AccountId: 011433970860
ContactId: 2261a611-96de-4301-acd5-44a703b8d095
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1493939 ms
Total Talk Time (AGENT): 287402 ms
Total Talk Time (CUSTOMER): 199885 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/2261a611-96de-4301-acd5-44a703b8d095_20250520T20:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] looking for dental benefits for patients.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on benefits. Can I get the policy number, please?
[CUSTOMER][NEUTRAL] It's 02116844.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII], sorry, [PII].
[AGENT][NEUTRAL] So patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh may I know the group number?
[AGENT][NEUTRAL] Group number is going to be.
[AGENT][NEUTRAL] LA, so L as in Lincoln, A as in Alpha, 0145.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And group name?
[AGENT][NEUTRAL] Health
[AGENT][NEUTRAL] In hospital, it looks like. Um, one moment.
[AGENT][NEUTRAL] Yeah, it looks like it's the Department of Health and Hospitals.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Annual maximum and deductibles.
[AGENT][NEUTRAL] Calendar year maximum is $1000 and the calendar year deductible is $50 per covered insured, up to $150 for the family.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient has full amount remaining and deductible.
[CUSTOMER][NEUTRAL] OK. And uh family deductible?
[AGENT][NEUTRAL] Up to 150.
[CUSTOMER][NEUTRAL] OK. And uh is there any waiting period or missing tooth cost?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] This policy does have a missing tooth clause.
[AGENT][NEUTRAL] I don't show any waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh coverage for basic and major services.
[AGENT][NEUTRAL] Uh, this plan pays on a fee schedule.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you'd like, we can send a fax back with the fee schedule.
[CUSTOMER][NEUTRAL] Mhm. And can you give me verbally?
[AGENT][NEUTRAL] What would you like off the fee schedule?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I have some quotes. May I know the frequencies and coverages?
[AGENT][NEUTRAL] What's the first code?
[CUSTOMER][NEUTRAL] 0120
[AGENT][NEUTRAL] Benefit amount is $31.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's once every 6 months.
[CUSTOMER][NEUTRAL] OK. 0140.
[AGENT][NEUTRAL] Benefit amount is $52.
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next is 0210.
[AGENT][NEUTRAL] Benefit amount is $86.
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1351
[AGENT][NEUTRAL] $31 per tooth.
[AGENT][NEUTRAL] Selans are limited to persons under the age of [PII].
[AGENT][NEUTRAL] Once every 3 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next is
[CUSTOMER][NEUTRAL] 0274
[AGENT][NEUTRAL] The benefit amount is $38.
[AGENT][NEUTRAL] Once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 2955.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] I do not see 4955 listed, so it's not covered.
[CUSTOMER][NEUTRAL] No, 2955.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2955, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Do not see 2955 listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next is 3330.
[AGENT][NEUTRAL] Alright, 3330 pays the benefit amount of 319.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't see any limitation on frequency.
[CUSTOMER][NEUTRAL] OK. 3310.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3310 pays the benefit of $202.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see any limitation on it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any others?
[CUSTOMER][NEUTRAL] 3320.
[AGENT][NEUTRAL] 3320 pays the benefit amount of 247 with no limitation.
[CUSTOMER][NEUTRAL] 3348.
[AGENT][NEGATIVE] I do not see 3348 listed, not covered.
[CUSTOMER][NEUTRAL] 3 3430.
[AGENT][NEGATIVE] I do not show 3430 listed, not covered.
[CUSTOMER][NEUTRAL] 3332.
[AGENT][NEUTRAL] 3332, is that what you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3332 is not listed.
[CUSTOMER][NEUTRAL] 3450.
[AGENT][NEUTRAL] Benefit amount of 141.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No limitation.
[CUSTOMER][NEUTRAL] 3333.
[AGENT][NEUTRAL] Do you not show that listed?
[CUSTOMER][NEUTRAL] 3331.
[AGENT][NEUTRAL] Do not show 3331 listed?
[CUSTOMER][NEUTRAL] 3351.
[AGENT][NEUTRAL] 3351 is not covered.
[CUSTOMER][NEUTRAL] Sorry, sorry, 0460.
[AGENT][NEUTRAL] 0460.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] $42 benefit amount.
[AGENT][NEUTRAL] Do not show a limitation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3355.
[AGENT][NEUTRAL] 3355 is not listed.
[CUSTOMER][NEUTRAL] 3357.
[AGENT][NEGATIVE] Not listed.
[CUSTOMER][NEUTRAL] 3431.
[AGENT][NEGATIVE] 3431, not listed, not covered.
[CUSTOMER][NEUTRAL] 3432.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] 7953 is not listed.
[CUSTOMER][NEUTRAL] 610
[AGENT][NEUTRAL] Don't show 6010 listed.
[CUSTOMER][NEUTRAL] That's 9310.
[AGENT][NEUTRAL] 9310 looks like it pays a benefit of 142, no limitation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 9230
[AGENT][NEUTRAL] 9230.
[AGENT][NEUTRAL] 9230 is not listed.
[AGENT][NEUTRAL] Did you have any others after 9230?
[AGENT][NEUTRAL] Are you still there, [PII]?
[CUSTOMER][NEUTRAL] Mm. Yes, hello?
[AGENT][NEUTRAL] Yes, did you have any others after 9230?
[CUSTOMER][NEUTRAL] Uh, the last one is 0364 after 9230.
[AGENT][NEUTRAL] 0364.
[AGENT][NEUTRAL] I don't see 0364 listed.
[CUSTOMER][NEUTRAL] OK. And what's the frequency and co-pay for 9230?
[AGENT][NEUTRAL] 9230.
[AGENT][NEGATIVE] 9230 doesn't show on the fax back, so it wouldn't be covered.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Yes. May I know the history on file that affects the frequency?
[AGENT][NEUTRAL] Uh, last date of service on file was [PII]. Patient had an orale valve and bite wings.
[CUSTOMER][NEUTRAL] OK. [PII] and
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next,
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It's the only thing I see on file, I don't see any full mouth X-rays on file for the patient.
[CUSTOMER][NEUTRAL] OK. And is there any history for basic or major services that affect the frequency like crowns, extractions?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] SRP
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK. And there's no history for this year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And may I know which free schedule shall we use?
[AGENT][NEUTRAL] We can send you a fax back with the fee schedule.
[CUSTOMER][NEUTRAL] Mhm, can I just know the name of the fee schedule? Is it Carrington?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Mm, no, it's an APL plan, so that's the fee schedule that uses.
[AGENT][NEUTRAL] That it uses.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, I'm asking the name of the free schedule. Is it Carrington Connection Dental, or?
[AGENT][NEUTRAL] Not to my knowledge. Let me double check on that, [PII], one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can use the Carringtonee schedule it looks like for it.
[CUSTOMER][NEUTRAL] OK. For Agen Dyer, right? For Doctor [PII]?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK. For Doctor [PII], right?
[AGENT][NEGATIVE] You asked what the fee schedule was and I'm letting you know that you can use the Carrington fee schedule. I don't understand what you're asking me.
[CUSTOMER][NEUTRAL] Mhm. OK. And yeah, that's all. And may I know the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. And what's the uh, and how do you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what's the reference number?
[AGENT][NEUTRAL] For references my name with today's date.
[CUSTOMER][POSITIVE] OK. And yeah, thanks for providing me all those details and have a great day. Bye.
[AGENT][NEUTRAL] Mhm. Bye bye.