AccountId: 011433970860
ContactId: 4849b018-c9bd-43a8-a7c8-cb340cae2b4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619820 ms
Total Talk Time (AGENT): 244786 ms
Total Talk Time (CUSTOMER): 134442 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/4849b018-c9bd-43a8-a7c8-cb340cae2b4b_20250618T13:15_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Boggy Creek Dental Care. I'm trying to verify dental benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] It is 02635289.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, um, so member will be, give me one moment.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII]. I'm calling for a dependent, [PII].
[AGENT][NEUTRAL] All right, and may I have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. And did you need a copy of the fax back or you have particular questions about it?
[CUSTOMER][NEUTRAL] Yeah, I need a copy of fax back and then um I need to verify if we are considered in network.
[AGENT][NEUTRAL] Alright, so this policy is on the Carrington PPO network. Um, however, if your provider is not a Carrington provider, the benefits are still the same. Um, if you need the number to Carrington to to confirm if your provider is in network, I can give you that number as well, but it's, we just don't have access to it because it's a different company.
[CUSTOMER][NEUTRAL] OK, what is the phone number for Carrington?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on the
[CUSTOMER][NEUTRAL] And are you able to help me with a full breakdown?
[AGENT][NEUTRAL] Sure, I can go over the fax back for you um before I fax it. Do you want me to fax it first?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment and that's attention [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So I'm faxing it over to you now.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so you should be receiving that shortly. Um, so you'll see the calendar year maximum deductible, all the percentages, frequencies, exclusions, all three ways to file a claim, and then there's a list of covered codes. Um, if the code you're looking for is not on this list, it wouldn't be covered by the policy.
[AGENT][NEUTRAL] Um, did you have particular questions about the sex bag?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, can you tell me um what are the.
[CUSTOMER][NEUTRAL] What is the maximum deductible and coinsurances?
[AGENT][NEUTRAL] OK. Um, so the calendar year max is $500 per insured.
[AGENT][NEUTRAL] The deductible is $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any benefits used?
[AGENT][NEUTRAL] No, not yet.
[CUSTOMER][NEUTRAL] And this is calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, any waiting periods?
[AGENT][NEUTRAL] Um, no waiting periods. This policy only covers preventative and basic.
[CUSTOMER][NEUTRAL] What is preventative fall under?
[AGENT][NEUTRAL] Like what is considered preventative?
[AGENT][NEUTRAL] Or percentages.
[CUSTOMER][NEUTRAL] Yeah, like what is the coinsurance is 100%.
[AGENT][NEUTRAL] It's, yes, preventative is at 100%, radiographs and basic is 80%.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] A major for us includes
[CUSTOMER][NEUTRAL] And those are all X-rays are 80%?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, go ahead.
[AGENT][NEUTRAL] I was just gonna let you know major major expenses for us include endodontic, periodontic, prosodontic, and oral surgery codes.
[CUSTOMER][NEUTRAL] So endo perio and oral surgery are considered under major which is no coverage.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I have the frequencies for like exam cleaning?
[AGENT][NEUTRAL] So, cleanings are once every 6 months?
[AGENT][NEUTRAL] Oral evaluations are 2 for 12 month period.
[AGENT][NEUTRAL] Fight wings are once per 12 month period.
[AGENT][NEUTRAL] Full mouth X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] What about PA's 0 to 20?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's covered under basic at 80%?
[CUSTOMER][NEUTRAL] Any frequency?
[AGENT][NEGATIVE] No, not for that code.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And Florid, what is the frequency on that?
[AGENT][NEUTRAL] So fluoride is under preventative, so that's at 100%. Um, let me see for adults.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Maximum of 1 procedure per 12-month period and limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK, and then what about sealants 1351?
[AGENT][NEUTRAL] The ceilings are also covered under preventative, um, maximum of 1 procedure for 36 months.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] OK, and then is there a downgrade for poster composites?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] And that's covered at 80%?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and what is the frequency for replacement on fillings?
[AGENT][NEUTRAL] Do you have a code for that?
[CUSTOMER][NEUTRAL] 2391.
[AGENT][NEUTRAL] Um, it's under basic restorative, so that's at 80%, um, replace.
[AGENT][NEUTRAL] Excuse me, replace existing only if in place for 24 months. And what's the other, maximum of 1 each tooth per 24 months.
[CUSTOMER][POSITIVE] OK perfect alright.
[CUSTOMER][NEUTRAL] All right, can you tell me the group name and group number please?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So the group number is 70101.
[AGENT][NEUTRAL] And the group name is Superior.
[AGENT][NEUTRAL] Skilled trades.
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] OK and then what is the um.
[CUSTOMER][NEUTRAL] Address for insurance claims.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And what about a payer ID please?
[AGENT][NEUTRAL] 60
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Perfect, thank you so much and then can you just confirm bye wings are also covered at 80%?
[AGENT][NEUTRAL] Um, but we are under preventative at 100%.
[CUSTOMER][NEUTRAL] OK, so it's just the panel FMX MPAs correct?
[CUSTOMER][NEUTRAL] That are 80%.
[AGENT][NEUTRAL] I'm not sure what the abbreviations, but it's basic, basic restorative and radiograph and FMX expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and any ortho coverage?
[AGENT][NEUTRAL] Um, no, there's no orthodontic treatment.
[CUSTOMER][NEUTRAL] And the deductible for $50 does it apply to all services or that's just for basic?
[AGENT][NEUTRAL] Just for basic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK thank you so much have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's all have a great day bye bye.
[AGENT][POSITIVE] Alright, you also thanks for calling AT.