AccountId: 011433970860
ContactId: 3990deec-e3a8-4855-a2dd-398d0d1598e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371760 ms
Total Talk Time (AGENT): 150472 ms
Total Talk Time (CUSTOMER): 125646 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/3990deec-e3a8-4855-a2dd-398d0d1598e4_20250616T15:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you um
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling with Comfort Dental. I was just calling to get patients dental benefits.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on benefits. What is their policy number?
[CUSTOMER][NEUTRAL] 02638746.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. So the patient is showing active. Their effective date on here is [PII].
[AGENT][POSITIVE] And if you want [PII], we can send a breakdown, um, a fax back if you'd like or I can verbally give you benefits, whatever works best.
[CUSTOMER][NEUTRAL] OK, he's already been waiting a half hour while I was on hold, so I think I'll just get him over the phone.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] What is this plan called?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So are you needing like the group number? What do you need off of?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like what insurance is this?
[AGENT][NEUTRAL] So the plan itself um participates like in the Carrington PPO network um it's not required to use it. The plan itself just pays off of UCR.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is it called American Public Life then or what is the essential? OK.
[AGENT][NEUTRAL] Yes, we're American, more American public life, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] see our free schedule. OK, and then, uh, what is the time for filing claims?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what's the claims address?
[AGENT][NEUTRAL] Claims mailing address is going to be [PII], [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, is that a deductible?
[AGENT][NEUTRAL] Uh, looks like there's a $50 deductible and their calendar year max is $500. The patient still has both remaining.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Almighty.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] What percent is diagnostic covered at?
[AGENT][NEUTRAL] Looks like 80%.
[CUSTOMER][NEUTRAL] OK, and then for preventative?
[AGENT][NEUTRAL] Is that 100?
[CUSTOMER][NEUTRAL] Basic.
[AGENT][NEUTRAL] Is that 80?
[CUSTOMER][NEUTRAL] And then it ended on exam period on and extractions under basic or no?
[AGENT][NEUTRAL] Uh, so that would be under major and the patient does not have major coverage on this plan. They have basic and um preventative only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is nitrous covered at all?
[AGENT][NEUTRAL] Do you have a code for it?
[CUSTOMER][NEUTRAL] 9230.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] Looks like it is not.
[CUSTOMER][NEUTRAL] OK, and then you fillings downgrade.
[AGENT][NEGATIVE] They do not.
[CUSTOMER][NEUTRAL] No, OK, is a night guard covered?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Do you have a code for the night guard?
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] Uh, no, I don't see that listed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then what's the frequency for the panoramic.
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] OK, and then for bite wings.
[AGENT][NEUTRAL] Uh, once per 12 months.
[CUSTOMER][NEUTRAL] An exam?
[AGENT][NEUTRAL] Um, cleanings are once every 6, and then oral evaluations are 2 for 12.
[CUSTOMER][NEUTRAL] Alright, is, um, fluoride covered?
[AGENT][NEUTRAL] Uh, let's see, it is, it does carry some restrictions. It's under preventative, so that would be at 100% and then.
[AGENT][NEUTRAL] It's limited to dependent children under the age of [PII] and it's a maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK, and then what was the number?
[AGENT][NEUTRAL] Oh, group number, one moment.
[AGENT][NEUTRAL] Group number is gonna be 70035.
[CUSTOMER][NEUTRAL] And you said they follow UCRC.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then is seas covered?
[AGENT][NEUTRAL] I'm sorry, is what covered?
[CUSTOMER][NEUTRAL] Sealants.
[AGENT][NEUTRAL] Oh, ceilings.
[AGENT][NEUTRAL] Uh, let's see, it is listed under preventative one moment.
[AGENT][NEUTRAL] It looks like it is also limited to dependent children under the age of [PII].
[CUSTOMER][POSITIVE] Alright perfect I think that is all I needed then thank you.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.