AccountId: 011433970860
ContactId: 45b95e41-586f-4c68-8ecc-2bb7f77013e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600799 ms
Total Talk Time (AGENT): 222722 ms
Total Talk Time (CUSTOMER): 210557 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/45b95e41-586f-4c68-8ecc-2bb7f77013e5_20250121T18:06_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, this is [PII] calling from dental office. Um, I need the full breakdown for the dental benefits.
[AGENT][NEUTRAL] I can help with benefits. Martina. What's the policy number, please?
[CUSTOMER][NEUTRAL] 002539241.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient name it's [PII]. Date of birth, [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. The policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Now, these policies have $500 per calendar year as the maximum.
[AGENT][NEUTRAL] That's just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] It covers basic, basic restorative and preventative services only. Um, so there's no major services, no endodontics, no periodontal services, um, it just covers the
[CUSTOMER][NEUTRAL] Oh, hold on.
[CUSTOMER][NEUTRAL] The major.
[CUSTOMER][NEUTRAL] Services and the, the end though, it's under major.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, is it the 3330?
[AGENT][NEUTRAL] Uh, 3330. Um, let me just check and see if that's covered.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is not covered under this policy.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] How about for the SRP, the 4341, and then the oral surgery?
[AGENT][NEGATIVE] Uh, that is not, uh, that's right. It is not covered under this under this policy.
[CUSTOMER][NEUTRAL] Is it same not cover it.
[CUSTOMER][NEGATIVE] Uh, just to make sure, 7140 and 7210, no coverage under this plan.
[AGENT][NEGATIVE] Uh, no, they are not covered under this plan.
[CUSTOMER][NEUTRAL] OK, hold on
[CUSTOMER][NEGATIVE] So same with the SRP not covered.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Is it means uh for your maintenance?
[AGENT][NEGATIVE] Per maintenance is not right. That is not going to be covered.
[CUSTOMER][NEUTRAL] The 491?
[CUSTOMER][POSITIVE] So no problem.
[AGENT][NEUTRAL] So it's, it's it's basically cleanings.
[AGENT][NEUTRAL] Simple extractions, that sort of thing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, cleaning 1110 FMX and panel and biting, that's the only uh hub a coverage under this plan.
[AGENT][NEUTRAL] Yes, there's also a simple extraction and filling, but that's it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, hold on. So the postster composite it's covered and downgraded for the AMA cup?
[AGENT][NEUTRAL] Uh, they are covered, but they're not downgraded.
[CUSTOMER][NEUTRAL] How about for a second she.
[AGENT][NEUTRAL] The, uh, for the fillings, um, let me just check here.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Just a second, OK.
[AGENT][NEUTRAL] OK, for that, it's uh replace existing only been placed for 24 months.
[AGENT][NEUTRAL] Maximum of 1 each 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's already, yeah, go.
[AGENT][NEUTRAL] Maximum of 1 each tooth for 24 months.
[CUSTOMER][MIXED] OK. And then, uh, night guard, no coverage also, but the coverage.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][POSITIVE] You for that then.
[AGENT][NEUTRAL] Yeah, that, that's, that's.
[CUSTOMER][NEUTRAL] Uh, same with the article.
[AGENT][NEUTRAL] I'm sorry, I, I, um, Marie, I didn't understand.
[CUSTOMER][NEGATIVE] Uh, same with the Oron, that's no coverage.
[AGENT][NEGATIVE] No, that, that is not covered. So this is just very, very basic.
[CUSTOMER][NEUTRAL] OK, um, and then the coordination of benefits.
[AGENT][NEUTRAL] Uh, there, there is no coordination of benefits.
[CUSTOMER][NEUTRAL] OK, no coordination.
[CUSTOMER][NEUTRAL] Sorry, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So fluoride shame not covered.
[AGENT][NEUTRAL] Right, it's just very, very, uh, basic, um basic dentistry, the, the cleanings, the filming of the teeth, the oral examinations. Now, I do have a fax that I can send to you if you would be interested. It shows you everything that is covered.
[CUSTOMER][NEUTRAL] OK, uh, but just wanna make sure, uh, can you double check for the 12 codes?
[CUSTOMER][NEUTRAL] Sure, for that. I need to double-check.
[AGENT][NEUTRAL] OK, what's
[AGENT][NEUTRAL] What's the first code?
[CUSTOMER][NEUTRAL] 0367.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that is not covered.
[CUSTOMER][NEUTRAL] 7950.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] 4263.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] 66056.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] 6058.
[AGENT][NEUTRAL] I'm sorry, that's not covered either.
[CUSTOMER][NEUTRAL] OK, uh, and the 9 to 4:30.
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] That is not covered either.
[CUSTOMER][NEUTRAL] I vote for X-ray 0220 and 0330.
[AGENT][NEUTRAL] Uh, the 0220 is covered under basic at 80%.
[CUSTOMER][NEUTRAL] Uh, I need the frequency limitation.
[AGENT][NEUTRAL] The films are, um, those are going to be, uh, once for 12 month period.
[CUSTOMER][NEUTRAL] OK, and then, uh, sharing seconds with buying.
[AGENT][NEUTRAL] The bite wings?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] The right wings are once.
[AGENT][NEUTRAL] Yeah, those are also once for 12 month period. Now, I don't have any history for Irma, so there's all available.
[CUSTOMER][NEUTRAL] OK and then uh ailing limit.
[AGENT][NEUTRAL] It's uh once every 6 months.
[CUSTOMER][POSITIVE] OK, thank you so much and um just to make sure no you set it on file for this patient.
[AGENT][NEGATIVE] There's nothing on file. There's, there's no history at all.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, what's her group name and the group number?
[AGENT][NEUTRAL] The group uh name and number for this employee, um, that is 70087, and it's partners 70087.
[CUSTOMER][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] 700.
[AGENT][NEUTRAL] And it's partners personnel.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] 77 70087.
[AGENT][NEUTRAL] Right, and it's partners personnel.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Personal
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] It's like a first uh [PII] and then partner.
[AGENT][NEUTRAL] [PII] Yes, it's [PII]
[AGENT][NEUTRAL] Personnel.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and uh can you check the participation of the dentist and then the fee schedule?
[AGENT][NEUTRAL] The fee schedule, we follow the Carrington PPO fee schedule. Um, there is no network, uh, so they can go to any dentist.
[CUSTOMER][NEGATIVE] Uh, no network then, no network.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So work
[CUSTOMER][NEUTRAL] Then the deductible is a 3 month preventive.
[AGENT][NEUTRAL] Uh, there is a $50 deductible that does not apply to the preventative services.
[CUSTOMER][NEUTRAL] OK, and then the mailing names and the payer ID.
[AGENT][NEUTRAL] The payer ID is 60801.
[AGENT][NEUTRAL] And our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Oh, by the way, for a.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] I is there what?
[CUSTOMER][NEUTRAL] Uh, for, uh, for exam, 01400120 and 0150, they all are sharing vacancy.
[AGENT][NEUTRAL] They share the same frequency that's 2 per calendar year.
[CUSTOMER][NEUTRAL] OK, yeah, um, I need the reference number and your name that's all I need.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're going to use that in today's date as a reference.
[AGENT][NEUTRAL] Is there anything else at all I can help with?
[CUSTOMER][POSITIVE] OK thank you so much have a good.
[CUSTOMER][POSITIVE] Uh, that's all I need. Thank you.
[AGENT][POSITIVE] OK, thanks for contacting us. Have a good day.