AccountId: 011433970860
ContactId: 4a0dcc43-9232-40bd-a806-0f639d4ece0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451519 ms
Total Talk Time (AGENT): 160004 ms
Total Talk Time (CUSTOMER): 156905 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/4a0dcc43-9232-40bd-a806-0f639d4ece0b_20250213T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Aspen Dental, and I'm trying to get eligibility and benefits on the patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] option 2.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have 02558649.
[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] [PII], date of birth is [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, um, it's been effective since [PII].
[AGENT][NEUTRAL] And did you need a
[CUSTOMER][NEUTRAL] And I said I
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Is it a single or family plan?
[AGENT][NEUTRAL] This is an individual policy.
[CUSTOMER][NEUTRAL] Is there a group number?
[AGENT][NEUTRAL] 70036.
[CUSTOMER][NEUTRAL] OK, and is there a group name?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just for the call, the information provided is a verification of benefits, not a guarantee of payment. And the group name is Crown Services INC.
[AGENT][NEUTRAL] Doing business as crown staffing.
[CUSTOMER][NEUTRAL] OK, and um, are we following the Carrington uh fee schedule?
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why is it not coming up for me? Let's see.
[CUSTOMER][NEUTRAL] CAR.
[AGENT][NEUTRAL] Oh, C A R E I.
[CUSTOMER][NEUTRAL] C A R E I. There we go. Thank you. I was struggling. Um, is it a um PPO plan or a discount plan, or?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, it is on the Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] OK, what is the claims address?
[AGENT][NEUTRAL] [PII] 248.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 248.
[CUSTOMER][NEUTRAL] 248-248.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Yeah, I just have so many of these to to scroll through sorry.
[AGENT][NEUTRAL] 000, OK.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm. [PII], [PII].
[CUSTOMER][POSITIVE] Perfect. And does the patient have out of network um benefits also?
[AGENT][NEUTRAL] Um, there's no out of network benefits. The the benefits are the same whether it's a Carrington provider or not.
[CUSTOMER][NEUTRAL] OK, um, if benefits are exhausted, do participating provider discount supply?
[AGENT][NEUTRAL] Um, no, the claim would most likely be denied if the benefits are exhausted.
[CUSTOMER][NEUTRAL] OK, is there a deductible on the plan?
[AGENT][NEUTRAL] Yes, there's a $50 deductible.
[CUSTOMER][POSITIVE] It applies to basic and major.
[AGENT][NEUTRAL] Yes, and it does not apply to preventative. This policy also doesn't cover major services. Um, major for us is endodontic, periodontic, proteodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So endoperiodontics, oral surgery, no dentures, no implants?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And has that deductible been met year to date yet?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEUTRAL] Um, so far, um, the deductible has not been met yet.
[CUSTOMER][NEUTRAL] OK, is there a max on the plan?
[AGENT][NEUTRAL] Yes, $500 per covered insured.
[CUSTOMER][NEUTRAL] Nothing been used, is it a calendar or contract?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any or no ortho coverage I'm assuming, right?
[AGENT][POSITIVE] Correct. Yes, you're correct.
[CUSTOMER][NEUTRAL] What, what's the percentage of coverage for diagnostic preventative?
[AGENT][NEUTRAL] Preventative is covered at 100%.
[CUSTOMER][NEUTRAL] And basic
[AGENT][NEUTRAL] Um, 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now is Crown and Bridge considered major?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Any waiting periods on the plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, perio maintenance, it, um, is it not covered at all?
[AGENT][NEUTRAL] Right, um, Pario is not covered.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] What about simple extractions?
[AGENT][NEUTRAL] Simple extractions covered under basic.
[CUSTOMER][NEUTRAL] OK, any missing tooth calls?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the frequency for an exam and cleaning?
[AGENT][NEUTRAL] Exam is 2 for 12-month period, cleaning is once every 6 months.
[CUSTOMER][NEUTRAL] What about bite wings?
[AGENT][NEUTRAL] Fight wings are once per 12 month period.
[CUSTOMER][NEUTRAL] FMX and Pao.
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about fluoride?
[AGENT][NEUTRAL] Fluoride is covered under preventative at 100%.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Frequency?
[AGENT][NEUTRAL] Depending on, is it a
[AGENT][NEUTRAL] Oh, she's an adult. OK, so hold on one moment.
[CUSTOMER][NEUTRAL] An adult?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum of 1 procedure per 12-month period and limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] OK, per maintenance none SRP not covered.
[CUSTOMER][NEGATIVE] Dentures not covered, bridges not covered, crowns not covered.
[CUSTOMER][NEUTRAL] Um, and do you downgrade any of your metals, um, for fillings?
[AGENT][NEUTRAL] No, we don't.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And can I get a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much and I appreciate it.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.