AccountId: 011433970860
ContactId: 493602ad-8fb2-4a10-b6c3-75b76bc8d8d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 739090 ms
Total Talk Time (AGENT): 302735 ms
Total Talk Time (CUSTOMER): 261318 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/493602ad-8fb2-4a10-b6c3-75b76bc8d8d2_20250411T15:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Uh, very good morning. Uh, [PII], this is [PII], and I'm looking for patient's dental benefits and eligibility on, uh, on a recorded line. And yes, how are you doing today, today?
[AGENT][POSITIVE] I'm doing great and I am so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] Um yes, my name is uh [PII] mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, and thank you for that.
[CUSTOMER][NEUTRAL] And may I know the spelling of your name as well?
[AGENT][NEUTRAL] The spelling of my name is [PII] yes, and go ahead with that policy number, please, sir.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And yes, the member ID I have here, it's uh 024.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 85,930.
[AGENT][POSITIVE] Alrighty, thank you so much for all of that information, [PII]. Let me get that pulled up and while I'm doing that, [PII], go ahead and give me a good return telephone call number please sir.
[CUSTOMER][NEUTRAL] Yes, sure. That would be [PII].
[CUSTOMER][NEUTRAL] [PII] and there's no extension?
[AGENT][NEUTRAL] Alrighty thank you so much for all that information then. Hang on just a moment. Computer is moving slow today on Friday. OK, here we go. Alright, [PII], what's your patient's name and date of birth please sir?
[CUSTOMER][POSITIVE] Most welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the patient's name that I have here. It's for patient name of uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you so much for all that information. Looks like [PII], excuse me, [PII] is the insured on this dental plan. This show the original effective date is [PII]. Patient is active and current, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want benefits. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, sir, right?
[AGENT][NEUTRAL] Alright then, let's see now, uh, what we do is a backpack of benefits.
[AGENT][NEUTRAL] Can you get that back back a benefits?
[CUSTOMER][NEUTRAL] OK, uh, like, do you also do like verbal, verbally?
[AGENT][NEUTRAL] I can do verbal. I can do verbal and fax back because it's kind of very detailed what's covered and what's not under this plan so that way you'll have it in, in, uh, writing, uh, you get the facts back of benefits because if the procedure code is not on this fax it's not covered here at all, and the only thing that would not be on this fax land would be the PPO network name and this patient is in the Carrington PPO network land.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you and yeah.
[CUSTOMER][NEUTRAL] So, uh, actually, I, I preferred it verbally if that's OK with you, because it's for verification purpose. OK OK.
[AGENT][NEUTRAL] Yeah, you
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. And of course.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] Go ahead and
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, let me get that pulled up.
[AGENT][NEUTRAL] So let's see, do you get fax because I mean I can fax it as well as do verbal in. I can do both.
[CUSTOMER][NEUTRAL] Uh, can I, can we do it verbally if that's OK with you?
[AGENT][NEUTRAL] OK, yeah, sure. OK, the maximum under this plan is $500 payable per calendar year.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] They have a $50 deductible per calendar year for basic benefit only, not preventative.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] Now this plan only covers preventative and basic. There is no major coverage here at all.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] And as well here.
[CUSTOMER][NEUTRAL] So, uh, before that, uh, is it OK if you assist me with the patient's room name, room number?
[AGENT][NEUTRAL] Let me get over to that screen. Let's see. Patient group number is 70069.
[AGENT][NEUTRAL] And the group name is ATC Healthcare Services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And as well, uh,
[CUSTOMER][NEUTRAL] What about the, uh, coverage type for this one? Is it a single or a family coverage policy?
[AGENT][NEUTRAL] Do you have any dependent names?
[CUSTOMER][NEUTRAL] No, I don't have, I just have [PII].
[AGENT][NEUTRAL] OK, because [PII] is, is who's covered.
[CUSTOMER][NEUTRAL] So it means is that an individual policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And as well here, OK. Well, uh, well, it runs on a county or fiscal year as well, I say?
[AGENT][NEUTRAL] Calendar year, yes, sir. January to December.
[CUSTOMER][NEUTRAL] OK. And as well, uh, is there any accumulations from the annual max of $500 and as well the uh individual policy, annual deductible?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let's see if she has any claims, no history at all, so she's not used any of her benefits for [PII] at all.
[CUSTOMER][NEUTRAL] OK. And uh is there any missing tooth loss waiting period as well?
[AGENT][POSITIVE] There's no waiting period because there's no major and there's no missing tooth cloths.
[CUSTOMER][NEUTRAL] OK. And so, OK, deductible applies only to basic services. OK. And uh uh-huh. So may I know the uh co-insurance for preventive and basic services? Is it like 180 or different?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, it's 180.
[AGENT][NEUTRAL] On preventative 80 basic after that $50 deductible was met, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. And as well, OK. Uh, what about the, uh, exams?
[CUSTOMER][NEUTRAL] Like, uh, periodic exams.
[CUSTOMER][NEUTRAL] The frequency since it's on the preventive.
[AGENT][NEUTRAL] Yeah, that's 2 a year. Yeah, 2 a year, mhm, 2 year, 6 months apart.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's like 2 pairs, 6 months, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And OK. What about the next one would be the uh prophylaxis?
[AGENT][NEUTRAL] Your puppy is gonna be once every 6 months as well.
[CUSTOMER][NEUTRAL] OK. Uh, what about the bite wings?
[AGENT][NEUTRAL] Once in a twelve-month period.
[CUSTOMER][NEUTRAL] OK. Uh, what about the FMX panel?
[AGENT][NEUTRAL] Uh, once every 5 years.
[CUSTOMER][NEUTRAL] OK. Uh, is it basic or major5MX panel?
[AGENT][NEUTRAL] No, it's covered under basic. There's no major at all.
[CUSTOMER][NEUTRAL] Oh yes, I'm sorry. Uh, what about the PH?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What about what?
[CUSTOMER][NEUTRAL] The periodical X-rays.
[AGENT][NEUTRAL] What's the code?
[CUSTOMER][NEUTRAL] 0220
[AGENT][NEUTRAL] Yeah, that's covered under basic.
[CUSTOMER][NEUTRAL] OK, and as well uh.
[CUSTOMER][NEUTRAL] What about the uh slow, right?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] I'm sorry, not covered because of the age limit or like simply not covered at all?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Coverage, not over age [PII] it's not covered.
[CUSTOMER][NEUTRAL] Age [PII], OK. What about the, uh, students?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See, see what's the code?
[CUSTOMER][NEUTRAL] 1351.
[AGENT][NEUTRAL] Alright, let me just make sure.
[AGENT][NEUTRAL] Yes, it is covered and it's covered under preventative.
[AGENT][NEUTRAL] And it's one procedure every 36 months.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any age limit for students as well?
[AGENT][NEUTRAL] Uh, let me make sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Limited to dependent, yes, it is that's not gonna be covered.
[AGENT][NEUTRAL] Yep, under age [PII] only.
[CUSTOMER][NEUTRAL] OK. And as well, uh, I just want to know if there's any P uh coverage like PPO and.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK. And what about this code 9248, is this a covered benefit?
[AGENT][NEUTRAL] 924-8, let's see. No, sir.
[CUSTOMER][NEUTRAL] Mhm. 7210.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] Yes, sir, under basic.
[AGENT][NEUTRAL] And the limitation is maximum one time per tooth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about this 1510?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 1510.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 1575, that is the last code.
[AGENT][NEUTRAL] 1575, not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And now, uh, will there be any downgrades for this code 2391?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] No downgrades, OK. And what about this code, uh, I mean, like, what about, oh, you didn't mention earlier that there's no history at all, nothing at all that would affect the patient's frequency, right?
[AGENT][NEUTRAL] Correct, no history at all?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh, uh, so yeah, that's good then I'm done this patient information here as well. And yeah, before we conclude here, can you assist me with the reference number as well I pay for today's call?
[AGENT][NEUTRAL] Well, is that all that I can help answer for you today, [PII]?
[CUSTOMER][POSITIVE] Oh yes, that's all the information I need for now. Thank you so much for asking.
[AGENT][NEUTRAL] Alrighty, [PII]. Yes, sir, and we don't give reference number, [PII], but you can use my name and today's date.
[AGENT][NEUTRAL] If you need to do so, OK.
[CUSTOMER][POSITIVE] Um, OK, sure, yeah, that's safe and, and then this patient. That's all the information. And thank you so much once again for assisting me today, I say. Uh, have a good one and have a good weekend as well, and bye for now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You as well, [PII], and thanks for calling APL. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.