AccountId: 011433970860
ContactId: 40bd6c31-26cc-4a26-8d94-5bc08c37588b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1162859 ms
Total Talk Time (AGENT): 390384 ms
Total Talk Time (CUSTOMER): 468002 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/40bd6c31-26cc-4a26-8d94-5bc08c37588b_20250321T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, good afternoon. [PII] here from dental office. How are you doing today?
[AGENT][POSITIVE] I'm doing good and could you repeat your name for me please?
[CUSTOMER][NEUTRAL] [PII]. Actually I have a patient here and I need the ineligibility of the patient's plan.
[AGENT][NEUTRAL] OK, may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy number.
[CUSTOMER][NEUTRAL] The policy number I have, let me tell you, it's 02574840.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is going to be there.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for eligibility. It does show that the policy is currently active with the effective date of [PII]. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Can you tell me if they covered the dental benefits or not?
[AGENT][NEUTRAL] Which benefits are you needing me to verify?
[CUSTOMER][NEUTRAL] Uh, like exams, dental services, exams, fillings, crown, as services, dentures, it's covered or not?
[AGENT][NEUTRAL] OK, now would you like for me to send me a fax back to you with the member's benefits?
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Did you hear my question?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Yeah I can hear you now. Actually your voice is breaking up.
[AGENT][NEUTRAL] Would you like for me to submit a fax back with the member's benefit list?
[CUSTOMER][NEUTRAL] Can you, yeah, mhm, yes, can you sending me the fax right?
[AGENT][NEUTRAL] Yes, may I have that fax number?
[CUSTOMER][NEUTRAL] Uh, yeah, let me tell you the fax number I have. It's going to be there.
[CUSTOMER][NEUTRAL] It's [PII] and they covered the dental benefits or not?
[AGENT][POSITIVE] Yes, it will show the benefits and everything for this member on that fax back.
[CUSTOMER][NEUTRAL] OK, so the effective date is [PII] when forum, right?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Uh, OK, and it's a name of the, it's American public like insurance name, I'm right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it's the number is [PII]. I'm right?
[AGENT][NEUTRAL] To contact us.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, the telephone number is [PII] option one.
[CUSTOMER][NEUTRAL] Hm OK, option one, that's way. Can you confirm me the pay ID 60801.
[AGENT][NEUTRAL] The electronic pay ID is 60801.
[CUSTOMER][NEUTRAL] OK and the address is?
[AGENT][NEUTRAL] The mailing address, excuse me, is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, with the, uh, is there any [PII] is a state? Is there any city including?
[CUSTOMER][NEUTRAL] [PII] after.
[AGENT][NEUTRAL] It is [PII], it is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] It's uh [PII], OK.
[AGENT][NEUTRAL] Would you like me to repeat the mailing address?
[CUSTOMER][NEUTRAL] No, I actually, I can, OK, uh, can you confirm me that timely funding limit of the claim?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you're sending me the fixed rate?
[AGENT][NEUTRAL] Yes, I'm sending a request for the fax back now.
[CUSTOMER][NEUTRAL] And how much time I can receive the fax rate?
[AGENT][NEUTRAL] You will receive it sometime today.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Can you, can I tell you the tax ID I need the fee schedule of my provider.
[AGENT][NEUTRAL] The fee schedule?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's based off of the member's policy, there's no fee schedule.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's no network plan. There's no using the fee schedule, right?
[AGENT][NEUTRAL] No, if
[CUSTOMER][NEUTRAL] All provider considered out of network.
[AGENT][NEUTRAL] It's not based off of the in or out of network for this policy.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So in and out of network is not required.
[CUSTOMER][NEUTRAL] And in and out of network benefits are same or change?
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] It's the same. There's no in or out of network for this policy.
[CUSTOMER][NEUTRAL] And it's a PPO plan or the uh discount plan?
[AGENT][NEUTRAL] There's no PPO network.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if you would like to check you're more than welcome to contact Carrington to see if your provider is listed in the PPO network. Would you like Carrington's number?
[CUSTOMER][NEUTRAL] No, I mean to say you said the provider is not considered the in network, no provider in network with this plan I'm right? and.
[AGENT][NEUTRAL] That is not what I'm stating. This policy, it doesn't matter if it's in or out of network, but you do have the option to contact Carrington to see if your provider is in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Mhm, yeah, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I know my provider is in that with the Carrington BPO.
[AGENT][NEUTRAL] OK, so that that's what it will be going up under would be the Carrington PPO network.
[CUSTOMER][NEUTRAL] Uh, yeah, OK, so that's means you are using the Carrington PPOE schedu[PII], I'm right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that's great.
[CUSTOMER][NEUTRAL] And what will be the group number and the name in this plan?
[AGENT][NEUTRAL] The group number is.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 70072.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is through hospitality staffing solutions.
[CUSTOMER][NEUTRAL] Uh, uh, can you confirm me the plan name it's group voluntary dental or not?
[AGENT][NEUTRAL] If it's called what again?
[CUSTOMER][NEUTRAL] Can you confirm me the group name?
[AGENT][NEUTRAL] Is hospitality staffing solutions.
[CUSTOMER][NEUTRAL] O
[CUSTOMER][NEUTRAL] TT.
[CUSTOMER][NEUTRAL] Specialty.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, hospitality speciality?
[AGENT][NEUTRAL] Is hospitality staffing solutions.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] Can you spell it for the maiden name?
[AGENT][NEUTRAL] You're talking about staffing.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] S T A F F I N G staffing.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, actually, uh, for me it's, uh, uh, what about the coordination of benefits and the waiting period and missing tooth loss.
[AGENT][NEUTRAL] That it will be listed on the fax back that is coming to you as of now.
[CUSTOMER][NEUTRAL] Actually I don't receive the fax currently how much time I can get the fax back because the patient is waiting on the clinic.
[AGENT][NEUTRAL] I just stated it's coming to you as of now. It's just been submitted.
[CUSTOMER][NEUTRAL] OK, and the missing tooth cloth is on the fix pack or not?
[AGENT][NEUTRAL] Yes, it will be listed on the fax back. Would you like for me to see if there is a missing tooth cloth?
[CUSTOMER][NEUTRAL] Uh, OK, there is a missing tooth cloth. I'm right?
[AGENT][NEUTRAL] I said, would you like for me to see if there is a missing tooth cloth?
[CUSTOMER][NEUTRAL] OK, and can you confirm me?
[AGENT][NEUTRAL] So for this policy, verification of coverage does not guarantee the payment of the claim. This policy does not, oh, I'm sorry, this policy does have a missing tooth clause and TMJ services are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the coordination of benefit I may, uh, I believe it's standard I right?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] OK, and can you confirm me the time frame between S service and pay your maintenance? They can be done on the same day and it will be any healing period including.
[AGENT][NEUTRAL] OK, so what benefits are you needing me to look up?
[CUSTOMER][NEUTRAL] It's a service and pay you maintenance.
[AGENT][NEUTRAL] OK, so you will have to give me the code.
[CUSTOMER][NEUTRAL] 43419 4910.
[AGENT][NEUTRAL] Let me pull those up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the codes you're questioning is 4341 and 4019. Those codes are not listed on here, so it's not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, 4341 and 41 49 10 is not listed on the fax, uh, on the I'm right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So that's where it's not covered in this plan.
[AGENT][NEUTRAL] Yes, for the code that you just asked about.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] OK, and can you confirm me the uh exam is covered in this plan or not?
[AGENT][NEUTRAL] Is it just a regular exam?
[CUSTOMER][NEUTRAL] Yeah, it's 01200140.
[CUSTOMER][NEUTRAL] And 0150.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for 0120 and 0150, those are listed up under the preventative expenses which is covered at 100% of a liable with zero waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then for the 0140 that is listed up under the basic expenses which is up on the 80% of allowable with zero waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And is there any frequency or not?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And which frequencies are you needing me to check for the basic?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] You're needing me to check for 0140?
[CUSTOMER][POSITIVE] I mean to say can the the the yeah all goods.
[AGENT][NEUTRAL] So for all codes, it's limited to 2 oral evaluation procedures in any combination of those codes per 12 month period.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There's no frequency in this plan, I'm right?
[AGENT][NEUTRAL] I just gave you the limitations.
[AGENT][NEUTRAL] So there's no frequencies.
[CUSTOMER][NEUTRAL] There is no frequency of 3, all three of them, right?
[AGENT][NEGATIVE] There is a limitation for those codes.
[CUSTOMER][NEUTRAL] Can you confirm me the limitation?
[AGENT][NEUTRAL] I just advise you of the limitation is limited to 2 oral evaluation procedures in any combination per 12 months.
[CUSTOMER][NEUTRAL] 2 by 12 months. OK, and can you confirm me the uh maximums and deductibles?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So for the calendar year max, the member has up to $500 per COVID insured with $50 deductible, which does not apply to the preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And orthodontic services are covered in this plan or not?
[AGENT][NEUTRAL] Orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] OK, and uh how many quads are allowed for a service in a day?
[AGENT][NEUTRAL] For which services?
[CUSTOMER][NEUTRAL] SR 4341.
[AGENT][NEUTRAL] OK, I stated 4341 is not covered.
[CUSTOMER][NEUTRAL] Uh, actually I need the guidelines, so you paid how many costs?
[AGENT][NEUTRAL] OK, you asked if 4341 for the quads is not covered under this policy, so there would not be any benefits.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][NEUTRAL] I, oh, OK, uh, can you confirm me the 0220 exact pretty X-rays and bite wing and panoramic X-ray.
[AGENT][NEUTRAL] So that's 0220 is the code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02200274 and 0210.
[AGENT][NEUTRAL] OK, now these will have to be the last codes because I did submit that fax back so those codes will be listed if it's on there. Let me check these last codes for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I, I received the text but just with me. I see, I check uh uh how how many calls I have.
[CUSTOMER][NEUTRAL] A $50 deductible basic services on 80% allowed but to you once for 12 months of the.
[CUSTOMER][NEUTRAL] Um, by wing is, uh, can you confirm is 02 stand for is on preventative or basic, uh, I need, I need only that that thing.
[AGENT][NEUTRAL] So for the fax back stating 0274 that is listing that is up under the preventative category of expenses.
[CUSTOMER][NEUTRAL] But like.
[CUSTOMER][NEUTRAL] OK, and the X-ray have preventative services or basic services?
[AGENT][NEUTRAL] What would that code be?
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] That is listed up on the basics.
[CUSTOMER][NEUTRAL] Mhm that's fine.
[CUSTOMER][NEUTRAL] OK, and can you confirm me 1206 and 1351 have any age limit or not?
[AGENT][NEUTRAL] OK. As I stated, those other codes would be the last codes that I can review. Did you not get the facts back?
[CUSTOMER][NEGATIVE] I received the fax back.
[AGENT][NEUTRAL] OK. So all those codes and the frequencies and limitations, if anything is listed, will be on that fax back.
[CUSTOMER][NEUTRAL] OK, let me check preventative, preventative preventative limitations 2220 OK.
[CUSTOMER][NEUTRAL] 03 9310. OK, some procedure codes are not covered in this, uh, are not considered in this plan. So you and not in the text so you consider the uh like uh it will be the predetermination or the not covered in this plan.
[AGENT][NEGATIVE] If the codes are not listed, it's not covered up under this plan.
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] And your name is sorry I didn't catch.
[AGENT][NEUTRAL] It is [PII], so the reference number would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] And wika, can you confirm me the FMX share with then or not?
[AGENT][NEUTRAL] I'm sorry, could you repeat that again?
[CUSTOMER][NEUTRAL] FMX full mouth X-rays shared with panoramic services or not?
[AGENT][NEUTRAL] May I have, you said if it's shared with it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so down there where it is giving the frequencies for services, it says full mouth X-rays and panoramics once every 5 years.
[CUSTOMER][NEUTRAL] They they should.
[CUSTOMER][NEUTRAL] And can you confirm me the crown page on seat date or prep date?
[CUSTOMER][NEUTRAL] You got
[AGENT][NEUTRAL] If what is paid on what now?
[CUSTOMER][NEUTRAL] 27408 will be the page on sea date or birth date.
[AGENT][NEUTRAL] OK. I'm needing that code again. What did you say?
[CUSTOMER][NEUTRAL] It's ground be on she dead or breed.
[AGENT][NEUTRAL] OK, I'm not understanding that question.
[CUSTOMER][NEUTRAL] Uh, can you confirm me the major services on going to be covered in this plan or not?
[AGENT][NEUTRAL] OK, so what I stated to you, Max, if any of those services are not listed, is not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you.