AccountId: 011433970860
ContactId: fc645364-fa9a-434e-8ec4-be17a3c77ed0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 732640 ms
Total Talk Time (AGENT): 154196 ms
Total Talk Time (CUSTOMER): 265153 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/fc645364-fa9a-434e-8ec4-be17a3c77ed0_20250417T17:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Bye you too.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] She can no, hold on. Yes.
[AGENT][NEUTRAL] Hello, this is [PII] with APL. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hey, yes ma'am. I was trying to confirm um a patient's eligibility.
[AGENT][NEUTRAL] OK, I can help you with eligibility. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] That's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your number?
[CUSTOMER][NEUTRAL] Um, that the telephone number is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, 259.
[CUSTOMER][NEUTRAL] 6952
[AGENT][NEUTRAL] OK, and the patient name and date of birth?
[CUSTOMER][NEUTRAL] That is [PII] [PII].
[AGENT][NEUTRAL] And you're just needing eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes, do you all do fax overs?
[AGENT][NEUTRAL] Yes, I can do a fax back. What's your fax number?
[CUSTOMER][NEUTRAL] OK. 770.
[CUSTOMER][NEUTRAL] 702.
[CUSTOMER][NEUTRAL] 1444 and and I do have uh just a few questions while I have you on the line for eligibility as well please.
[AGENT][NEUTRAL] OK, I've got the effective date is [PII] and it is active.
[AGENT][NEUTRAL] And then how can I help you on the questions?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is there a waiting period?
[CUSTOMER][NEUTRAL] For basic or major?
[AGENT][NEUTRAL] Um, anything I
[AGENT][NEUTRAL] Um, anything I quote is not a guarantee of payment based outline of the policy. Um, let me look at the waiting period.
[AGENT][NEUTRAL] Uh, for this plan, they do have a waiting period for basic restorative, major, endo and Pero.
[AGENT][NEUTRAL] 12 months.
[CUSTOMER][NEUTRAL] OK. And how, 12 months?
[CUSTOMER][NEGATIVE] Uh, missing tooth cloths.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There is a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, for preventative, is it 100%?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Basic 50%?
[AGENT][NEUTRAL] Uh, basics at 80% and that does include radiographs, FMX.
[CUSTOMER][NEUTRAL] 80.
[CUSTOMER][NEUTRAL] And you said that includes radiographs and FMX?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's subject to a $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they have a $50 deductible. OK, is there an annual max?
[AGENT][NEUTRAL] The annual max is 1500.
[CUSTOMER][NEUTRAL] And he used this, oh well, no, he just started.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, da da da da da da for major, um, what person is that covered under?
[AGENT][NEUTRAL] Uh, pays 40%.
[CUSTOMER][NEUTRAL] 40, OK. Um, oral surgery, is that what percent?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And that is uh let me look.
[AGENT][NEUTRAL] Uh, it looks like that is under major.
[CUSTOMER][NEUTRAL] OK, and is um Eo Imperial is that under major also?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] For um your FMX, what is the frequency?
[AGENT][NEUTRAL] The max is.
[AGENT][NEUTRAL] Uh, it looks like once per 36 months.
[CUSTOMER][NEUTRAL] OK, uh, is the pin all the same? That that'd be code [PII]?
[AGENT][NEUTRAL] OK, actually, I'm sorry, that's once for 5 years, same for Pana.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's one every 5 years.
[CUSTOMER][NEUTRAL] OK, um, bite wings and PA.
[CUSTOMER][NEUTRAL] And those codes are the bite wing is [PII].
[AGENT][NEUTRAL] It's once for 12 months.
[CUSTOMER][NEUTRAL] Um, code [PII].
[AGENT][NEUTRAL] Uh, there's no frequency listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about uh code [PII]?
[AGENT][NEUTRAL] Uh, 1 for 6 months.
[CUSTOMER][NEUTRAL] Um, code [PII].
[CUSTOMER][NEUTRAL] And um so these next three sometimes they go to get well I know the 120 and 140, they usually go together.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, we've got a specified 12, 140, 150, 160, 180, 2 in a 12 month period.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And 4341.
[AGENT][NEUTRAL] Uh, 1 each per quadrant in 24 months.
[CUSTOMER][NEUTRAL] Um, so that means they they can't be done on the same day, right?
[AGENT][NEUTRAL] Um, yeah, it just says.
[CUSTOMER][NEGATIVE] All quads on the same day, that would be no.
[AGENT][POSITIVE] Yeah, so, yes, correct.
[CUSTOMER][NEUTRAL] OK, 4910, that's superior maintenance.
[AGENT][NEUTRAL] Uh, one every 6 months.
[CUSTOMER][NEUTRAL] Um, healing period from a 4910 following a 4341.
[CUSTOMER][NEUTRAL] Is there a healing period um from a period maintenance to SRP?
[AGENT][NEUTRAL] Um, that's not ever heard of a healing period.
[AGENT][NEGATIVE] So it would not be applicable.
[CUSTOMER][NEUTRAL] Um, so some insurances that say no, and then some say 90 days, some say 60 days.
[CUSTOMER][NEUTRAL] But if you never heard of it, they might don't, they might not have one.
[AGENT][NEGATIVE] Yeah, I don't show healing. I can't, it's not the plan policy.
[CUSTOMER][NEUTRAL] OK, um, what about scaling 43, 46?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] In that code, and our fax back has all of these codes listed with all of the frequencies.
[CUSTOMER][NEUTRAL] OK cool well we can we can move on, um, I, I do have a couple more questions, but they're kind of just about the insurance. Is there a group number for this insurance?
[AGENT][NEUTRAL] Um, group number is.
[AGENT][NEUTRAL] 246-40.
[CUSTOMER][NEUTRAL] OK, a payer ID?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Address
[AGENT][NEUTRAL] Address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] And what's the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], sorry.
[CUSTOMER][NEUTRAL] OK, um, and the, and the insurance is, it's called American Public Life.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, is the group name the same?
[AGENT][NEUTRAL] Uh, group name is.
[AGENT][NEUTRAL] It's universal trucking.
[CUSTOMER][NEUTRAL] Universal tracking.
[CUSTOMER][POSITIVE] OK perfect um I do believe I have everything I need.
[CUSTOMER][NEUTRAL] Um, from you.
[CUSTOMER][POSITIVE] Yeah, I appreciate you thank you. Oh, reference number can I have a reference number? And does um do you all require a PT from patients?
[AGENT][NEUTRAL] Um, reference number is just my name and today's date, so it's [PII], first initial last name [PII] as in [PII] and today's date and then what was the question?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], I'm sorry, one second, thank you for choosing Mount Houston so. Can I get you to hold, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, um, I'm sorry, so you said for the reference it's going to be your name [PII]?
[AGENT][NEUTRAL] Uh-huh, and today's date.
[CUSTOMER][NEUTRAL] And today's date [PII]. OK, and, and do I need to have a last initial?
[AGENT][NEUTRAL] Oh, it's [PII]
[CUSTOMER][NEUTRAL] Last name [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And a PTE is a PTE required?
[AGENT][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] A pre-treatment, a, a um a pre-treatment.
[AGENT][NEUTRAL] Oh, no, it's
[AGENT][NEUTRAL] No, it's not. No, it's not required.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Perfect. Alright, [PII], well I really appreciate you. You have a great day, OK?
[AGENT][POSITIVE] OK, thank you for calling APL. You as well.
[CUSTOMER][POSITIVE] Thank you.