AccountId: 011433970860
ContactId: 5077bd0d-26e0-4b34-8af0-07918f8c1bbf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 797960 ms
Total Talk Time (AGENT): 258802 ms
Total Talk Time (CUSTOMER): 193152 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/5077bd0d-26e0-4b34-8af0-07918f8c1bbf_20250502T14:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, this is [PII] calling from um a provider's office, and I need to verify dental benefits.
[AGENT][NEUTRAL] OK, I can
[AGENT][NEUTRAL] Uh, with the benefits, Miss [PII], may I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the name of the facility, the dental office?
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] Center for Cosmetic and sedation dentistry.
[AGENT][NEUTRAL] OK, thank you very much. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So the patient's name is [PII]. It[PII] [PII] Last name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the ID number is 02609083.
[AGENT][NEUTRAL] OK, let me look her up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. The effective date of her policy is 4.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you give me your fax number, I can send you a fax back with the benefit breakdown for you.
[CUSTOMER][NEUTRAL] OK, because I can't get a verbal?
[AGENT][POSITIVE] Uh, you, you can, yes ma'am. Let me look it up real quick. Let me get that fax back pulled up for me so I can answer your questions.
[AGENT][NEUTRAL] Give me just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I have it pulled up now.
[CUSTOMER][NEUTRAL] OK, so, um, the first question I have is, is the insurance name APL or Carrington?
[AGENT][NEUTRAL] OK, the insurance company is APL, but we do work through Carrington, although the insured does not have to go to a network, a PPO Carrington PPO network.
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][NEUTRAL] OK, so do you show our office in or out of network?
[AGENT][POSITIVE] You'll be in network you'll be fine um this policy can be used anywhere.
[CUSTOMER][NEUTRAL] OK, so what fee schedule do we do we use?
[AGENT][NEUTRAL] You use the US um you use CR.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Then um.
[CUSTOMER][NEUTRAL] Can I get the maximum?
[AGENT][NEUTRAL] Yes ma'am, the maximum per calendar year and this is just to verify benefits. It's not a guarantee of payment is $500 and they have a $50 deductible, which let me see if that's been met yet.
[AGENT][NEUTRAL] They still have their 50
[AGENT][NEUTRAL] Deductible left to pay and they still have their full $500.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Does the deductible apply to preventive and diagnostics?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, is there a waiting period or missing tooth cloth?
[AGENT][NEUTRAL] There is a missing tooth clause and there's no waiting period for preventative radiographs or basic restorative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, a payer ID please.
[AGENT][NEUTRAL] The Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK and then um is this a calendar year plan or um fiscal year plan?
[AGENT][NEUTRAL] It's calendar year from January to January they get new benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so preventative is at 100.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, basics at 80 and major.
[CUSTOMER][NEUTRAL] Perio and oral surgery, is that 50?
[AGENT][NEUTRAL] Um, basic restorative, this policy does not have a major on it. It's just, uh, basic, preventative, basic, and basic restorative. The preventative is, as you know, is 100%. The basic is 80%, and then the basic restorative is also 80%.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEUTRAL] Um, is Pao covered?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The periodontic oral evaluation.
[CUSTOMER][NEUTRAL] Well, no, like the 4341 SRP deep cleaning.
[AGENT][NEUTRAL] OK, let me look. The code is 4341.
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No ma'am, that's not on the fax back so it's not a non-covered procedure.
[CUSTOMER][NEUTRAL] Honey, what is your location?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Is oral surgery covered?
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] Um, I have 7140, um, 7220, and 7230.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEGATIVE] That's not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for exams, um, do all exams share frequency?
[AGENT][NEUTRAL] Oh, let me see.
[CUSTOMER][NEUTRAL] Probably since you
[AGENT][NEUTRAL] OK, so on the um frequency for cleaning is once every 6 months. Oral evaluation is 2 every 12 month period, bite wings once every 12 months, and then full mouth X-rays and panoramics once every 5 years.
[CUSTOMER][NEUTRAL] I need a ID.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Doctor [PII].
[CUSTOMER][NEUTRAL] Henderson Mill Dental.
[CUSTOMER][NEUTRAL] OK and you said bye wings were um.
[CUSTOMER][NEUTRAL] Once every 12 months?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Are limited exams separate from the oral exams or do all exams share frequency?
[AGENT][NEUTRAL] Do you have a code for the limited? and I'll look and see.
[CUSTOMER][NEUTRAL] Yes, uh D0140.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEGATIVE] It's not on the fax back, so it's non-covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about D0150?
[AGENT][NEUTRAL] That is on the fax back um is considered preventative and let me read you the exclusion.
[AGENT][NEUTRAL] Limited to 2 oral evaluation procedures in any combination.
[AGENT][NEUTRAL] Per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, what about code uh D 1208?
[AGENT][NEUTRAL] I'm checking.
[AGENT][NEGATIVE] That's not on the fax back so it's non covered.
[CUSTOMER][NEUTRAL] What about 1351?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And, um,
[AGENT][NEUTRAL] Let me read you the exclusions.
[AGENT][NEUTRAL] Maximum of 1 procedure every 36 months limited to a dependent child under the age of [PII].
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Is there any ortho coverage of these 8040?
[AGENT][NEUTRAL] No, ma'am. This does not have orthodontics.
[CUSTOMER][NEUTRAL] OK, and then the claims mailing address is [PII]?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] I use the policy number as the ID number of 02609083.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK and then can I have um.
[CUSTOMER][NEUTRAL] Oh wait, do you have any history on file?
[AGENT][NEUTRAL] Let me look on him. He just got his policies. Let me check.
[AGENT][NEUTRAL] Or she did.
[AGENT][NEGATIVE] No, there's no history on file so far.
[CUSTOMER][NEUTRAL] OK and then your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] And then reference number?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] You're welcome Miss [PII]. Is that everything I can help you with today?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] OK, well, you have a wonderful weekend and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright thanks.
[CUSTOMER][POSITIVE] Alright thank you