AccountId: 011433970860
ContactId: 179e6f0a-0499-41ef-a252-a73a434a9b30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667219 ms
Total Talk Time (AGENT): 338718 ms
Total Talk Time (CUSTOMER): 170870 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/179e6f0a-0499-41ef-a252-a73a434a9b30_20250505T16:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I need to check and see if we're in network, um, and get, um, a members, um, benefits and eligibility.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and benefits and network information, Miss [PII]. May I have a callback number just in case we get disconnected and the name of the facility for my notation.
[CUSTOMER][NEUTRAL] Yeah, [PII] option 2 and then Aspen Dental.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, 02568288.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII] and then [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, can I have that policy number one more time? That's not what I pulled.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02568288.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] Um, do you have a copy of the card?
[CUSTOMER][NEUTRAL] I don't they gave me their information over the phone.
[AGENT][NEUTRAL] OK, yeah, it seems, uh maybe a wrong number in there. Um, yeah, I keep pulling another person for that number. Um, do you have a social or do you have any other information on the patient?
[CUSTOMER][NEUTRAL] Um, I don't think, oh, yes, I have a social, it's [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, here he is.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] And I'm sorry, can you verify the date of birth one more time?
[CUSTOMER][NEUTRAL] Yeah, of course, um, [PII].
[AGENT][POSITIVE] Perfect, yes, I I pulled up. OK, let me start off by giving you the correct policy number. Let me know when you're ready.
[CUSTOMER][POSITIVE] Um, yeah, uh, I'm ready.
[AGENT][NEUTRAL] OK. So it's gonna be basically the same number. The only thing we're gonna change is the 82 to a 92.
[CUSTOMER][NEUTRAL] Oh, OK, he's a little bit older, so he might have just didn't have his glasses or something.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Yeah, it's OK, no problem.
[CUSTOMER][NEUTRAL] So it's 82
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it's so it's 02569288?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK awesome um and then can I verify if for a network as well?
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, this particular dental policy doesn't have any networks. We pay usual and customary rates, which is UCR.
[CUSTOMER][NEUTRAL] OK, um, is there a group name or group number?
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, there is. Let me go ahead and get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII]. The group number is 21768.
[AGENT][NEUTRAL] The group name is Universal Trucking Western Flyer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Western Flyer.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, and what's the patient effective date?
[AGENT][NEUTRAL] OK. Effective date on this plan is [PII].
[CUSTOMER][POSITIVE] OK, awesome and then give me just one second please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, and what is the um the claims address?
[AGENT][NEUTRAL] The address to submit claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII]. We also have a payer ID and a fax number if you need it.
[CUSTOMER][NEUTRAL] Um, no, I, uh, the system automatically put that in and then for deductible, is there any deductible on this plan?
[AGENT][NEUTRAL] Yes, there is a $50 deductible. And let me give you the calendar year maximum, and this is not a guarantee of payment, just a verification of coverage. The calendar year maximum is $1500.
[CUSTOMER][NEUTRAL] 1500. OK, and has it been used year to date?
[AGENT][NEUTRAL] And I can check for you. Let's see.
[CUSTOMER][NEUTRAL] Sorry, did you say that none of it was used?
[AGENT][NEUTRAL] Um, give me just a minute. I'm waiting on the system.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] It's OK. All right, thank you. OK, so it looks like he has not used his benefits for [PII] as of today. He still have the full amount available of 1500 with the deductible of 50.
[CUSTOMER][NEUTRAL] OK, and is there any ortho coverage for this plan?
[AGENT][NEUTRAL] No, there's no or or implants, no cover.
[CUSTOMER][NEUTRAL] OK, um, and then, um, are there any waiting periods?
[AGENT][NEUTRAL] Um, this one does have a 12 month waiting period for any major service.
[CUSTOMER][NEUTRAL] But none for basic and diagnostic preventative?
[AGENT][NEUTRAL] Correct, um, for a basic, like preventative, basic expense, basic restorative, and FMX those doesn't have a waiting period. Now, for anything major, including endoonics, periodontics, prosthodontic repair or surgery, those have a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, so endoperio and oral surgery are considered major?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and are dentures, bridges, and crowns also covered?
[AGENT][NEUTRAL] That's gonna be after the 12-month waiting period, and that's also on the major.
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][POSITIVE] OK awesome and then um I need frequencies and I'll give you codes if that's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, bear with me just a second, let me pull that.
[AGENT][POSITIVE] And if break down here we go, um, let me go back. I'm so sorry.
[AGENT][NEUTRAL] Uh um.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][POSITIVE] OK, and I'm gonna need them one by one. I'm ready.
[CUSTOMER][NEUTRAL] OK, uh 0120.
[AGENT][NEUTRAL] OK, that's 0120, that's going to be limited to two oral evaluation procedures in any combination of 120, 140, 150, 160, or 180 for 12 month waiting I'm sorry, 12 month period.
[CUSTOMER][NEUTRAL] OK, um, and then clean uh cleaning, I'm sorry, go ahead.
[AGENT][NEUTRAL] And that one is
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's OK. No one was paid on preventatives. OK. Um, you said cleaning proffe.
[CUSTOMER][NEUTRAL] So it's 1110.
[AGENT][NEUTRAL] OK. So that one, that one is gonna be once every 6 months and that's also under preventative.
[CUSTOMER][NEUTRAL] OK, uh, by wings 0270.
[AGENT][NEUTRAL] OK, but winds is also under preventative, so let me give you that um limitation.
[AGENT][NEUTRAL] OK, so it's gonna be limited to one I'm sorry, one by X-ray procedure and any combination of 270, 2702, 274 for 12 month period.
[CUSTOMER][NEUTRAL] OK, um, full mouth X-rays and panoramics it's 0210.
[AGENT][NEUTRAL] OK, so that one is going to be limited to one X-ray procedure in any combination of 210, 277, and 330 per 5 year period. And that one is on the radiograph FMX which is 80%.
[CUSTOMER][NEUTRAL] OK, and then fluoride uh 1208.
[AGENT][NEUTRAL] OK, so that one is going to be, let's see one moment.
[AGENT][NEUTRAL] OK, maximum of 1 procedure for 12 months, limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK, and then, um, periodontal maintenance 4910.
[AGENT][NEUTRAL] OK, 4910 is gonna be after the 12 month waiting period is under major. Now that's once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um are simple extractions considered basic major oral surgery?
[AGENT][NEUTRAL] Basic, simple extraction is under basic.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEGATIVE] Yes, there is a missing tooth class.
[CUSTOMER][NEUTRAL] OK, and then SRP 4341.
[AGENT][NEUTRAL] OK, 4341 is also gonna be under major services which is a periodonic and um let me see what's the limitation on that one.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Going to be a maximum of 1 each quad for 24 months.
[CUSTOMER][NEUTRAL] OK, um, and then 0431 oral cancer screening, is that covered?
[AGENT][NEUTRAL] That was 0341.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, 0
[CUSTOMER][NEGATIVE] Oh sorry 0431.
[AGENT][NEUTRAL] 0431 OK.
[AGENT][NEGATIVE] No, that one is not covered.
[CUSTOMER][NEUTRAL] OK, and then dentures uh 5110.
[AGENT][NEUTRAL] OK, so the insurance is gonna be after the 12 month waiting period that's on their major and let me see we have.
[AGENT][NEUTRAL] Maximum of 1 per 5-year period.
[CUSTOMER][NEUTRAL] OK, and are there any downgrades to the plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and is predetermination mandatory?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Alrighty, that is, wait, I think I need one more thing. Give me just one second.
[AGENT][NEUTRAL] OK. Sure, yes.
[CUSTOMER][POSITIVE] Um, no, that is everything. Thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] You you too bye bye.
[AGENT][POSITIVE] Thank you