AccountId: 011433970860
ContactId: 46aa7b98-e156-43c8-a266-2ec7a7957456
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 758010 ms
Total Talk Time (AGENT): 300384 ms
Total Talk Time (CUSTOMER): 272950 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/46aa7b98-e156-43c8-a266-2ec7a7957456_20250506T15:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I'm calling to check on dental benefits.
[AGENT][NEUTRAL] OK, I could check those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Oh yes, I have it. That is 0256.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4654.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Patient name is [PII] with date of birth, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and if you would like, I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][POSITIVE] That would be very helpful. Can you fax me that?
[AGENT][POSITIVE] Awesome, absolutely what was that fax number for you?
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was 510929-4914?
[CUSTOMER][POSITIVE] That is right.
[AGENT][NEUTRAL] All right. I will go ahead and get that sent now. It should get it within about 10 minutes or so. Uh, if you're looking for a specific procedure and you don't see it listed on the fax back, that simply means it's not going to be covered. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Can I have group number first for this policy?
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][NEUTRAL] And the policy ID I gave you is the member ID, right?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, and that group number is 70,030.
[CUSTOMER][NEUTRAL] 70,030. Is that right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Group name?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is Creative Circle LLC.
[CUSTOMER][POSITIVE] Creative then circle.
[AGENT][POSITIVE] Creative circle.
[CUSTOMER][NEUTRAL] OK. Is this policy calendar year?
[AGENT][NEUTRAL] Yes, it is a calendar year policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can I have claims mailing address for this one?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From [PII]
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Information benefits within your
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you repeat the ZIP code for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] 3.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] And payer ID?
[AGENT][NEUTRAL] And I've also got a, uh, yes, I've got a pair ID and a fax number if you'd like as well that pair ID is 60801.
[CUSTOMER][NEUTRAL] 60801. Is that right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] And are you sure this is the payer ID correct one?
[AGENT][NEUTRAL] Yes, 60801.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And we are out of network just to let you know, what will be the age limit for dependents on this plan?
[AGENT][NEUTRAL] Um, it does depend on the procedure. However, there are no dependents, uh, under this policy.
[CUSTOMER][NEUTRAL] I'm talking uh uh.
[CUSTOMER][NEUTRAL] OK. I'm talking in general, is it [PII] years?
[AGENT][NEUTRAL] Oh, I see um.
[CUSTOMER][NEUTRAL] For depending on age limit.
[AGENT][NEUTRAL] I see. I apologize. Yes, [PII].
[CUSTOMER][NEUTRAL] Any building period for
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Any waiting period?
[AGENT][NEUTRAL] Not for this plan, no. Uh, as there is no major coverage, this plan only provides uh preventative and basic coverage, so there is no waiting period.
[CUSTOMER][POSITIVE] No, that is, that is perfect.
[CUSTOMER][NEGATIVE] Any missing too close.
[AGENT][NEGATIVE] Yes, there is a missing teeth cloth.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] That is OK. Coordination of benefits?
[AGENT][NEGATIVE] There is no coordination of benefits with this plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Individual deductible.
[AGENT][NEUTRAL] That is $50 per calendar year, but that does not apply to preventative services.
[CUSTOMER][NEUTRAL] And family deductible?
[AGENT][NEUTRAL] Uh, that is up to $150 per family.
[CUSTOMER][NEUTRAL] Applies on basic and major.
[AGENT][NEUTRAL] Um, so preventative is at 100%, uh, radiographs and basic are at 80%. Major is not covered under this policy.
[CUSTOMER][NEUTRAL] Ma'am, I'm asking, uh,
[CUSTOMER][NEUTRAL] Deductible applies on which service basic only.
[AGENT][POSITIVE] Oh, I'm so sorry. Yes, uh, basic and radiographs. I apologize.
[CUSTOMER][NEUTRAL] Basic and radiographs.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] FMX
[CUSTOMER][NEUTRAL] Crops, OK.
[CUSTOMER][NEUTRAL] Just give me a second, and we'll mask for this patient?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] $500 per calendar year.
[CUSTOMER][NEUTRAL] $500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] In in and out both have the same annual max 500.
[AGENT][POSITIVE] That's, yes, that's correct.
[CUSTOMER][NEUTRAL] You said 500, right, not 5000.
[AGENT][NEUTRAL] Right, 500.
[CUSTOMER][NEUTRAL] Any pending claims?
[AGENT][NEUTRAL] Oh, let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, no, no pending claims for this number.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] There are no pending claims for this number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And assignments of benefits are accepted, signature on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, covered percentage for preventive and basic.
[AGENT][NEUTRAL] Yes, preventative is at 100%. Basic is at 80%.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, in and out both have the same percentage, 180.
[AGENT][NEUTRAL] That's correct. utilization of a provider within this network is not required.
[CUSTOMER][NEUTRAL] So in and out both have the same benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, covered percentage and frequency for panel and FMX.
[AGENT][NEUTRAL] The frequencies, I'm sorry, is that what you said?
[CUSTOMER][NEUTRAL] Yes, covered percentage and frequency for panel and FMX.
[AGENT][NEUTRAL] Yes, percentage is 80%, uh, frequency is once every 5 years.
[CUSTOMER][NEUTRAL] Once in 5 years, percentage is 80 basic.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] They both share
[AGENT][NEUTRAL] Yes, they do.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] What about rosy?
[AGENT][NEUTRAL] Uh, profy, that's, uh, is once every 6 months, and that is under preventative, so 100%.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] 4910 is not a coverage procedure under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1208
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 3881.
[AGENT][NEUTRAL] 1208 is not covered either.
[CUSTOMER][NEUTRAL] Is it due to age limit?
[AGENT][NEUTRAL] No, it is simply not a covered procedure under this plan.
[CUSTOMER][NEUTRAL] 2391
[AGENT][NEUTRAL] 2391 is covered under that is basic, so 80%.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So maximum of 1 each tooth per 24 months and replace existing if in place for 24 months.
[CUSTOMER][NEUTRAL] Does it downgrade?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And on 3330.
[AGENT][NEGATIVE] No, uh, that's not going to be covered under this policy.
[CUSTOMER][NEUTRAL] 9944
[AGENT][NEGATIVE] That one is not going to be covered either.
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] 2740
[AGENT][NEUTRAL] 2740 is not a covered procedure.
[CUSTOMER][NEUTRAL] 0, 2962.
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEGATIVE] No, 2962 is not covered.
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEUTRAL] I'm sorry, that was 4341?
[CUSTOMER][POSITIVE] That is right.
[AGENT][NEUTRAL] OK, uh, that's not going to be a covered procedure under this policy.
[CUSTOMER][NEUTRAL] And 6010 implants, not covered, right?
[AGENT][NEUTRAL] That is correct. Implants are not covered under this policy.
[CUSTOMER][NEUTRAL] 6056 and 59.
[AGENT][NEUTRAL] Neither of those policies or excuse me, neither of those procedures are covered under this policy?
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] That one is not covered?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] That one is not covered either.
[CUSTOMER][NEUTRAL] any.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about 6740 and 5214?
[AGENT][NEUTRAL] 6740 is not covered. Uh, what was the other one? I'm sorry?
[CUSTOMER][NEUTRAL] 5214.
[AGENT][NEUTRAL] No, 5214 is not a covered procedure either.
[CUSTOMER][NEUTRAL] Uh, or is it covered on this policy, orthodontics?
[AGENT][NEUTRAL] No, orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] Is it due to wage limit or is not covered at all on this plan?
[AGENT][NEGATIVE] It is not covered at all under this plan.
[CUSTOMER][NEUTRAL] Any history for this patient at all?
[AGENT][NEUTRAL] What was that? I'm sorry?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Any history for this patient at all?
[AGENT][NEUTRAL] I have no history on file for this number.
[CUSTOMER][NEUTRAL] And what about the fax? Is it on its way?
[AGENT][NEUTRAL] It is, yes, I did just send it a little bit ago.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, perfect. And [PII], can I have a reference number for
[CUSTOMER][NEUTRAL] For this patient as well.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, ma'am, that's all. Thank you so much. Bye-bye.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Uh, ma'am, at my end, I can see the payer ID is 60801. OK, you gave the right one. Perfect then. Thank you so much.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, alright, no problem, have a great day.
[CUSTOMER][NEUTRAL] And can you, uh, uh, can you make sure that I will receive the fax? Can you send it again? Cause I haven't received it yet.
[AGENT][POSITIVE] Yeah, it can take about 10 minutes or so, but I can go ahead and send it again for good measure. You should be getting it here pretty soon.
[CUSTOMER][POSITIVE] OK, I appreciate that. Thank you so much. Bye-bye.
[AGENT][NEUTRAL] All right. Of course. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.