AccountId: 011433970860
ContactId: 3223ce9f-0cbf-4dc0-82ae-512bd7ae02d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420320 ms
Total Talk Time (AGENT): 196661 ms
Total Talk Time (CUSTOMER): 184891 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/3223ce9f-0cbf-4dc0-82ae-512bd7ae02d2_20250203T14:19_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling on behalf of the dental office to check the eligibility and benefit for a member on a recorded line. Could you please help me with that?
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with benefits for a patient. What is the callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Sure, policy number for the member is 02546136.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII] with the date of birth of [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with eligibility and benefits. I am showing that Mr. [PII]'s policy is active.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a limited dental policy that participates in the Carrington PPO network, but not required.
[AGENT][POSITIVE] And I do have a breakdown that I can fax to you with all the policy information if you're interested.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] But I'm having a few questions which are, I think some other on the uh facts.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, yes, but, uh, firstly, I wanna know is the member to subscribed on this plan?
[AGENT][NEUTRAL] He is.
[CUSTOMER][NEUTRAL] OK, and what about the group name?
[AGENT][NEUTRAL] The group name is, and you're correct, this is not on the facts back. Group name is Econ Employment Solutions. Econ is E T as in Tango, C as in Charlie, O N as in November.
[CUSTOMER][NEUTRAL] OK, employment solution, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and, and the group number.
[AGENT][NEUTRAL] 70022
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, 70022 right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is it a family plan or a single coverage?
[AGENT][NEUTRAL] It is single.
[CUSTOMER][NEUTRAL] Single coverage and you said the provider needs to be worked with Carrington, right?
[AGENT][NEUTRAL] What participates in the Carrington network, however, network participation is not required for benefits.
[CUSTOMER][NEUTRAL] OK, so what kind of plan it is? Is it a PPO plan, indemnity plan?
[AGENT][NEUTRAL] It is a limited um Carrington PPO plan. It does not cover major procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I got that. And what about the claim meeting address?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip, I'm sorry, the zip code is [PII].
[AGENT][NEUTRAL] Claims can also be faxed or we have a payer ID.
[CUSTOMER][POSITIVE] OK. Amazing.
[CUSTOMER][NEUTRAL] 60801, right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, great. So do you accept assignment of benefit to an out of network provider?
[AGENT][NEUTRAL] We do standard.
[CUSTOMER][NEUTRAL] If if the benefits are exhausted, is there a participating to a discount?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] For non-covered services, is there a participating to a discount?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, you're saying no discount. Uh, what about the deductible, the max, and the used amount of this plan?
[AGENT][NEUTRAL] It is and all benefits given over the phone is a verification of coverage, not a guarantee of payment. This plan provides a $500 calendar year max.
[AGENT][NEUTRAL] There is a $50 deductible. It does not apply to preventive services.
[CUSTOMER][NEUTRAL] OK, applies to basic and major, right?
[AGENT][NEGATIVE] Nature is not covered. It only applies to basic.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Is orthodontic service covered?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] What about the coffee shop preventative and basic.
[AGENT][NEUTRAL] Preventive is 100%, basic is 80%.
[CUSTOMER][NEUTRAL] What about endedontic periodontic and oral surgery, are they covered under the basic or any service?
[AGENT][NEGATIVE] They're not covered. They're considered majors, so no, they're not covered.
[CUSTOMER][NEUTRAL] All three of them, right?
[AGENT][NEUTRAL] Yes, sir, all 3.
[CUSTOMER][NEGATIVE] And no coverage for crown bridge tensions and implant as well right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] What about P maintenance and simple extraction?
[AGENT][NEUTRAL] Simple extraction is covered, the perial maintenance not.
[CUSTOMER][NEUTRAL] Simple extraction on the basic, right?
[AGENT][NEUTRAL] That's correct. The 7140.
[CUSTOMER][NEUTRAL] Any waiting period on mhm sorry to interrupt you. Any waiting period on missing the loss?
[AGENT][NEGATIVE] No, no waiting period. There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] There is a missing two clause, but missing two clause won't apply because major is not covered, right.
[AGENT][NEUTRAL] Well, the simple extraction is covered.
[CUSTOMER][NEUTRAL] OK, so missing two clauses for simple extraction you're saying.
[AGENT][NEUTRAL] Uh, for, yes, it does apply.
[CUSTOMER][NEUTRAL] OK, I got that. Can I get the frequency for preventative services?
[AGENT][NEUTRAL] 100%.
[CUSTOMER][NEUTRAL] No, the, uh, what I see, yeah.
[AGENT][POSITIVE] Uh frequencies. I'm so sorry.
[AGENT][NEUTRAL] I apologize. The trophies are once every 6 months.
[CUSTOMER][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And bite wings are once for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now FMX and Paos are basic, and they're once every 5 years.
[CUSTOMER][POSITIVE] Amazing. What about fluoro and, yeah, fluoride.
[AGENT][NEUTRAL] Fluoride is under the age of [PII] and it's every 12 months.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And one last code that is 0431 that is covered or not I know that.
[AGENT][NEUTRAL] 0431 is not a covered benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Any downgrade for filings?
[AGENT][NEGATIVE] We do not downgrade.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Just to make sure PSRP won't be covered, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEGATIVE] PDSRP won't be covered.
[AGENT][NEUTRAL] SRPs are not covered.
[CUSTOMER][NEUTRAL] And [PII], can I get the reference number for the day's call.
[AGENT][NEUTRAL] Reference number is my name and today's date, and I spell my name [PII] of [PII] last [PII] is [PII].
[AGENT][POSITIVE] And it was a pleasure to assist you with that breakdown, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] For the data with the questions and thank you for the information you provided this year.
[AGENT][POSITIVE] Oh it's been my pleasure, [PII]. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You do as well. Bye bye. Take care.
[AGENT][NEUTRAL] You too. Bye-bye.