AccountId: 011433970860
ContactId: 21641c58-0afe-4d99-9a35-ebf09a9bc724
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231979 ms
Total Talk Time (AGENT): 86552 ms
Total Talk Time (CUSTOMER): 93879 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/21641c58-0afe-4d99-9a35-ebf09a9bc724_20250404T15:23_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Doctor [PII]'s office, and I'm trying to get some information on a patient's dental plan, please.
[AGENT][NEUTRAL] OK. Do you have a callback number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number is 026-07283.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII], and you were just needing benefits.
[CUSTOMER][NEUTRAL] Um, first I need to check because we're not preferred providers if she has out of network benefits and if you accept assignment of benefits.
[AGENT][NEUTRAL] OK, I can help you with that. Yes, ma'am. We do accept assignment. We will pay a non-provider. Our providers go through Carrington.
[CUSTOMER][NEUTRAL] OK, so we're not a Carrington provider, but you'll still make a payment in our office?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK fantastic thank you so much then we're a root canal specialist office I need maximum what's left deductible whether or not it's been met and then I need to check for procedure codes.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date is [PII]. Any benefits given over the phone is not a guarantee of payment.
[AGENT][NEGATIVE] Now, under this policy, root canals are not covered. It does not cover major work, it only covers preventative and basic.
[AGENT][NEUTRAL] They have a $500 calendar year maximum.
[AGENT][NEUTRAL] $50 deductible on everything except for preventative.
[AGENT][NEUTRAL] Preventative is paid at 100% the usual and customary rate. Basic is paid at 80%.
[CUSTOMER][NEUTRAL] OK, so a [PII] problem focused oral exam. Some insurance companies consider it preventative, some consider it basic because you're being referred to a specialist because you have a problem.
[AGENT][NEUTRAL] It is under basic.
[CUSTOMER][NEUTRAL] Can you tell me it's uh basic, OK, which would be the 80% after the deductible. OK, is there a frequency limitation on it?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All exams are 2 for 12 months.
[CUSTOMER][NEUTRAL] OK, can you tell if she's eligible for one at this time?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] She is eligible. She has no history.
[CUSTOMER][NEUTRAL] OK fantastic. The other question that I have for you is the cone beam 3D scan 0364. Is that a covered benefit on our plan?
[AGENT][NEUTRAL] Hold on just a moment, I'll check for you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] No, ma'am, that would not be covered.
[CUSTOMER][POSITIVE] OK, thank you very much I appreciate that information.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No thanks [PII] you've been awesome.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.