AccountId: 011433970860
ContactId: ffb5975b-a02d-44ed-9f67-ef39c3ea9d13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415359 ms
Total Talk Time (AGENT): 238303 ms
Total Talk Time (CUSTOMER): 120114 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/ffb5975b-a02d-44ed-9f67-ef39c3ea9d13_20250109T16:22_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], and I work in Dental Express and I have a couple of questions about a patient that's in our office.
[AGENT][NEUTRAL] OK, uh, questions about uh benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can take a look at that for you, [PII]. um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's gonna be [PII], no extension.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes, it's gonna be 02482844.
[AGENT][NEUTRAL] All right, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] It's gonna be [PII] and date of birth is [PII], I mean [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that, [PII]. Alright, uh, so the policy is active. Effective date was [PII]. Give me just a moment, I'll get the policy pulled up.
[AGENT][NEUTRAL] And what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] What is the group name?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, the group name is Universal Trucking.
[AGENT][NEUTRAL] PGT.
[AGENT][NEUTRAL] Trucking.
[AGENT][NEUTRAL] P as in Paul, G as in Golf. T as in Tango.
[CUSTOMER][NEUTRAL] Sorry, I'm writing all this down. OK, and what is the?
[AGENT][NEUTRAL] That's OK. I'm like those three letters all sound the same.
[CUSTOMER][NEUTRAL] What is the group or plan number?
[AGENT][NEUTRAL] Group number is 12317.
[CUSTOMER][NEUTRAL] And what's the plan name?
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] The plan name is so it's D as in Delta, 4 F as in Foxtrot, F as in Foxtrot, S as in Sierra, U, T as in Tango, BA.
[CUSTOMER][NEUTRAL] BA.
[AGENT][NEUTRAL] Yes, B as in boy and then A.
[CUSTOMER][NEUTRAL] OK, and how much is the annual max?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and of course I will let you know, [PII], verification of coverage is not a guarantee of payment for claims. Uh, their calendar year maximum is $1500 per insured, and they do have a $50 deductible per insured up to $150 per family, and that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then do you require prior authorizations for bridges, crowns, dentures, partials?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No ma'am, no authorization is required.
[CUSTOMER][NEUTRAL] And now I have SRP questions. How many quads per visit?
[AGENT][NEUTRAL] Let me take a look here.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So let me see
[AGENT][NEUTRAL] Um, it depends on the procedure. Did you have a specific code this was in regard to?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so some of the procedures, um, it would be a maximum of 1 each quadrant for 12 months, 1 each quadrant per 24, um, so basically any procedure, all 4 quads could potentially be done at the same time it's just for each quad, um, it's per 12 or 24 months. Does that make sense?
[CUSTOMER][NEUTRAL] So you said 4 could be done but depending on the procedure.
[AGENT][NEUTRAL] Um, for each procedure, they can all be done at once. It's just if, you know, more work needed to be done on a different quad, um, you couldn't go back to that same one for another 12 or 24 months. Does that make sense?
[CUSTOMER][NEUTRAL] So the quads is like for a deep cleaning like a scaling, like how many quads can that be done?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] All all of them can be done at once. All 4 could be done at once.
[CUSTOMER][NEUTRAL] OK, and OK, and then can we do a SRP in the same day as a pro fee?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Is the 4381 and 2991 covered?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Let me take a look.
[AGENT][NEUTRAL] 4381.
[AGENT][NEUTRAL] Yes, um, that is covered under a periodontic, so that would be at 40%.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] 2991 is not a covered procedure.
[CUSTOMER][NEUTRAL] And is there a missing two cloth or a waiting period?
[AGENT][NEUTRAL] There is a missing teeth clause, uh, and there is a waiting period. Um, waiting period only applies to major expenses. Um, major endodontic periodontic oral surgery has a waiting period of 12 months. Preventative and basic expenses have no waiting period.
[CUSTOMER][NEUTRAL] And is there any history on file?
[AGENT][NEUTRAL] Let me take a look and while I'm getting this uh pulled up, I can send you a copy of this fax back if you'd like [PII] that does show all of their benefit information.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, this was for [PII]. Um, I do have some history here. Let's see [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, it was all [PII], um.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Procedure 11,100,120.
[AGENT][NEUTRAL] And that's it. OK, that's what she had on uh June.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, what's that fax number for you, [PII]? I'll go ahead and get this sent to you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna just put this to your attention.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, um, attention to [PII].
[AGENT][POSITIVE] OK perfect I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And do we have to honor discounts after the annual maxes?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like that's
[AGENT][NEUTRAL] Let's see, no, there's nothing specific about that, and this plan just goes off of UCR, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] And I believe once that uh maximum is met, um, then we just simply wouldn't be able to pay any benefits.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last initial is [PII] is there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] And you said today's date?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Nope, I'm done.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.