AccountId: 011433970860
ContactId: 419e74a6-f329-44b9-b94c-0557798a0463
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908210 ms
Total Talk Time (AGENT): 314964 ms
Total Talk Time (CUSTOMER): 254257 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/419e74a6-f329-44b9-b94c-0557798a0463_20250515T12:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm calling regarding patients dental benefit on behalf of provider's office. Could you please help?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the member's dental benefits, and how are you doing today, [PII]?
[CUSTOMER][POSITIVE] Wonderful. Thank you. Hi, you're doing great so far. How about you?
[AGENT][POSITIVE] I'm doing well. And [PII], may I have a good contact number in case for this?
[CUSTOMER][POSITIVE] Wonderful, good to hear that.
[AGENT][POSITIVE] Good, and in case we're disconnected in the policy number?
[CUSTOMER][NEUTRAL] No worries. It will be [PII].
[AGENT][NEUTRAL] All right. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. It'll be 262-272-9.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes, so member here is I'm showing Sunday Cervantes. It shows [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] [PII]. OK, so that's calendar year plan or fiscal?
[AGENT][NEUTRAL] This is a calendar year policy. Did you need a copy of the fax back?
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] Oh, the, can you give me a call because I have like a general appointment already in the office to do that.
[AGENT][NEUTRAL] Oh, we can do it over the phone still. I'm just asking if you need a copy.
[CUSTOMER][NEUTRAL] Uh yes, yes, please, uh, no, that's fine. If you give me another call, that's fine. And, uh, first of all, can you confirm provider status whether they're in network or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this policy is on the Carrington PPO network. Um, however, if your provider is not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] Wonder
[CUSTOMER][NEUTRAL] OK, so you from your end, uh, you cannot check whether the network or not if I give you a tax ID.
[CUSTOMER][NEUTRAL] N PI
[AGENT][NEUTRAL] I cannot because Carrington is a different company, but I can give you their phone number if you'd like to check if you're in network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that's fine, but uh you said there will be it will be like same exact same benefit, right?
[AGENT][NEUTRAL] Right, whether the providers in network or not.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] No problem. And um do you have group name and number, [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is 70.
[AGENT][NEUTRAL] 101.
[AGENT][NEUTRAL] The group name, Oops, hold on one second. It's Superior.
[AGENT][NEUTRAL] Skilled
[CUSTOMER][NEUTRAL] Superior.
[AGENT][NEUTRAL] Superior Skilled Trades LLC.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, trade T R A D E.
[AGENT][NEUTRAL] Yes, T R A D E S and then LLC.
[CUSTOMER][POSITIVE] OK, great, perfect. And it is single or family coverage facility?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] This is a family policy.
[CUSTOMER][NEUTRAL] Family. OK, you, you mentioned it's a calendar plan in January, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, this is a calendar year plan you mentioned renews every January, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Wonderful. And do you have a machine to cloth or waiting period?
[AGENT][NEUTRAL] Hold on one moment. Let me, I'm trying to get the calendar year max for you. Do you mind if I place you on just a brief hold?
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][POSITIVE] No problem. Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is happening right now?
[AGENT][NEUTRAL] Let me go back to
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] No, not that one, this one.
[AGENT][NEUTRAL] OK, that's what I thought. CLVD4.
[AGENT][NEUTRAL] Oh, wait, wait, wait, wait.
[AGENT][NEUTRAL] I think that's the same kind of policy as with Crysta. So with these 750 policies.
[AGENT][NEUTRAL] What, oh, OK, we can figure that out later, but that's what happened cause that's what [PII] had to do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Thank you for holding. I apologize for that wait. So yes, this policy does have a missing tooth cloth.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And how about waiting period?
[AGENT][NEUTRAL] Um, there's no waiting period. This policy only covers preventative and basic.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, no major or author, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] As well.
[CUSTOMER][POSITIVE] Perfect. Thank you. And uh what type of COB considered sort of benefit.
[AGENT][NEUTRAL] Major for us is
[AGENT][NEUTRAL] I'm sorry, did you want me to continue or answer the question you were asking?
[CUSTOMER][POSITIVE] Oh yes, yes, continue please.
[AGENT][NEUTRAL] Major for us is um endodontic, periodontic and prosodontic as well as oral surgery.
[CUSTOMER][NEUTRAL] OK, so all of them will be in there to make sure, mhm.
[AGENT][NEGATIVE] There is no coordination of benefits.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Let's go ahead. I was just confirming.
[AGENT][NEUTRAL] There's no coordination of benefits, however, the, the claim is received in whatever order, we'll process it.
[CUSTOMER][POSITIVE] Wonderful
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK then, and uh you mentioned endo period and oral uh would be considered a major and not covered, right?
[AGENT][NEUTRAL] Endopperiorosioonic, and oral surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oral surgery. How about simple attractions that's covered or not as well.
[AGENT][NEUTRAL] Simple extractions, yes, under basic.
[CUSTOMER][POSITIVE] That's gonna consider the basic. OK, perfect. And it's gonna help me with their maximums and deductibles now.
[AGENT][NEUTRAL] The maximum is $750 per calendar year. The um deductible is $50 per person up to $150 per family.
[CUSTOMER][POSITIVE] Wonderful. Thank you. And this year they have accumulated anything? 10 years or me?
[AGENT][NEUTRAL] Um, no, they have not used any of the benefits, um, yet.
[CUSTOMER][POSITIVE] Nothing is that all. Perfect. Thank you. Any history with no history at all?
[AGENT][NEUTRAL] There's no history on file.
[CUSTOMER][NEUTRAL] Just started like me so of course and that's preventive and basic what what are the coinstrument levels for that.
[AGENT][NEUTRAL] Preventative is covered at 100% of allowable, radiographs and FMX expenses, basic and basic restorative are all at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful. It'll be in the 80. Thank you. And lastly, I need frequencies. Can I help with that for that preventative services.
[AGENT][NEUTRAL] OK, um, you can provide me with your list of codes.
[CUSTOMER][NEUTRAL] Sure. So 0120.
[CUSTOMER][NEUTRAL] 1110 0274 0330 02 20.
[CUSTOMER][NEUTRAL] 02 1012 08 1351.
[CUSTOMER][NEUTRAL] 1354 1510, 1575 9248, 99 45 99 44, and 4910.
[CUSTOMER][NEUTRAL] That's all.
[AGENT][NEUTRAL] OK, hold on one moment for me, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Did I open this one in the browser I did. OK, so I'll put this over here.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, 100.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So code 0120, preventative at 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Limited to 2 oral evaluations per 12-month period.
[AGENT][NEUTRAL] It's paired with 140, 50, and 60.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] S.
[AGENT][NEUTRAL] 11:10.
[AGENT][NEUTRAL] It's preventative at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Max of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 270274 is preventative at 100%.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Limited to one bite wing X-ray procedure for 12-month period.
[AGENT][NEUTRAL] It's paired with 270 and 272.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0330 is 80%.
[AGENT][NEUTRAL] Limited to 1 X-ray procedure for 5 years.
[AGENT][NEUTRAL] And it's paired with um 210 and 277.
[AGENT][NEUTRAL] 0220 is basic at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 210 is basic restorative at 80%, limited to one X-ray procedure per 5-year period.
[CUSTOMER][POSITIVE] Wonderful.
[AGENT][NEUTRAL] 1208 is not covered?
[AGENT][NEUTRAL] 1351.
[AGENT][NEUTRAL] Is preventative at 100%?
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][POSITIVE] Wonderful and you said 1208 is not covered, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 1208 you said not covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh, so 1354 is not covered?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1510 is preventative at 100%.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[AGENT][NEUTRAL] And maximum of one per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] Let's see, yeah.
[AGENT][NEUTRAL] Um, all the other clothes are not covered.
[CUSTOMER][NEGATIVE] OK, 924-8 that would not be covered.
[CUSTOMER][POSITIVE] Perfect. And one thing to, I want to confirm, uh, deductible applies to which services? On the like basic or what?
[AGENT][NEUTRAL] Um, it applies to every well this only covers basic, so for this policy, um, it just doesn't apply to preventative.
[CUSTOMER][NEUTRAL] On the basic, so, uh, FMX and uh BA will be a basic and, uh, 0220 what's the frequency limit you said?
[AGENT][NEGATIVE] I didn't get, there's no frequency for that.
[CUSTOMER][NEUTRAL] OK then, so yes, that's all for that, [PII], and can you help me with the mailing address lastly your ID.
[AGENT][NEUTRAL] Our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] 240
[CUSTOMER][POSITIVE] Wonderful.
[AGENT][NEUTRAL] And our payer ID is 60801.
[CUSTOMER][POSITIVE] Excellent and call reference number please.
[AGENT][NEUTRAL] And 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].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful. And that's all done with all the concerns, OK, thank you very much for your help, [PII].
[AGENT][POSITIVE] Alright, well, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Yes wish a day too bye bye and you take care.
[AGENT][POSITIVE] Thank you. Bye-bye.