AccountId: 011433970860
ContactId: 3e037921-cbf5-4f5a-9f45-6b06598a110d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 721940 ms
Total Talk Time (AGENT): 236696 ms
Total Talk Time (CUSTOMER): 200282 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/3e037921-cbf5-4f5a-9f45-6b06598a110d_20250513T16:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], this is [PII] here calling on behalf of the provider dental office for benefit and eligibility verification. Could you please help me with that?
[AGENT][NEUTRAL] I'm happy to check on benefits and eligibility, [PII]. What's the patient policy number?
[CUSTOMER][NEUTRAL] Uh, yes, that would be 02596874.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, that would be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. So, patient is active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like the effective date on here is going to be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you so much for that. And uh could you please help me with the provider status, whether the provider will be in or out of network under this plan?
[AGENT][NEUTRAL] Uh, so the policy does participate in the Carrington [PII] network. however, a provider within that network is not required for usage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK. Thank you so much for that. So, can I get the group name under this plan?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Group name is Hospitality Staffing Solutions.
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Can I hear that again?
[AGENT][NEUTRAL] Hospitality.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Staffing
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Solutions.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And can I also get the group number?
[AGENT][NEUTRAL] Group number is 70072.
[CUSTOMER][POSITIVE] Thank you so much for that. So, uh, this is a calendar plan, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And the coordination of benefit will be standard on non duplication.
[AGENT][NEGATIVE] Yeah, there's no coordination of benefits.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So, can I get the annual maximum and deductible under this plan?
[AGENT][NEUTRAL] Yes, one moment. Let me just check that for you.
[AGENT][NEUTRAL] Alright, so the calendar year maximum is going to be $500 deductible is $50 patient has both remaining.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And is there any family deductible?
[AGENT][NEUTRAL] There is up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] And, uh, the annual maximum, it's $500 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And does this plan cover orthodontics?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] OK, thank you. So will there be any missing two calls or waiting period under this plan?
[AGENT][NEUTRAL] This policy does have a missing tooth clause. There is no waiting period.
[CUSTOMER][NEUTRAL] Thank you. Can I get the uh co-insurance for preventative basic and major?
[AGENT][NEUTRAL] Preventative is covered at 100% of allowable.
[AGENT][NEGATIVE] And then basic is covered at 80. There is no major coverage on this patient plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh, OK, thank you so much for that.
[CUSTOMER][NEUTRAL] Uh, so for endopper and oral surgery, did they fall on the basic major?
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] OK, thank you so much for that. So could you please help me with the list of codes here? I need the insurance and frequency.
[AGENT][NEUTRAL] What is the first code?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 0210 is covered at 100% under preventative.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] It is limited to 2 oral evaluation procedures in a 12 month period.
[CUSTOMER][NEUTRAL] Thank you. And the next one is 0 to 10.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And it was 0210, correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] 0210 is looks like limitation on that is a limit to 1 X-ray procedure per 5 year period.
[AGENT][NEUTRAL] It is covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. And the next one, it's uh 0274.
[AGENT][NEUTRAL] Covered at 100% under preventative, limited to one bite X-ray procedure per 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][POSITIVE] Thank you. And the next one it's uh 11:10.
[AGENT][NEUTRAL] 1110 is covered at 100%.
[AGENT][NEUTRAL] It's a maximum of 1 per 6 months.
[CUSTOMER][POSITIVE] Thank you. And the next one is 1208.
[AGENT][NEUTRAL] 1208 is not listed, therefore, it's not covered.
[CUSTOMER][NEUTRAL] OK. And the next one is 1351.
[AGENT][NEUTRAL] 1351 is a preventative at 100%.
[AGENT][NEUTRAL] It carries a limitation of a maximum of 1 procedure per 36 months. It is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Applications can only be made to permanent molar teeth.
[CUSTOMER][NEUTRAL] OK, thank you. And the next one, it's 2393.
[AGENT][NEUTRAL] 2393.
[AGENT][NEUTRAL] 2393 is covered at 80%.
[AGENT][NEUTRAL] Limitations include a maximum of 1 tooth for 24 months.
[AGENT][NEUTRAL] And replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] OK, and is it downgraded or covered?
[AGENT][POSITIVE] There's no downgrade.
[CUSTOMER][POSITIVE] Thank you. And the next one, it's 4341.
[AGENT][NEGATIVE] 4341 is not listed, not covered.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4910 is not listed either.
[CUSTOMER][NEUTRAL] OK. And the next one is 7140.
[AGENT][NEUTRAL] 7140 is covered at 80%. It's a maximum of 1 time per tooth.
[CUSTOMER][POSITIVE] Thank you. And the next one, it's uh 9223.
[AGENT][NEUTRAL] 9223 is not covered.
[CUSTOMER][NEUTRAL] OK. And the next one is 9310.
[AGENT][NEUTRAL] 9310 is covered at 80%, no limitation.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the next one, it's, and the last one would be 9944.
[AGENT][NEUTRAL] 9944 is not covered.
[CUSTOMER][POSITIVE] OK, thank you so much for that, [PII]. Uh, so, is there any history on this patient here that will affect the frequency?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][POSITIVE] OK. Thank you so much for that, [PII]. Uh, so then that's all that I need for this patient here. Uh, so is it possible to help me with another patient here under a different provider?
[AGENT][POSITIVE] Um, yeah, absolutely. Let me just notate this one and then we can check the next 11 moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] I'm ready for the next patient policy number when you are.
[CUSTOMER][NEUTRAL] Ah yes, that would be.
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 352-50
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, that would be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. So, patient is um let's see.
[AGENT][NEUTRAL] Patient has lapsed as of [PII]. No longer active with us. They do not have any other active coverage either.
[CUSTOMER][NEUTRAL] Uh, can I get the term date again? Uh, [PII], right?
[AGENT][NEUTRAL] Yes, term date [PII].
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] Uh, so then that's all that I need here, [PII]. So before I let you go, can I get your reference number for this call?
[AGENT][NEUTRAL] And call references my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for that, [PII]. So then I hope you have a nice day. Stay safe and take care.
[AGENT][NEUTRAL] You too. Bye bye.