AccountId: 011433970860
ContactId: 191d9695-253d-4c61-a1a1-aef89f106b64
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410119 ms
Total Talk Time (AGENT): 191600 ms
Total Talk Time (CUSTOMER): 145618 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/191d9695-253d-4c61-a1a1-aef89f106b64_20250508T19:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, so, uh, this is [PII], and I'm checking patients dental eligibility and benefits.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and benefits, Miss [PII] And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um, yes, the name is Southern Pine Dental.
[AGENT][NEUTRAL] OK, thank you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, direct line [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number [PII]?
[CUSTOMER][NEUTRAL] Patient number 02560461.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Do you have a specific questions or you need a full breakdown of benefits?
[CUSTOMER][NEUTRAL] Um, I need the full breakdown. Um, is a doctor in network? Can you please double check for me?
[AGENT][NEUTRAL] This one doesn't have any networks. If the provider participates with Carrington PPO, they can use their fee schedule, but it is not required.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, what's the group number?
[AGENT][NEUTRAL] On the group number, let me get that for you, one moment.
[AGENT][NEUTRAL] OK, so that's group number 70056.
[CUSTOMER][NEUTRAL] 56 group name please?
[AGENT][NEUTRAL] M A U
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] A Mary, A Alpha.
[CUSTOMER][NEUTRAL] You under, correct?
[AGENT][NEUTRAL] Yes, yes. M as in Mary, A as in apple, U as in umbrella. U.
[CUSTOMER][NEUTRAL] Thank you. What's the claim address?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The address is to make claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The ZIP code is [PII].
[CUSTOMER][NEUTRAL] Thank you. Is [PII] the subscriber here?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How much is the max and deductibles?
[AGENT][NEUTRAL] He has not used his benefits for [PII] as of today.
[CUSTOMER][NEUTRAL] Mhm. How much?
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. The calendar year maximum is $500 with the $50 deductible.
[CUSTOMER][NEUTRAL] OK, not being used. Is there a family deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it's a family plan, it's 150.
[CUSTOMER][NEUTRAL] How about Ortho? Is there Orthomax?
[AGENT][NEUTRAL] No, there's no auto service benefits.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] How about car insurance, preventive basic and major service percentages?
[AGENT][NEUTRAL] OK, so this one doesn't have any major service. Um, this one is just basic. So we have uh preventative is 100%. Radiograph FMX is 80%, basic expense and basic restorative expense is 80%. And again, there's no major, so endodontics, periodontics, prosthodontic repair, and oral surgeries are not covered.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] Periodonic, um, use for your maintenance for the 9-10 covered?
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] Not covered. So, scaling, not covered. How about the um implants?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No coverage for implants, no.
[CUSTOMER][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Not night guards.
[AGENT][NEUTRAL] What's the code for the night guard?
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4346, not covered as well?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oral surgery.
[AGENT][NEUTRAL] No, surgeries are major, not covered.
[CUSTOMER][NEUTRAL] OK thank you. Now for exam and cleaning, what's the frequency?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so we have, let's see, for cleaning profies once every 6 months, oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings is once for 12 month period.
[AGENT][NEUTRAL] Informal X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] Once every 5 plan runs in the calendar year, starts January to December.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct. So, um, crown that covered SRP. How about fluoride and sealants?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for fluoride, we have a maximum of 1 procedure for 12 months and it's gonna be uh limited to dependent children aged [PII]. For sealants, we have maximum of 1 procedure for 36 months, limited to dependent children under the age of [PII] and application made to the permanent Maltese only.
[CUSTOMER][POSITIVE] Thank you. No waiting period, no missing the class?
[AGENT][NEGATIVE] Not on this one because there's no major service.
[CUSTOMER][NEUTRAL] Uh, composites. Um, is there a downgrade?
[AGENT][NEUTRAL] Mm, no, we don't downgrade.
[CUSTOMER][NEUTRAL] History for exams [PII] and [PII].
[AGENT][NEUTRAL] OK, let me check on the history. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um there's no history for this member.
[CUSTOMER][NEUTRAL] No history at all, just to make sure.
[AGENT][NEUTRAL] Mhm. Correct. No history at all.
[CUSTOMER][NEUTRAL] OK, thank you. And one moment, let me check if I still have, I'm missing here to be as while you're, you're still there. By the way, may I know your name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's if you will.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is there anything
[CUSTOMER][POSITIVE] OK. OK, so, I think that would be all. Thank you so much and have a great day. Goodbye and take care.
[AGENT][POSITIVE] You as well, Miss [PII] thank you for calling APL. Have a good day. Bye.