AccountId: 011433970860
ContactId: 07a85834-ebf7-4905-994a-6ad5502be1ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639200 ms
Total Talk Time (AGENT): 256078 ms
Total Talk Time (CUSTOMER): 317329 ms
Interruptions: 10
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/07a85834-ebf7-4905-994a-6ad5502be1ed_20250103T19:09_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling in regards to a patient that's here in our office. Uh, I need to verify dental coverage, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and call back number?
[CUSTOMER][NEUTRAL] Uh, yes, uh, my name is [PII]. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], could you provide me with the member's policy number?
[CUSTOMER][NEUTRAL] Can I get a breakdown.
[CUSTOMER][NEUTRAL] I'm sorry, what do you think?
[AGENT][NEUTRAL] The policy number, could you provide me the policy number of the member that you're inquiring benefits for today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's going to be.
[CUSTOMER][NEUTRAL] The policy number it is.
[CUSTOMER][NEUTRAL] 02537595.
[AGENT][NEUTRAL] Can you verify this patient's name and date of birth, and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Uh, it's it's [PII]. Can I get her date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Go ahead and try to do it and then so it's gonna be a double um tooth for that.
[AGENT][NEUTRAL] This policy has been active since [PII] and is currently active. She has a maximum benefit amount of $500 per calendar year with a $50 deductible per calendar year that does not.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hold on, please. Hold on. You're going too fast. Hold on, please. Let me get a pen.
[AGENT][NEUTRAL] Would you like for me to send you a fax?
[CUSTOMER][NEUTRAL] I'm sorry, so you said the patient has a $500 maximum?
[AGENT][NEUTRAL] Yes, per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] With a $50 deductible per insured up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guaranteed benefits, just a disclaimer of the policy's coverage. Her policy only covers preventative and basic services, major endoperoprosthesis or surgery crowns, bridges, ortho dentures, dentures. Mm, none of that is covered on the policy, none of that is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's only, I don't, I'm sorry, uh, we're in Enodonnis, we're root canal specialist, so she has no coverage, right? 0 coverage. OK, um, for preventative, can you just, um, how about, uh, so crown bridges, those are, so when you say basic and, uh, preventative and basics, just X-rays, cleanings, uh, exam, consultations, and that's it, right?
[AGENT][NEUTRAL] It's not
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] And simple extractions.
[AGENT][NEUTRAL] Mhm, that's the Buddhist question.
[CUSTOMER][POSITIVE] And simple extractions. OK, wonderful. Um, can you let me know if the limited exam is covered? The 0140?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 0
[AGENT][NEGATIVE] This falls under her basic at 80%.
[CUSTOMER][NEUTRAL] Is there a frequency on that or no?
[AGENT][NEUTRAL] Limited to 2 or evaluation procedures in any combination of D0120, D0150 and D0160 for 12 month period.
[CUSTOMER][NEUTRAL] OK, for 12 months and is the 9310 a covered benefit?
[AGENT][NEUTRAL] It's not
[CUSTOMER][NEGATIVE] It's not covered. Are X-rays covered at 100% or 80%?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Do you have a particular procedure code cause bite wings are covered at 100%.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] So the 02200230 and the 0270.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] 230 is covered at 80%.
[AGENT][NEUTRAL] And you said 270?
[CUSTOMER][NEUTRAL] 0, 230 is at 80%?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, the 220.
[AGENT][NEUTRAL] 80% as well. All of them are 80%.
[CUSTOMER][NEUTRAL] By wings also the 0270 is also at 80.
[AGENT][NEUTRAL] No, OK, so before I gave you that information, I stated that bite wings was paid at 100%.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] But the regular X-rays of the procedure codes that you gave me of D0220 and D0230 is covered at 80%.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what's the frequency on those, please?
[AGENT][NEUTRAL] I just gave them to you. You want the frequency on the bite wings?
[AGENT][NEUTRAL] Are you able to hear me?
[CUSTOMER][NEUTRAL] But wings and you said.
[CUSTOMER][NEUTRAL] No, you're, you're breaking in and out, that's why. So what's the frequency for PAs?
[AGENT][NEUTRAL] So the frequencies for PAs is limited to two or evaluation procedures in any combination of D0120, D0140, D0150 and D0160.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] No, for, OK, we're talking about the frequency on the, we're talking about the frequency for the D0220 and the D0230.
[AGENT][NEUTRAL] Oh, cause I was
[CUSTOMER][NEUTRAL] You already told me the other one, I have that already.
[AGENT][NEUTRAL] Oh, my apologies because I was like, she didn't hear me? I thought she didn't hear me. There's no frequencies on those colds and bite wings is once every 12 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so by wings it's 1 and 12 months. OK, um, is the 046, I'm sorry.
[AGENT][NEUTRAL] Mhm, and I can send a text message if you would like.
[CUSTOMER][NEUTRAL] And is the 4 0460 covered?
[AGENT][NEUTRAL] No. Yes, 60,460 covered on the base to get 80%, no limitation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like for me to send you a fax back?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, what?
[AGENT][NEUTRAL] Fax back of the dental schedules.
[CUSTOMER][NEUTRAL] Um, no, it's, can you ask, can you, uh, yes, and I just want one more code, that's [PII].
[CUSTOMER][NEUTRAL] Is that covered?
[AGENT][NEUTRAL] What is the description of the code?
[CUSTOMER][NEUTRAL] It's a cone beam um scan.
[AGENT][NEGATIVE] No, that's not covered.
[CUSTOMER][NEUTRAL] So it's not covered
[CUSTOMER][NEUTRAL] And um what fee schedule is this under?
[AGENT][NEUTRAL] Based on user and customary, however, this is a Carrington network, but the member does not have to utilize the Carrington network provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, what, so can you check to see if we're in network and what preschedule we need to use.
[AGENT][NEUTRAL] I can't, I can transfer you to Carrington to verify that information.
[CUSTOMER][NEUTRAL] So Carrington. Hold on.
[CUSTOMER][NEUTRAL] OK, Carrington, and what's the, can you provide me the group number and everything and the group name?
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] The group name is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Staff Pro LLC.
[CUSTOMER][NEUTRAL] I'm sorry, what is it? Staff?
[AGENT][NEUTRAL] Pro
[CUSTOMER][NEUTRAL] Pro?
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] LLC and what's the group number please?
[AGENT][NEUTRAL] 700.
[AGENT][NEUTRAL] 66.
[CUSTOMER][NEUTRAL] 70066 uh you said effective is what's the effective date [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Repeat the effective date that you stated.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Oh, what's the effect of Dane?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh what's the remaining max for the patient?
[AGENT][NEGATIVE] The member has not utilized any of their benefits for [PII].
[CUSTOMER][NEUTRAL] OK, and um if you can provide me the uh payer ID and the mailing address and the name.
[AGENT][NEUTRAL] 60801 is the payer ID.
[CUSTOMER][NEUTRAL] 60801 OK.
[AGENT][NEUTRAL] And to mail it is to address it to American public life.
[CUSTOMER][NEUTRAL] Yes, and that's it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] Public life, OK.
[AGENT][NEUTRAL] PO Box 248,950 that's PO Box 248,950.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What part did you not hear?
[CUSTOMER][NEUTRAL] OK, PO Box 2 I'm sorry, PO Box 248,950, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the city and state is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And it's [PII] correct?
[AGENT][NEUTRAL] No, that's, I stayed at [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], OK. [PII], what's the abbreviation for [PII]? It's just [PII]. Oh my goodness. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yeah, thank you for that. So [PII], OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um what do you have the allowed fees or no?
[AGENT][NEUTRAL] No, it's just user based on user and customary.
[CUSTOMER][NEUTRAL] You said you like customer, but then if we're a Carrington provider, then it'll be under Carrington fees, right? No? Oh, so it is user. OK, perfect. And what is the, um, so has the the patient hasn't met her deductible either, and that that deductible applies to all services.
[AGENT][NEUTRAL] Right, would you like for me to transfer you to Carrington?
[AGENT][NEUTRAL] The deductible applies to everything but preventative services.
[CUSTOMER][NEUTRAL] And um what, what is preventative? Is X-rays considered preventative or no?
[AGENT][NEUTRAL] No, it's considered as basic.
[CUSTOMER][NEUTRAL] That's considered basic. OK, sounds good and um is there any waiting period?
[AGENT][NEUTRAL] No, there is no waiting period. There's no major services covered under the policy.
[CUSTOMER][NEUTRAL] OK, OK, OK, can I get your name and the reference number for this call?
[AGENT][NEUTRAL] My name is [PII], and unfortunately we don't provide reference numbers, [PII]. You can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK wonderful [PII] thank you for all your help you have a nice day.
[AGENT][POSITIVE] You're welcome, thanks for calling APL. Have a great day bye.
[CUSTOMER][NEUTRAL] Bye bye.