
[CUSTOMER][NEUTRAL] Um, can you come again with that, uh, 1 4355?
[CUSTOMER][NEUTRAL] 80%.
[AGENT][NEUTRAL] Yes, 4, 40% that is covered under periodontic, uh, some major, that is 40%.
[CUSTOMER][NEUTRAL] And the frequency.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Maximum 1 each quadrant per uh per 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Once for 24 months. Thank you. And what about the uh 4 4381?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] 4381 is also covered under periodontic, so 40%, and that one does not have a limitation.
[CUSTOMER][NEUTRAL] All right. I will put that. And I just, uh, is there any issue on file for the FMX and the uh SRP?
[AGENT][NEUTRAL] Oh, let me check. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Would you mind giving me those procedure codes [PII]?
[CUSTOMER][NEUTRAL] Uh, sure. 44 0 F 02 10.
[CUSTOMER][NEUTRAL] And 4341.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we do have a 4341 that was on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Um, for the upper right and the lower right.
[CUSTOMER][NEUTRAL] Just upper right number, right?
[AGENT][NEUTRAL] Correct, um, well, let me continue looking give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, it was also it's on the [PII], upper left and lower left, so all four quadrants.
[CUSTOMER][NEUTRAL] All right. What about the 0 to 10 or 0330?
[AGENT][NEUTRAL] Bear with me. I'm not seeing either of those. Let's see. Uh, there's uh 0330, uh, that was also on, um, [PII].
[CUSTOMER][NEUTRAL] All right. And what about the uh history of the cleanings and pay maintenance, is there any?
[AGENT][NEUTRAL] Do you have those specific codes by chance?
[CUSTOMER][NEUTRAL] Sure. It's uh 1110 and 4910.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, there is 4910 that was on [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII]. And the um
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Mhm. And the
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] Um, I do not see an instance of [PII]:10.
[AGENT][NEUTRAL] No, we have no history for that procedure.
[CUSTOMER][NEUTRAL] 1725.
[CUSTOMER][NEUTRAL] All right, let me just check here.
[CUSTOMER][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] And uh all right then I think we are very special. oh yes. Uh let me just check here, and I believe there are of no benefits for this patient here.
[AGENT][NEUTRAL] What was that? I'm sorry?
[CUSTOMER][NEUTRAL] Uh, can I have the group name and group number?
[AGENT][NEUTRAL] Oh yes, one moment, let me get that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the group name is Universal Trucking.
[AGENT][NEUTRAL] Wall Street Systems.
[CUSTOMER][NEUTRAL] Universal checking Wall Street systems.
[AGENT][NEUTRAL] Uh trucking, T U R T R U C K I N G.
[CUSTOMER][NEUTRAL] Universal uh checking, CHEC checking.
[AGENT][NEUTRAL] Trucking, no, uh T R U C K I N G Trucking.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, TR UC uh universal trucking and then after trucking.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, wall, wall.
[AGENT][NEUTRAL] Street
[CUSTOMER][NEUTRAL] Wall Street.
[AGENT][NEUTRAL] Systems
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] Group number is 13003.
[CUSTOMER][NEUTRAL] 13003. All right, thank you for that one. All right, [PII] uh this patient. And would you mind spell your name for me please for recommendation?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, it's [PII]. And was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right. OK. All right, [PII], I think the office patient here and I do appreciate your kind help with today, [PII]. You do have a great day and enjoy the.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Thanks, [PII], you too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye, [PII].