AccountId: 011433970860
ContactId: 00b6e407-a86c-479d-a582-69b7894590ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660760 ms
Total Talk Time (AGENT): 279751 ms
Total Talk Time (CUSTOMER): 300539 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/00b6e407-a86c-479d-a582-69b7894590ee_20250319T18:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hello, sir. My name is [PII] from the dental office.
[AGENT][NEUTRAL] Ms. [PII], how may I assist you?
[CUSTOMER][NEUTRAL] So it is in regards with the benefit, uh yeah, benefit information of our patients.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] OK, sure. I can assist you with benefits [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, the best callback number, that would be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, the name of the office, that would be Milltown Family Dentistry.
[AGENT][NEUTRAL] I'm sorry, you said Mil Milton. How do you spell that?
[CUSTOMER][NEUTRAL] Oh yeah. It is [PII] L L and then Town, T [PII]
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Family dentity. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the patient's policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I have. How many zeros is this? 5 consecutive zeros.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 249
[CUSTOMER][NEUTRAL] 873 1.
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] Thank you. And do you need a full breakdown of benefits given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Uh, verbally, I'm sorry. We already requested it like 3 times earlier. We haven't received it. I think it is on our end because even to other insurance, we cannot receive fax.
[AGENT][NEUTRAL] OK, OK, fine. All right, so let me go ahead and pull the benefit information. One moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, OK, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And we have a calendar year maximum of 500 per cover insured with a calendar year deductible of $50 per cover insured, $150 per family if it's a family plan, and deductible does not apply to preventatives.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, preventative, our cover 100%, Radiograph FMX 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Basic expense and basic restorative expenses cover 80%. There's no major services, so endodontics, periodontics, prosthodontic repair, and oral surgery are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So major services are not covered. OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You're not covered. Um, for their frequencies, um, we have cleanings once every 6 months. Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings is once per 12 month period.
[AGENT][NEUTRAL] Inhoma X-rays or panels are once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 5 years. OK, thank you so much. Let me just enter that one here. OK, I'll just go ahead and enter it later. Um, just to be sure, and though for you in order.
[CUSTOMER][NEUTRAL] Do they fall under basic or major?
[AGENT][NEGATIVE] Major and they're not covered.
[CUSTOMER][NEUTRAL] So, and, OK, thank you. Let me put 0.0.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 0, as well as or not covered, right?
[AGENT][NEUTRAL] Yes, or no it's not covered.
[CUSTOMER][NEUTRAL] OK. Thank you so much. Let me put not covered, not covered, not covered. Um, also, no waiting period on file. Is there a missing two class?
[AGENT][NEUTRAL] No, not because it's just a basic dental.
[CUSTOMER][POSITIVE] OK. Thank you so much. And also, may I have the effective date, please?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right. You have an effective date of, let's see, this is for [PII], um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. This is a calendar year plan, right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, the doctor, um, [PII], is she in-network on the patient's plan?
[AGENT][NEUTRAL] The what? I'm sorry?
[CUSTOMER][NEUTRAL] Oh, is the, the, the doctor is in-network on the patient's plan?
[AGENT][NEUTRAL] Oh, this one doesn't have any network. If the provider participates with Carrington, they can use their fee schedule, but it is not required because we're not contracted. So there's no network.
[CUSTOMER][NEUTRAL] Oh, so no network status, correct? No network status.
[AGENT][POSITIVE] Mhm. Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] And also the fee schedule. For the fee schedule, which means
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No fee scheduled as well.
[AGENT][NEUTRAL] Um, if the provider participates with Carrington, they can use their fee schedule. If not, we pay on the usual customary rates, UCR.
[CUSTOMER][NEUTRAL] So it depends. Uh-huh. OK, thank you.
[AGENT][NEUTRAL] Yes, uh-huh, yeah, it depends. You're welcome.
[CUSTOMER][NEUTRAL] But for the co-insurance and then the first I'm sorry, percentage and then the frequency in and out is the same thing as well as the maximum, right?
[AGENT][NEUTRAL] Correct, yes, there's no difference because there's no uh network.
[CUSTOMER][POSITIVE] Thank you so much. And also,
[AGENT][NEUTRAL] We will pay the same thing.
[CUSTOMER][POSITIVE] OK, perfect. May I have the group number and then the group name, please?
[AGENT][NEUTRAL] Oh, sure, let me get that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK OK then group number is 70056. The group name is MAU, which is Man, analysis and utilization.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] The management analysis utilization. Let me update this one.
[CUSTOMER][NEUTRAL] OK, thank you. And also, let me double check. I got the FMX panop prophylaxis, as well as the bit wing uh co-insurance. Could you please try C and Blue Ride 1351?
[AGENT][NEUTRAL] Um, so you need to know if it's covered or because those are under preventative. So that one is a 100% covered. Um, now they have, um, age limitation. So for fluoride, the age limitation is um up to the age of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Forces is up to the age of [PII].
[AGENT][NEUTRAL] Um, fluoride is gonna be maximum of 1 procedure for 12 months and um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Clans is gonna be one procedure per 36 months and application made to the molar teeth only.
[CUSTOMER][NEUTRAL] OK. For
[CUSTOMER][NEUTRAL] A smaller seat only, like for premoers, right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Once in every 36 months, I have this one already. OK. And uh yeah, same thing with the 1208. They're both fluoride. How about the cone bean, 0383. Is it covered or no?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which code again? 0383?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEGATIVE] No, that one is not covered.
[CUSTOMER][NEUTRAL] How about 1354? I'm not sure if it's the same thing with um Finland.
[AGENT][NEUTRAL] 1354 um no, that one is not covered.
[CUSTOMER][NEUTRAL] Not covered as well. So, the 2391 fillings, it is part of the basic. Is it covered? I just need, yeah, I just wanted to know if it is covered.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Which one?
[CUSTOMER][NEUTRAL] 2391 fillings.
[AGENT][NEUTRAL] 2391.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, yes, that's on basic restorative.
[AGENT][NEUTRAL] Which is 80%.
[CUSTOMER][NEUTRAL] Do they downgrade?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] No downgrade. Thank you so much. And I think these are not covered. The veneers, correct? These are not covered for the OK for, how about, I'm sorry. I just need, let me double check. 1234 codes only and I'm done.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, they're not covered. No.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for your maintenance, is it covered?
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] OK. SRP is not covered as well, right?
[AGENT][NEUTRAL] What is that called?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEUTRAL] Yeah, that one is not covered.
[CUSTOMER][NEGATIVE] Not covered as well, OK. 442 not covered, of course. Could you please check the 4346, but I think this is not covered as well.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Correct, it's not covered.
[CUSTOMER][NEUTRAL] Not covered. And the last code, actually, the second to the last, yeah, 9944 and 9945, are they covered?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] 9944 is not covered, 9945 is not covered.
[CUSTOMER][POSITIVE] OK. Thank you. And of course, 6000 series implants are not covered. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I don't that count.
[CUSTOMER][NEUTRAL] OK. And actually, I'm done. I just need, if there's history on file that might affect the frequency, but I guess none because no use amount for this.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Year, right?
[AGENT][NEUTRAL] Mm, let me check. Um, yeah, she has not used her benefits, there's no history.
[CUSTOMER][POSITIVE] OK. Thank you so much. I just need the spelling of your name and then the reference number, and I am done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we don't have reference numbers. You can use my name in today's date. My name is [PII], that's [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. And please do have a blessed day ahead. Bye-bye.
[AGENT][POSITIVE] And you're welcome.
[AGENT][POSITIVE] You as well thank you for calling ATL. Bye bye.
[CUSTOMER][POSITIVE] Thank you.