Upload metlife-2198304359042.txt

metlife-2198304359042.txt

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+Robocall: Thanks for calling MetLife. Your call may be recorded for quality assurance purposes so I can get you to the right place. Please tell me the type of policy or MetLife product you're calling about today
+
+Amy: Dental
+
+Robocall:  Thanks, let me get you to dental insurance. Welcome to MetLife Dental customer service centre. Your call may be recorded for quality assurance purposes. To get started, please tell me are you a plan member or a dental services provider?
+
+Amy: Provider.
+
+Robocall: You'll need to use your phone keypad to make your selections going forward. If you'd like to submit a claim or pretreatment estimate, or if you're looking for information about the preferred dentist program or the Met Dental website, press on 1, for any other inquiries, press 2
+
+Amy:  2
+
+Robocall:  To get started, enter the primary insured employee ID or Social Security number, followed by the pound key
+
+Amy: 305083320
+
+Robocall:: I have that ID as 305083320. Did I get that right press one for yes and two for no?
+
+Amy: 1
+
+Robocall: I did not find a policy for that ID. Please enter the primary insured's employee ID or Social Security number followed by the pound key.
+
+Robocall: I didn't hear you press any buttons. In order to proceed with this automated system, you need to enter a primary insurance ID or Social Security number. If I don't receive a valid entry, I'll have to end this call.
+
+Amy: 593-3156. 
+
+Robocall: To confirm I found the right account are the 1st 3 letters of the insured's last name.ORT press one for yes or two for no
+
+Amy:  1
+
+Robocall  I have that ID as 593-3156.Did I get that right? Press one for yes and two for no.
+
+Amy:  1
+
+Robocall: I did not find a policy for that ID. OK, please enter the next primary insurance, employee ID or Social Security number followed by the pound key.
+
+Amy:  343495060
+
+Robocall: I wasn't able to find a policy with that information. To hear our general menu, press 1. To select another member, press 2.To hear our general menu.For instructions on filing claims and pretreatment estimates, press 1 if you're interested.
+
+Amy:  1
+
+Robocall: That was an invalid selection. For filing instructions, press 1. To learn more about our preferred dentist program, press 2. Or if you need a provider directory, press 3.For filing instructions, press 1. To learn more about our preferred dentist program, press 2, or if you need a provider directory, press 3.If you'd like to speak to a representative about benefits or eligibility, press one. For anything else, press 2.
+
+Amy: 1
+
+Robocall: If you're calling about in network benefits, press one for out of network benefits.Please hold while I transfer you to someone who can help.
+
+Robocall:  Please note you are on a recorded line and may be monitored for quality assurance. If you do not wish to have your call monitored, please notify the Customer Service Consultant.
+
+Insurance_Agent:  Hello, thank you for calling Math Life Dental. My name is Stephanie. Who do I have the pleasure of speaking to?
+
+Amy: Hi, this is Shanna. Sorry, how do you spell your name?
+
+Insurance_Agent: :  S-T-E-P-H-E-N-Y.
+
+Amy:  And the initial to your last.?
+
+Insurance_Agent:   G for George or G for golf. 
+
+Amy: Thank you. I'm just calling in to check umm a dental code if it's covered by the plan or not.
+
+Insurance_Agent:    Sure what is the subscribe Umm what is the tax ID of the dentist
+
+Amy:  464?446-461-6848
+
+Insurance_Agent:   And what is the name of the dentist?
+
+Amy:This is for Doctor Olivine Adi Kukwe
+
+Insurance_Agent:   Thank you for that information. Let me just pull it up
+ 
+Insurance_Agent:   Thank you. And what is the name of the patient?
+
+Amy:  I'm looking for Mark Luma. Last name is M-UMMA
+
+Insurance_Agent:   Oh, what is the Social Security number member ID for that patient or policy?
+
+Amy: The member ID that I entered to the AVR is not being recognised but what we have is 305-0833 to zero
+
+Insurance_Agent:   Let's see. Sorry, I'm just searching and you said that the name is Mark. What is the last name and date of birth of Mark?
+
+Amy: Muma MUMMA birthday is.MMM October the 12th, 1989.
+
+Insurance_Agent:  Thank you so much. Let me pull up the information.It's coming up now.
+
+Insurance_Agent:  Right. You're welcome. Hold on a second. I'm still trying to pull it up.
+
+Insurance_Agent:  All right. And I was able to pull up the account of Mark and how may I help you?
+
+Amy:  Can I have if Can I have the member ID that you have for umm claim filing purposes?
+
+Insurance_Agent:  Uh, member ID is the same as the one you provided.
+
+Amy: MMM, I see. I'm wondering why is the automated system not recognizing it? Is there any actually?
+
+Insurance_Agent:   Actually the first time that when I opened the account I the first member ID 
+provided is not coming up and then the second one I mean the one you entered on the IVR did not come up or there is a person umm, there is umm, what you call this there is umm.So when you entered a member ID on the IVR, the person came up is different then when you provided me the member ID. Now over the phone, I was able to find Mark.
+
+Amy:  All right. Can you read it back to me? The one that were you able to pull up Mark's account?
+
+Insurance_Agent: : I'm sorry, I cannot do that. Is it OK if you will confirm and then I'll say yes.
+
+Amy:  OK. Is that 305083320?
+
+Insurance_Agent:  Yes, yes. 
+
+Amy:  No letters before the numbers or no any additional numbers?
+
+Insurance_Agent:  No additional numbers, just that the one you provided.
+
+Amy:  OK.Will you be able to check the procedure code if the plan will, if it will be payable 
+by the plan or if any prior authorisation will be required?
+
+Insurance_Agent:   Let me check what is the code
+
+Amy: .N for Nancy, 2920.
+
+Insurance_Agent: 2920 Let me check.Hold on a second.2920 that is 80%, one in 24 consecutive months to the month, no age limit
+
+Insurance_Agent: And for Nancy, right the the letter of the code, it's not D, it's N
+
+
+Insurance_Agent:  2920
+
+Amy:   so I'm not sure about the number you provided that I'm sorry I'm not sure about the letter you provided because you're in MetLife. We have the the 09200140, something like that. I'm not sure about the end.
+
+Insurance_Agent:  What is the description of the 2920 on your end to make sure that we're on the same page? 
+
+Amy:    Let me check. Hold on 2920 space maintain. Hold on. No, no, no. Give me a second. Let me just check what this is 2920. Give me a second, I cannot find it 2920.Resumes crown. Is that right?  Three cement crown.
+
+Insurance_Agent: Yeah, that's what I have. Resumed crown.
+
+Amy:   Perfect. And you said it's the maximum will be 80% to be to be paid by the plan, right?
+
+Insurance_Agent: Yeah, the coverage is 80% correct based on carrying, uh, sorry, connection dental fee schedule
+
+Amy: : Alright. And there's no other copay or deductible aside from that?
+
+Insurance_Agent:  Uh, there, let me just check hold on a second. There is a deductible that will apply because this is basic service
+
+Amy: :   How much is the deductible that they need to met?
+
+Insurance_Agent:   Umm. Upon checking here, the deductible is $50.
+
+Amy:    No accumulation yet for that
+
+Insurance_Agent:    exactly. Yeah, it hasn't been, umm, it hasn't been satisfied.
+
+Amy:   OK, so the number will be needing first to satisfy the $50 before they will be covered at 80%
+
+Insurance_Agent:  No, Umm oh hold on. Yeah you need, they need to apply first the $50.00 and then they will apply the 80%.
+
+Amy:  OK, is there any prior authorization required for the code?
+
+Insurance_Agent: Uh we suggest for authorization for our procedures above $300.00? It's still update if you would like to pre authorize the the procedure.
+
+Amy:   Alright. Is there any dollar limit or maximum dollar limit on this account by year or lifetime?
+
+Insurance_Agent:  $1000 is the annual Max $1000.
+
+Amy:   The the the plan runs per calendar year.
+
+Insurance_Agent::  Yes.
+
+Amy:   Is there any accumulation to the $1000 already?
+
+Insurance_Agent:  Nothing has been oh hold on, let me double check. Nothing has been used yet from the $1000 Max
+.
+Amy: : OK umm is there any visit limit or frequency limit for this code?
+
+Insurance_Agent:   One in 24 consecutive months for the month.
+
+Amy:   Sorry, can you explain it?
+
+Insurance_Agent: One in 24 months is the coverage
+
+Amy:  01 in 24 months and there's no procedure that has been performed yet in the past 24 months.
+
+Insurance_Agent:: No history. Yeah, no history for the code 2920.
+
+Amy:: OK. I just want to make sure that there's no 2920 umm claim yet in the past two years, right?
+Insurance_Agent:   Right. There's nothing yet on file for the 2920 yet.
+
+Amy:  Is it possible for you to fax the the benefit information as well?
+
+Insurance_Agent:  Umm, yes, but I need the address of Mark Muma. Do you have the address of Mark? 
+
+Amy:  Yes, I do have it here. Umm, so the one that Mark provided to us is that 228 Rockwood St. La Porte, 465 Zero, Indiana.
+
+Insurance_Agent: Mm-hmm. And. Zip code please
+
+Amy:  465 zero is the zip code
+
+Insurance_Agent:  46350 OK, great. Let me just send it to you. Bear with me a second. Give me a second. Yeah, yeah. You're welcome. So the dentist is in direct. I also have an option for the e-mail. Would you like an e-mail or still fax?
+
+Amy::   Can we? Yeah. Can you do the fax instead?
+
+Insurance_Agent:  Sure. What is your fax number?
+
+Amy:  646-298-1945
+
+Insurance_Agent: All right. Thank you, 6460981945.
+
+Amy:: That's right. Mm-hmm
+
+Insurance_Agent:  That's right. Mm-hmm.All right. Thank you. I was able to send it, .Hold on a second here, let me send it to you
+
+Insurance_Agent:   All right, umm, I was able to send it to you and no waiting period on this plan. And umm, you will receive the fax within 15 minutes or approximately 15 minutes.
+
+Amy::  Perfect,  and is there a call reference number for this?
+
+Insurance_Agent:   Yeah, I have that. That is 198265106.
+
+Amy:: 198265106.
+
+