AccountId: 011433970860
ContactId: 3c894b53-30cb-49a4-b61c-cecc7204763f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745559 ms
Total Talk Time (AGENT): 320516 ms
Total Talk Time (CUSTOMER): 162869 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/3c894b53-30cb-49a4-b61c-cecc7204763f_20250313T19:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I need some dental benefits. Can you help me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02 033632
[AGENT][NEUTRAL] 02033632
[CUSTOMER][NEUTRAL] Yes, 02033632.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII], [PII].
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Can you hear me now?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, for some reason, the my headset was unmuted, but the phone muted itself, so I don't know how that happened. I apologize, um, but I was, um, so I don't know what you heard because I didn't know that, that you couldn't hear me. Um, did you hear the effective date?
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so the policy has been active since [PII]?
[AGENT][POSITIVE] And I also thank you for
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] And I also thank you for verifying and I gave the disclaimer. So just again, all the information provided is a verification of benefits, not a guarantee of payment. And what benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Firstly, can I, uh, can you provide me the pay ID?
[AGENT][NEUTRAL] 60
[AGENT][NEUTRAL] 80
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Billing address [PII].
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Our zip code is [PII].
[CUSTOMER][NEUTRAL] Provider is in network or out of network. Can you check that, please?
[AGENT][NEUTRAL] We don't have access to the list of providers. Um, hold on one moment, let me pull up the benefits for the dental policy. Did you need a copy of the fax back?
[CUSTOMER][NEUTRAL] Firstly, I need verbally because it's urgent.
[AGENT][NEUTRAL] I understand. I can still fax it to you later if you need it though.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this policy is on the Carrington PPO network. Um, we don't have access to Carrington's list of providers. I can give you their phone number if you'd like to check and see if your network.
[CUSTOMER][NEUTRAL] Uh, we are, can I have the group number?
[AGENT][NEUTRAL] Group number, sure. Hold on one moment.
[AGENT][NEUTRAL] 70052.
[CUSTOMER][NEUTRAL] 70052.
[CUSTOMER][NEUTRAL] What about the group name?
[AGENT][NEUTRAL] Oxford Global Resources.
[CUSTOMER][NEUTRAL] OK. What about the effective date you provided [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Then what about the max and deductible? Is there any use to me from that?
[AGENT][NEUTRAL] So the calendar year is max is $500 and the deductible is $50. Um, hold on, let me see if it has been used.
[AGENT][NEGATIVE] And so far for [PII], none of the benefits have been used and the and the deductible has not been met.
[CUSTOMER][NEUTRAL] No family deductible.
[AGENT][NEUTRAL] Up to 150 per family, but this is an individual policy.
[CUSTOMER][NEUTRAL] What about the orthodontics, it's covered or not?
[AGENT][NEUTRAL] There is no orthodontic treatment?
[CUSTOMER][NEUTRAL] Is there any waiting period or a missing tooth closs?
[AGENT][NEUTRAL] There is a missing tooth cloth and no waiting period because the policy does not cover major expenses. Major for us includes endo.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] What is the percentage of preventative, basic and major.
[AGENT][NEUTRAL] So again, major expenses for us includes periodontic, prosodontic, and endodontic. Major services are not covered on this policy.
[AGENT][NEUTRAL] Preventative is covered at 100%.
[AGENT][NEUTRAL] Radio graphs and FMX expenses.
[AGENT][NEUTRAL] Basic expenses and basic restorative expenses are all at 80%.
[CUSTOMER][NEUTRAL] What is the frequency for exam?
[AGENT][NEUTRAL] 2 for 12 month period?
[CUSTOMER][NEUTRAL] White wings.
[AGENT][NEUTRAL] One for 12 month period?
[CUSTOMER][NEUTRAL] FMX and pano.
[AGENT][NEUTRAL] Once every 5 years?
[CUSTOMER][NEUTRAL] And it's under basic, am I right?
[AGENT][NEUTRAL] Um, full mouth X-rays and panels is a category by itself.
[CUSTOMER][NEUTRAL] 0210 and 0330.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's on the basic or preventative.
[AGENT][NEUTRAL] So there are 3 options are preventative, radiograph and FMX, basic, and basic restorative is under basic as well. Radiograph and FMX is under its own category at 80%, so it's not basic or preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Do you have a code for that?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] 0220. Hold on one second.
[AGENT][NEUTRAL] 0220 is under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Brophy
[AGENT][NEUTRAL] Prophy is preventative at 100%.
[CUSTOMER][NEUTRAL] Frequency.
[AGENT][NEUTRAL] Once per 6-month period?
[CUSTOMER][POSITIVE] OK. You're right.
[AGENT][NEUTRAL] Fluoride is under preventative at 100%.
[AGENT][NEUTRAL] The frequency, hold on one second.
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months and limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Seans
[AGENT][NEUTRAL] Sealings are under preventative at 100%, maximum of 1 procedure for 36 months, limited to dependent children under age [PII], and applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] Billings.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Fillings, 2391.
[AGENT][NEUTRAL] 2391 is under basic restorative at 80%, replace existing if only if in place for 24 months, and let me see what the other one was. Maximum of 1 each tooth per 24 months.
[CUSTOMER][NEGATIVE] Uh, 33, 3000 on its not covered.
[AGENT][NEUTRAL] You said 3330?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] That's not a covered code on the policy.
[CUSTOMER][NEUTRAL] Same with HRP 4341.
[AGENT][NEUTRAL] Right, those are major codes. It's not covered by this policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Are we still not covered?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Eriston, 4381.
[AGENT][NEUTRAL] Correct. Major services are not covered on this policy.
[CUSTOMER][NEGATIVE] Uh, pay you maintenance.
[AGENT][NEUTRAL] OK, so major services for us includes periodontic, prosodontic, and oral surgery.
[AGENT][NEGATIVE] There's no coverage for major expenses on this policy.
[CUSTOMER][NEUTRAL] Same with expressions.
[AGENT][NEUTRAL] There's a simple extraction, 7140 under basic at 80%.
[AGENT][NEUTRAL] Maximum of one time per tooth.
[CUSTOMER][NEUTRAL] 17.
[CUSTOMER][NEGATIVE] 70 to 10 not covered.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] 70 to 10 not covered.
[AGENT][NEUTRAL] 7210. Let me see.
[AGENT][NEUTRAL] Correct, um, not covered on the policy.
[CUSTOMER][NEUTRAL] OK. Now I need to verify the history, please.
[AGENT][NEUTRAL] OK, and what code would you like to check the history for?
[CUSTOMER][NEUTRAL] Which may affect the benefits. I don't have any specific code to verify.
[AGENT][NEUTRAL] So we will have to go through every claim that we've processed if you know what code you're looking for to check history, I can use the code and search through the claims.
[CUSTOMER][NEUTRAL] Can you check uh exam?
[AGENT][NEUTRAL] Do you have a code that you'd like me to check?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Last day of service for 00120 was [PII].
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] There's no um claim on file with that code.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Um, no claim on file.
[CUSTOMER][NEUTRAL] OK. 1 0274.
[AGENT][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] Um, no claim on file.
[CUSTOMER][NEUTRAL] History, uh sorry, reference number, please.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], my first name is [PII]
[CUSTOMER][NEUTRAL] And uh can you send me a fax, please?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And does that need to be attention, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] 351 68, you're right. Thank you so much for helping. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I could assist with?
[CUSTOMER][POSITIVE] I know, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You have been removed from the call. Goodbye.