AccountId: 011433970860
ContactId: 4a3228c2-e450-4eb1-aba0-7cf4a0e0e54c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317230 ms
Total Talk Time (AGENT): 147656 ms
Total Talk Time (CUSTOMER): 89510 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/4a3228c2-e450-4eb1-aba0-7cf4a0e0e54c_20250520T16:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I am calling to get some information on the patient's policy.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits or eligibility. And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You know
[AGENT][POSITIVE] Thank you, Ms. [PII]. May I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from, from my notes?
[CUSTOMER][POSITIVE] Picking and smiles.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It is gonna be 02623675.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And how may I assist you with this number, [PII]?
[CUSTOMER][NEUTRAL] I'm calling. I'm looking at his insurance card and it says to submit claims to PO Box 248,950.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because I, I know we had one that was PO Box 925 that's why I was questioning it.
[AGENT][NEUTRAL] Oh, OK, yeah, that's an old address so we don't have that building any longer in [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK good alright and then as far as the basic services, what's all included in basic?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, basic, um, includes like the fillings and simple extraction. Um, so endodontics, periodontics, prosthodontic repair, or surgery, they're all major service, so those are not gonna be covered.
[CUSTOMER][NEUTRAL] OK great and as far as the 0140 and 0220, is that considered basic or preventative?
[AGENT][NEUTRAL] I think that's gonna be basic. Let me double check. 014019.
[AGENT][NEUTRAL] Let me put the schedule up in one moment.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] OK, 0140.
[AGENT][NEUTRAL] Yeah, that's gonna be on the basics.
[CUSTOMER][NEUTRAL] Both of them?
[AGENT][NEUTRAL] The other one was 0150.
[CUSTOMER][NEUTRAL] 0140 and the other one was 0220.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 022020.
[AGENT][NEUTRAL] Yes, that's also on the basic. Mhm.
[CUSTOMER][NEUTRAL] Alright, and what's the schedule do y'all go by?
[AGENT][NEUTRAL] If the provider participates with Carrington, we, um, you can utilize their fee schedule. If you don't, then we pay on the usual and customer rates UCR.
[CUSTOMER][NEUTRAL] OK, and how many pro fees and exams they get a year?
[AGENT][NEUTRAL] OK, so for the pro fees, we have once every 6 months. For the oral evaluation, it's 2 for 12 month period.
[CUSTOMER][NEUTRAL] The only evaluation I'm sorry, is what 2?
[AGENT][NEUTRAL] 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK, and does that share with the 0140?
[AGENT][NEUTRAL] Yes, um, it's going to be, uh, limited to two oral evaluation procedures in any combination of 120, 140, 150, or 160 per 12 month period.
[CUSTOMER][NEUTRAL] OK, and what is the frequency on the bite wings and FMX?
[AGENT][NEUTRAL] Mm. All right. So for the bite wings, we have once every 12 months. And for the full X-rays or panels, it's once every 5 years.
[AGENT][NEUTRAL] So for the um uh panels and my X-rays, the 210, 277, and 330, they all share frequency up to 5 years. And then we have for the bite wings 270, 272, and 274, and that's one for 12 months.
[CUSTOMER][NEUTRAL] OK, and do y'all cover the 0367?
[AGENT][NEGATIVE] No, that one is not covered.
[CUSTOMER][NEUTRAL] OK, and what is the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] I'm sorry, 60801?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, that's all.
[AGENT][POSITIVE] OK, thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.