AccountId: 011433970860
ContactId: 1caf2687-ac4c-48c0-b379-7b2cf04707a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1013520 ms
Total Talk Time (AGENT): 311136 ms
Total Talk Time (CUSTOMER): 286846 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/1caf2687-ac4c-48c0-b379-7b2cf04707a6_20250425T15:45_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the provider service to check those with your patient. Can you please help me out with that?
[AGENT][NEUTRAL] Yeah, sure, I can assist you with eligibility, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEGATIVE] And there is no extension.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Uh, it's 251-023-9.
[AGENT][NEUTRAL] OK, thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, [PII], date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And this is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And the effective date of the policy is [PII]. It is active at the moment and this is one of our basic dental policies.
[CUSTOMER][NEUTRAL] OK, is it still so subscriber.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What's the group number?
[AGENT][NEUTRAL] OK, the group number is
[AGENT][NEUTRAL] 70,030.
[CUSTOMER][NEUTRAL] Oh, good name?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm looking for it, one moment.
[AGENT][NEUTRAL] OK, the group name is let's see, Creative Circle.
[CUSTOMER][NEUTRAL] OK, can you please send a fax back?
[AGENT][NEUTRAL] Mhm what's the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To your attention, it's OK?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] To your attention? Is it OK if I put your attention on it?
[CUSTOMER][POSITIVE] Yes, yes, yes, yes, yes.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah, oh sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes, sure, uh, this is a calendar year PPO plan, right?
[AGENT][NEUTRAL] This is a calendar year plan. Um, it is not a PPO or an HMO, but if you participate with Carrington, you can use their PPO fee schedule.
[CUSTOMER][NEUTRAL] OK, uh, can you, can you please check whether the providers in network or out of network?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We, we don't have any networks, Ms. [PII].
[CUSTOMER][NEUTRAL] It's out of network?
[AGENT][NEGATIVE] No networks.
[CUSTOMER][NEGATIVE] None at work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mm, just one minute.
[CUSTOMER][NEUTRAL] Can you please recheck because uh last year when we verified this account it's showing that in network.
[AGENT][NEUTRAL] If you participate with Carrington PPO, then you're probably in network with Carrington PPO but not with us because we don't have any networks.
[CUSTOMER][NEUTRAL] OK, so we, we use Carrington BPO, so we can, I mean Carrington.
[AGENT][NEUTRAL] So you are in network with PPO, yes, mhm, yes.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And uh what's the coordination of benefits use for this one?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, is there any missing toothlo or waiting here for this one?
[AGENT][NEGATIVE] Not for this one because this is just the basic.
[CUSTOMER][POSITIVE] No missing too close.
[AGENT][NEUTRAL] No, it's just basic. So there's no missing tooth cloths.
[CUSTOMER][NEUTRAL] And no waiting period annual maximum does it applies to all the services.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Annual maximum, uh, family deductible in digit deductible, and the remaining.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and let's see let me see what's remaining.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's the calendar year maximum of $500 with a $50 deductible, and she has not used her benefits, and this is an individual plan.
[CUSTOMER][NEUTRAL] What about family deductible?
[AGENT][NEUTRAL] It's 150 if it's a family plan, which this one is an individual.
[CUSTOMER][NEUTRAL] So the patient is not used or me anything out of all this, right?
[AGENT][NEUTRAL] Not for [PII] as of today.
[CUSTOMER][NEUTRAL] OK, uh, is there any auto coverage for this one?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Coverage for preventive basic and major.
[AGENT][NEUTRAL] No major.
[CUSTOMER][NEUTRAL] Preventive basic.
[AGENT][POSITIVE] Preventative and basic, yes, that's correct.
[CUSTOMER][NEUTRAL] It's 180, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, uh, what's the coverage for the code 6010 and 60?
[AGENT][NEUTRAL] Um, bear with me just a second, and I'm gonna need that one by one, bear with me.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You said 0, what's the number?
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] Let me see. No coverage?
[CUSTOMER][NEUTRAL] 6058.
[AGENT][NEGATIVE] No coverage. There's no implants.
[CUSTOMER][NEGATIVE] 605 uh 7 uh there's no coverage at all right.
[AGENT][NEGATIVE] No, no coverage.
[CUSTOMER][NEUTRAL] 02300240.
[AGENT][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] 0230 and 0240.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, um, one moment.
[AGENT][NEUTRAL] Hey, those two are under basic 02.
[CUSTOMER][NEUTRAL] 334. Yes. 334 6.
[AGENT][NEUTRAL] 230.
[AGENT][NEUTRAL] 846
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] 3347 and 3348.
[AGENT][NEGATIVE] Not covered, you're not covered.
[CUSTOMER][NEUTRAL] Is there any history for this patient?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Under the history, I got um on [PII]. I got a [PII] and let's see.
[AGENT][NEUTRAL] On [PII] and [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, I got a prophy.
[AGENT][NEUTRAL] Um, I got a panel. I got bite wings, and I got an evaluation.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Evaluation comprehensive evaluation.
[AGENT][NEUTRAL] Yes, 150.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK, uh, exempt does all of our exempt share the frequency?
[AGENT][NEUTRAL] Um, give me a code.
[CUSTOMER][NEUTRAL] 012001400150 and 0180.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, limited to to all oral evaluation procedures, combination is 120, 140, 150, and 160.
[CUSTOMER][NEUTRAL] OK, so 121 41, 15 160 share the frequency, right?
[AGENT][NEUTRAL] For 12 months.
[AGENT][NEUTRAL] 120, 140, 150, and 160, they share frequencies, which is 2 per 12 month period.
[CUSTOMER][NEUTRAL] 111 80.
[AGENT][NEUTRAL] When 80.
[AGENT][NEUTRAL] I don't see that one listed.
[CUSTOMER][NEGATIVE] So it's not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] By wings frequency.
[AGENT][NEUTRAL] Limited to one by in X-ray procedure and any combination of 270, 272, and 274 per 12 month period.
[CUSTOMER][NEUTRAL] FMX and panel this is share the frequency.
[AGENT][NEUTRAL] Yes. Um, it's gonna be one X-ray procedure and any combination of 210, 277, or 330 per 5-year period.
[CUSTOMER][NEUTRAL] Uh, H for Brophy, 1120.
[AGENT][NEUTRAL] Um, that's gonna be limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, not including [PII] or including [PII]?
[AGENT][NEUTRAL] I got limited to depend on children aged [PII], so I guess it's [PII] and under.
[CUSTOMER][NEUTRAL] OK, what about uh 1110 age limit for profit 1110.
[AGENT][NEUTRAL] Mm, that was the age limit for the trophy.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] OK, um, age limit per per per adult, um, I don't, I don't have a age limit on that one.
[AGENT][NEUTRAL] On the 1110.
[CUSTOMER][NEUTRAL] OK. Uh, it's once every 6 months, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Fluoride.
[CUSTOMER][NEUTRAL] Is there any coverage for full ride?
[AGENT][NEUTRAL] Yes, um.
[AGENT][NEUTRAL] And that one is
[AGENT][NEUTRAL] Limited to dependent children aged [PII], a maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK, C ones, is there any coverage for C ones?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For sealants, uh, for sealings it's gonna be a maximum of 1 procedure for 36 months limited to dependent children age [PII], and application made to the permanent molar teeth only.
[CUSTOMER][NEUTRAL] Permanentum what it's once every 36 months, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Once every 36 months. OK. What about 1352?
[AGENT][NEUTRAL] 1352 is not listed.
[CUSTOMER][NEUTRAL] OK, uh, so there's no major, uh, composite is a downgraded amalgam.
[AGENT][NEUTRAL] There's no downgrades or upgrades?
[CUSTOMER][NEUTRAL] OK, so there is no coverage for major services like crown score build up.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] No, correct.
[CUSTOMER][NEUTRAL] Is there any coverage for video services like SRP, ginger oil, scaling, full multibra and arresting for maintenance tanges and bridges?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Your garage.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Palliative 9110, the frequency and coverage.
[AGENT][NEUTRAL] 9110. OK. One moment.
[AGENT][NEUTRAL] OK, so that's gonna be under basic and there is no limitations under that one.
[CUSTOMER][NEUTRAL] Uh, does it need a narrative?
[AGENT][POSITIVE] Just what I'm sorry.
[CUSTOMER][NEUTRAL] Narrative.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK. Nitros and night guards, is it a covered benefit?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] What's the code?
[CUSTOMER][NEUTRAL] 9230 and when I got it's 9944 up to 9946.
[AGENT][NEGATIVE] No, there's no coverage.
[CUSTOMER][NEUTRAL] No coverage for all these quotes, OK, uh, so that's all I need. Uh, thank you so much for helping me out today. Can you please provide the reference number for the call? And also, can you please provide what's your name?
[AGENT][NEUTRAL] We don't have reference numbers.
[AGENT][NEUTRAL] You can use my name in today's date. Mhm. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] So, OK, so the group number once again it's 70,030, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. Bye.
[AGENT][POSITIVE] You have a good day. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] And happy weekend.
[AGENT][NEUTRAL] You too.