AccountId: 011433970860
ContactId: 314f663e-04fa-463d-a6b3-34c9be6ec515
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 914260 ms
Total Talk Time (AGENT): 258340 ms
Total Talk Time (CUSTOMER): 197321 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/314f663e-04fa-463d-a6b3-34c9be6ec515_20250505T14:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, hi, my name is [PII]. I'd like to check some benefits for a patient, please.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits eligibility. OK. I didn't get your name in the beginning.
[CUSTOMER][POSITIVE] Well eligibility.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, uh, [PII].
[AGENT][NEUTRAL] OK, I got too many numbers. Um, can you repeat that one more time?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. All right. And what is the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02595506.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said you need eligibility and benefits, and this is for dental.
[CUSTOMER][NEUTRAL] Dental, yes.
[AGENT][NEUTRAL] OK, you need this information given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Uh, verbally, please.
[AGENT][NEUTRAL] OK, right, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And this is one of our basic dental policies. Um, we have a calendar year maximum on this one of, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wait one second, um, before you give me the benefits, I want to know if Doctor [PII] is 8 work with the plan.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, this one doesn't have any network. If the provider participates with Carrington PPO, they can use their fee schedule, but it is not required. We're not contracted. There's no network.
[CUSTOMER][NEUTRAL] OK, alright, no network, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah yeah.
[CUSTOMER][POSITIVE] Alright, I'm ready for the benefits.
[AGENT][NEUTRAL] OK, bear with me one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the calendar year maximum is $750 with the $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has not used or met the deductible as of today. Her effective date is [PII], and it is active at the moment.
[AGENT][NEUTRAL] And this one is one of our basic dental policies. Um, the basic dental policies is covered, um, preventative 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiograph FMX is 80%.
[AGENT][NEUTRAL] Basic expense is 80% and basic restorative is 80%. There's no major service, so endedonics, periodontics, prosthetic repair or surgeries are not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 45 minutes.
[CUSTOMER][NEUTRAL] Wait one second, um, preventative it's 180 basic.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, preventative is 100, Radiograph FMX is 80, basic expense and basic restorative expense is 80.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And there is no major service.
[CUSTOMER][NEUTRAL] Oh, no major, OK.
[AGENT][NEUTRAL] Oh, and no major. So endodontics, periodontics, prosadonic repair, and oral surgeries are not covered.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No end or surgery, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see. Do you need the frequencies?
[CUSTOMER][NEUTRAL] Uh, yes, before that, any waiting period or any missing [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Not on this one because this is just basic.
[CUSTOMER][NEUTRAL] Oh yes, OK, and can I get frequency for exam, cleaning and?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and let's see one moment.
[AGENT][NEUTRAL] OK, for the frequencies, we have Proffi cleanings once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By wings is once per 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And ulna x-rays or panels is once per 5-year period.
[CUSTOMER][NEUTRAL] OK, the buying is also under basic or?
[AGENT][NEUTRAL] The, yes, um, Bins is gonna be under preventatives.
[CUSTOMER][NEUTRAL] It's on.
[CUSTOMER][NEUTRAL] OK, and the FMX is basic, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I check some codes if it's covered or not, please?
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Oh, and is there any history for preventative for the patient?
[AGENT][NEUTRAL] OK, I can check on it for you. One moment.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK mm.
[CUSTOMER][NEUTRAL] Give me 1 2nd, OK, what's your name again?
[AGENT][NEUTRAL] Sure, my name is [PII]
[CUSTOMER][NEUTRAL] OK, give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, [PII], this is [PII].
[CUSTOMER][NEUTRAL] [PII] for today, OK?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] Used to, but they stopped sending it to us.
[CUSTOMER][NEUTRAL] You need.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] Yes, thank you so much for waiting so it's any history or no?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] No, there is no history on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] History and the codes I have. The first one is the 4341.
[AGENT][NEUTRAL] OK, that one is not covered.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Oh not covered. OK, 4910.
[AGENT][NEGATIVE] No, and it's not covered.
[CUSTOMER][NEUTRAL] OK, uh, 9110.
[CUSTOMER][NEUTRAL] And I want my son my son.
[AGENT][NEUTRAL] OK, 9110 is gonna be under basic. There's no limitation on that one.
[CUSTOMER][NEUTRAL] So my husband was my boyfriend.
[CUSTOMER][NEUTRAL] OK, uh, 9944. I, I doubt it.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Yeah, not car, OK, and just two more. I just need the claim address where I can send the claim to.
[AGENT][NEUTRAL] Sure, the addresses to make claims is [PII].
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Because you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Wait, um, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm. OK. OK, alright, [PII] OK and can you send me the fee schedule please for this patient plan?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] 8950.
[AGENT][NEUTRAL] You sure. What is the fax number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's correct.
[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] She
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[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, Ms. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Uh, no, nothing else. I got everything, thank you.
[AGENT][POSITIVE] OK, well, thank you for calling ATL. You're welcome. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.