AccountId: 011433970860
ContactId: 0c4f0319-1845-4d8c-9c32-892aac818373
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368739 ms
Total Talk Time (AGENT): 130283 ms
Total Talk Time (CUSTOMER): 123573 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/0c4f0319-1845-4d8c-9c32-892aac818373_20250218T18:31_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh yes, [PII], my name is [PII] and I'm calling from Aspen Dental in [PII], and I have a patient in office and I was just needing to get eligibility and benefits for.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It is area code [PII], and that will be option number 2.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 02571867.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Um, date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is, excuse me, [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What information did you need to verify today?
[CUSTOMER][NEUTRAL] Now is this a discount plan or?
[CUSTOMER][NEUTRAL] What kind of plan is this?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It's a regular dental plan.
[CUSTOMER][NEUTRAL] And is it falling under the Carrington PPO?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, Carry Carrington PPO alright and what is gonna be the mailing address that we would send the claims to?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII]?
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] 22. OK. All right.
[CUSTOMER][NEUTRAL] And do you accept assignment of benefits to a nonparticipating provider?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Alright, and what would be the individual, uh, deductible and maximum?
[AGENT][NEUTRAL] Maximum is $500 per calendar year and the deductible is $50.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And the calendar year, does it start from the day that they got service or just beginning of the year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Calendar year got you OK alright and as far as diagnostic and preventative, basic and major, what percentage does this policy cover?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Policy does not cover for major, only preventative and basic, and preventative is covered at 100%. Basic is covered at 80% with no waiting period, and the policy does have a missing tooth clause, and we do not do downgrades.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about endoperio and oral surgery? Is that falling under basic or major?
[AGENT][NEGATIVE] Major, it's not covered.
[CUSTOMER][NEUTRAL] Not covered. What about simple extractions? Would that be covered under basic or major?
[AGENT][NEUTRAL] Basic.
[CUSTOMER][NEUTRAL] OK, and as far as for exams, what would be the frequency per year?
[AGENT][NEUTRAL] Um, for exams it is.
[AGENT][NEUTRAL] 2 per every 12 months period.
[CUSTOMER][NEUTRAL] All right, what about an adult proofing?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What's that called?
[CUSTOMER][NEUTRAL] 11 1110.
[AGENT][NEUTRAL] One procedure for 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and as far as bite wings, what would that be?
[CUSTOMER][NEUTRAL] And that would be 2074.
[CUSTOMER][POSITIVE] Yeah that's right.
[AGENT][NEUTRAL] OK, so that is uh OK.
[AGENT][NEUTRAL] Limited to one bite wing procedure for 12 month period.
[CUSTOMER][NEUTRAL] Alright, and what about FMX under code 0210?
[AGENT][NEUTRAL] That.
[AGENT][NEUTRAL] 0210, that is not on here.
[CUSTOMER][NEUTRAL] For the full mouth X-ray.
[AGENT][NEUTRAL] 0, maybe let me look again 02.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] 021 unless we have a different code I'll have to fax you over the codes that are covered but I don't see that on there. We may have it listed as a different number.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] What about um for a pano under code 0330, would that be covered?
[AGENT][NEUTRAL] Yeah, that's covered. Oh, there it is, it's down at the bottom next to the panel. That's why I couldn't find it.
[AGENT][NEUTRAL] OK, so yeah, it's sitting next to panel. It was out of order.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] So the 210 is on there and the panel is on there and both of their frequencies, let's see, is limited to one procedure per five-year period.
[CUSTOMER][POSITIVE] Got you. Alright, that's what I needed to know, thank you so very much.
[AGENT][POSITIVE] OK, well, thank you for choosing APO and you have a good day.
[CUSTOMER][NEUTRAL] OK, now bye bye.
[AGENT][NEUTRAL] Bye bye.