AccountId: 011433970860
ContactId: 338869d8-869c-4966-9233-2da823c2ae34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327380 ms
Total Talk Time (AGENT): 141295 ms
Total Talk Time (CUSTOMER): 99949 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/338869d8-869c-4966-9233-2da823c2ae34_20250220T13:36_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting UPL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi I was calling to see if the patients had active coverage.
[AGENT][NEUTRAL] I can help with eligibility. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] Yeah, thank you. What is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] 02592800
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you. Is there a call back number.
[CUSTOMER][NEUTRAL] [PII] option 2 and option 4.
[AGENT][NEUTRAL] Thank you, I appreciate that, [PII]. The policy went into effect on [PII]. It is active. Is there anything else I can tell you about the dental policy besides just the eligibility?
[CUSTOMER][NEUTRAL] Is there a group name or group number on this policy?
[AGENT][NEUTRAL] The group number is 700.
[AGENT][NEUTRAL] 54
[AGENT][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Hold on, you broke up, hon.
[AGENT][NEUTRAL] Yes, I'm sorry. The group number for this.
[AGENT][NEUTRAL] 70054.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is Miller, oh let's see, oh excuse me, I'm sorry, 70054. Uh the group name is um.
[CUSTOMER][NEUTRAL] Any group name at all?
[CUSTOMER][NEUTRAL] Oops sorry.
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEGATIVE] Taking me a second here. My computer doesn't want to work.
[CUSTOMER][POSITIVE] You're OK.
[AGENT][POSITIVE] Innovative staff solutions.
[CUSTOMER][NEUTRAL] OK, and is this a PPO plan?
[AGENT][NEUTRAL] Uh, no, this is a discounted plan. It has $500 per calendar year as a uh as a maximum.
[AGENT][NEUTRAL] And it covers basic.
[CUSTOMER][NEUTRAL] And is it through Carrington?
[AGENT][NEUTRAL] Well, we use the Carrington PTO fee schedule. Now, you don't need to be a member of Carrington in order to have the policy pay out. Um, as long as you're not using major cover, I mean, you know, you're not doing major uh services such as endoontics, uh, periodontal services, oral surgery, then we're good. Um, there's everything else is covered. The preventative, basic, and basic restorative are the only things that are covered on this policy.
[CUSTOMER][NEUTRAL] OK, and you said it's just a discount, so is it like a Carrington 500 discount, or how I'm just trying to figure out how I would put this in.
[AGENT][NEUTRAL] Uh, it's a Carrington PPO, uh, discount.
[CUSTOMER][NEUTRAL] OK, I mean, I've got the Carrington PPO. Is there like a claims address?
[AGENT][NEUTRAL] Yes, our address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Let
[AGENT][NEUTRAL] That is in [PII].
[CUSTOMER][NEUTRAL] OK, let me find that real quick.
[CUSTOMER][NEUTRAL] So is there like a deductible on this plan?
[AGENT][NEUTRAL] Yes, there's a $50 deductible that does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK, how about a maximum?
[AGENT][NEUTRAL] It's $500 per calendar year and that's just the verification of the benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, is there any ortho coverage at all?
[AGENT][NEUTRAL] Uh, no, there is not.
[CUSTOMER][NEUTRAL] OK, and then did you say that Indo and Pero are not covered?
[AGENT][NEGATIVE] They are not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] How about oral surgery?
[AGENT][NEUTRAL] Uh, that is not covered.
[CUSTOMER][NEUTRAL] OK, um, preventative, that is that covered at 100%?
[AGENT][NEUTRAL] Uh, it's preventative, it's at 100% and the um
[AGENT][NEUTRAL] Basic and basic restorative are at 80%.
[CUSTOMER][NEUTRAL] 80, OK, so.
[CUSTOMER][NEUTRAL] Are simple extractions covered under basic or are they not covered?
[AGENT][NEUTRAL] They're covered under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about like frequencies for exams?
[AGENT][NEUTRAL] The exams are 2 per calendar year.
[CUSTOMER][NEUTRAL] And bite wings?
[AGENT][NEUTRAL] But wings once every 12 months.
[CUSTOMER][NEUTRAL] And then Full mouth and pano.
[AGENT][NEUTRAL] That's once every 5. Now, if you would like, I have a fax pack that I can send to you if you would be interested, it has all of the benefits on it.
[CUSTOMER][NEUTRAL] It looks like they requested it yesterday and I didn't see that we received it so I was just trying to go over real fast because this patient does come in in about 20 minutes.
[AGENT][NEUTRAL] Oh, OK, yes, of course.
[CUSTOMER][NEUTRAL] And then, um, fluoride how often can we do that?
[AGENT][NEUTRAL] Well, the fluoride is for uh patients [PII] old and younger.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right looks like that is all I needed.
[AGENT][POSITIVE] OK, well thank you very much for contacting ATL. You have a very good morning.