AccountId: 011433970860
ContactId: 144f897d-3cc0-481e-ad89-6780e33c12fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1133400 ms
Total Talk Time (AGENT): 409735 ms
Total Talk Time (CUSTOMER): 296851 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/144f897d-3cc0-481e-ad89-6780e33c12fc_20250328T17:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII]. I'm calling from West Coast Dental in [PII]. I'm calling to see if you can help me get a breakdown of benefits for a patient's dental coverage.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Oh, [PII], I'm so sorry about that. OK, and [PII], you're needing a dental fact pack of benefits on a member, is that correct?
[CUSTOMER][NEUTRAL] A breakdown.
[AGENT][NEUTRAL] Yes, ma'am, we do have fact facts of the member's benefits that I'll be happy to send to you. Um, but first off, what is the
[CUSTOMER][NEUTRAL] Yeah if you can send it to me you don't, you don't do physical breakdowns?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I can
[CUSTOMER][NEUTRAL] I mean verbal breakdown?
[AGENT][NEUTRAL] If you have specific questions I can answer them instead of sending you the fax back.
[CUSTOMER][NEUTRAL] So you can't do both you can do either or?
[AGENT][POSITIVE] Uh, yes, ma'am. If you need for me to do both, I can.
[CUSTOMER][NEUTRAL] The 8
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so are you able to give me a verbal breakdown and fax over?
[AGENT][NEUTRAL] If that is what you need, I can do that. And what is your callback number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Oh, I'm so sorry I gave you the wrong fax. I gave you our phone number. I'm so sorry. It's 562.
[AGENT][NEUTRAL] Um, I needed the phone number. Yes, ma'am. That was the phone number that I needed. Is that the phone number you gave me?
[CUSTOMER][NEUTRAL] Oh OK, yes, yes.
[CUSTOMER][NEUTRAL] You need the fax number?
[AGENT][NEUTRAL] Not yet. No, ma'am.
[AGENT][NEUTRAL] And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is 602-609-408.
[AGENT][NEUTRAL] OK, now that is not an American public life policy number, [PII].
[CUSTOMER][NEUTRAL] me
[CUSTOMER][NEUTRAL] Let me see um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it say is a policy certificate number, is it that one?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or that's something else.
[AGENT][NEUTRAL] On the ID card for APL, yes.
[CUSTOMER][NEUTRAL] Um, I have 02502331.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is for [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show here as a subscriber on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Do you have a payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 0801 is your payer ID.
[AGENT][NEUTRAL] 660801.
[CUSTOMER][NEUTRAL] 60801 OK.
[CUSTOMER][NEUTRAL] Um, can I get a group number?
[AGENT][NEUTRAL] Which this should also be on his ID card, 70087.
[CUSTOMER][NEUTRAL] 70087
[CUSTOMER][NEUTRAL] OK, employer?
[AGENT][NEUTRAL] Partners personnel management services.
[CUSTOMER][NEUTRAL] Partners.
[CUSTOMER][NEUTRAL] Personnel.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Management services.
[CUSTOMER][NEUTRAL] OK, management.
[CUSTOMER][NEUTRAL] Services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The name of the fee schedule?
[AGENT][NEUTRAL] This plan participates with the Carrington PPO network, but they are not required to use a Carrington provider.
[CUSTOMER][NEUTRAL] Carrington PPOC.
[AGENT][NEUTRAL] And that is also on the fax side.
[CUSTOMER][NEUTRAL] OK, [PII] please.
[AGENT][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip is [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am, and that should also be on his ID card.
[CUSTOMER][NEUTRAL] And then in network, did you check if the provider was in network?
[AGENT][NEUTRAL] You would have to sit at Carrington if you're not aware if your provider participates with Carrington or not.
[AGENT][NEUTRAL] And I can
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Um, so you're not able to check on your end.
[AGENT][NEUTRAL] For a network to to to determine with your providers in network, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not with Carrington.
[AGENT][NEUTRAL] Carrington's phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, this plan runs in the calendar year?
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] Um, what is the maximum on this patient's plan?
[AGENT][NEUTRAL] $500 per covered insured for covered services with a $50 calendar year deductible per covered insured.
[CUSTOMER][NEUTRAL] There's no family deductible?
[AGENT][NEUTRAL] This is an individual policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That still remaining and 50 deductibles still remaining also.
[AGENT][NEUTRAL] I can check to see if anything has been used yet for this calendar year. Just one moment and I'll check that for you.
[CUSTOMER][NEUTRAL] Everything still remaining?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] As of now, he has not used any benefits for this calendar year or met his deductible.
[CUSTOMER][NEUTRAL] OK, are prior extractions covered and is there any waiting periods?
[AGENT][NEUTRAL] There are no waiting periods?
[AGENT][NEUTRAL] And what was your other question? A missing tooth cloth?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] So perkstructors are not covered, right?
[AGENT][NEUTRAL] Again, the exclusion is the policy does have a missing tooth closed.
[CUSTOMER][NEUTRAL] So yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so if there's a missing tooth louse, then that means the per extraction is not covered, correct? OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That is correct. It's an exclusion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what percent is preventative and diagnostic cover now?
[AGENT][NEUTRAL] Preventative is 100% of allowable radiographs, FMX Basic and basic restorative are 80%.
[AGENT][NEUTRAL] I've covered expenses and they are basic and uh FMX radiographs are subject to the $50 calendar year deductible. There's no coverage on this policy for major endo period.
[AGENT][NEUTRAL] Oral surgery, anything like that. It's only preventative and basic.
[CUSTOMER][NEUTRAL] Only preventative and basic coverage?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so did anything change in the past year then because it looks like we have an old breakdown and it shows on my old breakdown that the major was covered at 80%.
[AGENT][NEUTRAL] That must have been with a different company.
[CUSTOMER][NEUTRAL] And Endo was 80.
[AGENT][NEUTRAL] No, ma'am, not on the plan here. This policy has been active from 6-17-2024 to current.
[CUSTOMER][NEUTRAL] Perio 80 OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have the same thing for the last one, and that's what they wrote on here so I don't know, OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Now, we wouldn't write anything on there, so I'm not sure where that came from, but our fax facts and breakdown of benefits would not be handwritten.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So preventive diagnostic 100 basic 80, you said there's no major oral surgery and no imperial coverage.
[AGENT][NEUTRAL] Or, or so, yeah, the only covered services is preventive. Yes, and that information is on the fact that, but the only covered services are preventative.
[CUSTOMER][NEUTRAL] Or ortho.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Radiographs, FMX, and basic and basic restoratives.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I give you a few codes and you give me the percent and frequency?
[AGENT][NEUTRAL] What is the first code?
[CUSTOMER][NEUTRAL] Um, how many can you give me because I have a few, so I wanna know that way I give you the main.
[AGENT][NEUTRAL] Well, I mean, they're all on the fact, all codes. Yes, ma'am. All the codes are on the fact sites.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That are covered under his plan?
[AGENT][NEUTRAL] I can do as many as you want me to do if you don't need the fax like sent to you with that information on it.
[CUSTOMER][NEUTRAL] No, I still need the fax back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So are you going to give me codes or are you just gonna wait for the fact facts?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] How many codes do you have? Cause you said you had a few. So how many codes do you have?
[CUSTOMER][NEUTRAL] No, I'm not gonna give you the call give me one sec.
[CUSTOMER][NEUTRAL] Um, well, I have.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] I have about 5 to 10 codes.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] 5 to 10 codes.
[AGENT][NEUTRAL] OK, 4241 is not covered.
[CUSTOMER][NEUTRAL] 4043 41.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 4341 not covered.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 2391.
[AGENT][NEUTRAL] That falls under basic restorative.
[CUSTOMER][NEUTRAL] 80%, what is the frequency?
[AGENT][NEUTRAL] Replace existing only is in place for 24 months.
[CUSTOMER][NEUTRAL] Dad
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And also,
[AGENT][NEUTRAL] Maximum 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] Once every 24 months?
[CUSTOMER][POSITIVE] I'm sorry
[CUSTOMER][NEUTRAL] Is that what you said?
[AGENT][NEUTRAL] I said replace existing only if in place for 24 months and maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] Does the downgrade?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Falls under preventative.
[AGENT][NEUTRAL] Limited to one bite wing X-ray procedures, 027002720274 per 12 month period.
[CUSTOMER][NEUTRAL] I'm sorry, you said 0 I'm sorry, you said 2740 you said covered at 100?
[AGENT][NEUTRAL] No, ma'am. That's not
[AGENT][NEUTRAL] 027.
[CUSTOMER][NEUTRAL] You said 100% you said preventative.
[AGENT][NEUTRAL] 27
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] 2740 is the code.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] So, that's not covered at all.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 522 5.
[AGENT][NEUTRAL] Not covered?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 2381.
[AGENT][NEUTRAL] I'm sorry, I can't hear you. There's some type of scratching on the line. I wasn't able to understand what you said.
[CUSTOMER][NEUTRAL] 4381.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 5995.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 5996.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 4921.
[AGENT][NEUTRAL] Not covered?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 4949 10.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, if you could just send me the fax back please.
[AGENT][NEUTRAL] What is your fax number, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment for me to get that pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Yes, my name [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and again, you said that your fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so that has just been sent to you, and so provided there's not any type of technical issue, you should be receiving that very shortly. And then also if you all do file a claim with APL once the claim has been processed by us, we do have a portal in which you can check claim status and our.
[AGENT][NEUTRAL] The portal website, Karina is secured. [PII].
[CUSTOMER][NEUTRAL] OK, and then what was your name?
[AGENT][NEUTRAL] Again, my name is [PII] and my name in today's date would be your call reference number if you need one.
[AGENT][POSITIVE] And can I help you with anything else today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, well, if you can send me the fee schedule also.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Again, you would need to contact [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome and thank you again for calling APL. I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you