AccountId: 011433970860
ContactId: 07252a68-86c1-459a-aa51-a863d141ec35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354640 ms
Total Talk Time (AGENT): 180863 ms
Total Talk Time (CUSTOMER): 126865 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/07252a68-86c1-459a-aa51-a863d141ec35_20250304T18:30_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to check on a patient's uh policy to see if our office is in network with insurance.
[AGENT][NEUTRAL] OK, yes, I can certainly look that up, and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], yeah, thank you. And what is that policy number that I'm looking at, please?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02587317.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] Thank you. Um, I do need to have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Well, first of all, the policy went into effect on [PII]. It is uh active. Now, these policies pay a percentage of uh or or it follows the Carrington PPO fee schedule, but you don't need to be a member of Carrington.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In order for the policy to pay out, the, the policy, uh, it doesn't matter where the insured goes, they can go um to any provider, but the policy only covers preventative, basic, and basic restorative. So they can go to any provider. There is no network. It's just that the services, the only services that are covered are the basic, basic restorative and preventative services.
[CUSTOMER][NEUTRAL] Um, preventative and basic. What, what, what is that covered under? Is it like 100 and 100 or?
[AGENT][NEUTRAL] Well, the preventative is 100% of the allowable of the Carrington PPO fee schedule, and the basic and basic restorative is 80%. There's also a $50 deductible that does not apply to the preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's not only it's the basic. Is there, does she have a maximum to the policy?
[AGENT][NEUTRAL] It's $500 per calendar year and that's just a verification, not a guarantee of payment. I have a fax that I can send to you, or is there anything in particular that I could help with?
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] I, yeah, there are some codes um that I would need.
[AGENT][NEUTRAL] Sure, what's the first one?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The first one
[AGENT][NEUTRAL] And, and I'll tell you that endedon periodontal services ortho those aren't covered, but I'm sorry, what's the first code?
[CUSTOMER][NEUTRAL] 435.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, you said Perry O'Donnell and Eo is not covered and Crowns, obviously.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, no, they're not gonna be covered.
[CUSTOMER][NEUTRAL] Um, how about 4355, would that be a coverage benefit?
[AGENT][NEUTRAL] Uh, let's see. I do not believe so, but let me just check here really quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Um, no, it is not.
[CUSTOMER][NEUTRAL] No. Uh, how about extraction for 7140?
[AGENT][NEUTRAL] Now, that is covered at 80%.
[CUSTOMER][NEUTRAL] 8% um composites for filling 2391.
[AGENT][NEUTRAL] That's covered at 80%, but they don't downgrade to amalgam.
[CUSTOMER][NEUTRAL] OK, is there a replacement frequency for that?
[AGENT][NEUTRAL] Yes, uh, the replacement for that, um,
[AGENT][NEUTRAL] That's a maximum of 1 tooth for 24 months and replace existing only in place for 24 months.
[CUSTOMER][NEUTRAL] OK. Um, is 0210 covered benefit?
[AGENT][NEUTRAL] Uh, yes, that is covered. Um, the FMX or pano, those are covered, and it's once every 5 years.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And then 0274.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] Uh, no, that is not.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] Uh, no, that's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not covered. Um, now, are the cleaning 6 months to the exact day or is it any time in the year?
[AGENT][NEUTRAL] I, the cleanings are once every 6 months. The exams are 2 for 12 month period.
[AGENT][NEUTRAL] Um, the, uh, the filming, the inner oral X-ray, that's once for 12 months.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, so 6 months. OK. Uh, OK, perfect. Oh, actually, is there a payer ID for this policy?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] And then um a group number.
[AGENT][NEUTRAL] Yes, um, let me just see here really quickly. I think the group number is uh.
[AGENT][NEUTRAL] That group number is 70069 and that is ATC Healthcare.
[CUSTOMER][NEUTRAL] A A P A TC Healthcare.
[AGENT][NEUTRAL] Um, no, um, A as in apple, T as in Tom, C as in Charlie, Healthcare.
[CUSTOMER][NEUTRAL] Healthcare.
[CUSTOMER][NEUTRAL] OK, and then the member ID is the policy number I gave you earlier, correct?
[AGENT][POSITIVE] That, that's correct.
[CUSTOMER][NEUTRAL] 587 um do you guys have a claim address?
[AGENT][NEUTRAL] Yes, her address is [PII].
[AGENT][NEUTRAL] That's gonna be in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Um, and then, OK, perfect. OK, thank you.
[CUSTOMER][NEUTRAL] So lunch that's one here.
[AGENT][NEUTRAL] OK, is there's
[AGENT][NEUTRAL] If there's nothing else I can help with, then thank you for contacting APR.
[CUSTOMER][POSITIVE] Thank you