AccountId: 011433970860
ContactId: 5f8236e3-7556-4df2-993a-ee2de712a2b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483329 ms
Total Talk Time (AGENT): 262617 ms
Total Talk Time (CUSTOMER): 127502 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/5f8236e3-7556-4df2-993a-ee2de712a2b7_20241231T14:05_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. My name is [PII]. How may I help you?
[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] calling on behalf of the dental office to check eligibility and benefits for the patient on recorded line. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking. And [PII], do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII]
[AGENT][POSITIVE] All right, thank you. And how are you today, [PII]?
[CUSTOMER][POSITIVE] I'm fine, thanks for asking.
[AGENT][POSITIVE] Good, and what is a good callback number?
[CUSTOMER][NEUTRAL] [PII] with the direct line.
[AGENT][POSITIVE] Thank you, [PII], and the policy number for the patient, please.
[CUSTOMER][NEUTRAL] It's 02510118.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Patient name is [PII] sir. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be a pleasure to assist you with eligibility and benefits for [PII].
[AGENT][NEUTRAL] And I do have a fax back I can send to you with all of the policy information if you're interested in that [PII].
[CUSTOMER][NEUTRAL] Uh, if it is possible, could you please help me verbally, please?
[AGENT][POSITIVE] Sure, I can do that as well. Now, I am showing that the policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a limited dental policy, Rey. It does not have any coverage for major services, for any major services. That includes oral surgery, prosthodontic repair, any periodontal services, and endodontic services. Those are not covered.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And uh may I know the group name and the number?
[AGENT][NEUTRAL] Sure, the group name is.
[AGENT][POSITIVE] B as in Bravo. G as in Golf, Staffing Incorporated.
[CUSTOMER][NEUTRAL] OK. And what's the group number?
[AGENT][NEUTRAL] 70019
[CUSTOMER][NEUTRAL] Got it. And uh could you please check that the provider is in network and the schedule of the provider, please?
[AGENT][NEUTRAL] So the policy participates in the Carrington PPO network. If you are a Carrington provider, you would use that fee schedule. If not, you would use your own fee schedule. We pay both in and out of network benefits the same.
[CUSTOMER][NEUTRAL] OK, so could you please just check that this provider is in network because I'm confused about the fee schedule of the Carrington. That's why.
[AGENT][NEUTRAL] Yeah, so with our policy it participates in the Carrington PPO, but it's not required. Therefore, there's no network on this policy.
[CUSTOMER][POSITIVE] OK. No problem.
[AGENT][NEUTRAL] We, it
[AGENT][NEUTRAL] Payments are not dependent upon network participation.
[CUSTOMER][NEUTRAL] OK, and uh what's the annual maximum deductible?
[AGENT][NEUTRAL] Now all benefits given over the phone is a verification of coverage, not a guarantee of payment. The calendar year max is $500.
[AGENT][NEUTRAL] There is a $50 deductible up to $150 per family, and the deductible does not apply to preventive services.
[AGENT][NEUTRAL] And at this time, [PII], there's no history on file, so he has not used any of it as benefits nor met his deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it and coordination of benefit is standard.
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] OK. Uh, is there any waiting period of missing tooth loss?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] There is a missing tooth cloth, no waiting period.
[CUSTOMER][NEUTRAL] OK. And percentage for and basic services?
[AGENT][NEUTRAL] 100% for preventive.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] 80% for basic, that includes radiographs, FMX basic basic expenses, and basic restorative expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the percentage and frequency for exam limited exam cleaning by doing FMX fluoride insulin.
[AGENT][NEUTRAL] The proceeds or once every 6 months?
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings for once for 12 month period.
[AGENT][NEUTRAL] FMX Antennas or once every 5 years.
[AGENT][NEUTRAL] And then for sealants, it's under the age of 14, permanent molars only every 36 months.
[AGENT][NEUTRAL] Fluoride is under the age of [PII] every 12 months.
[CUSTOMER][NEUTRAL] OK. And for the PS 0 to 20?
[AGENT][NEUTRAL] 0220? No frequency.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and for 0140?
[AGENT][NEUTRAL] 0140.
[AGENT][NEUTRAL] I'm checking, bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0140 is not listed, so it's not covered.
[CUSTOMER][NEGATIVE] Not good, got it.
[CUSTOMER][NEUTRAL] 4341. It's not 4, right? Because it's under period? OK.
[AGENT][POSITIVE] That's correct. That's right.
[CUSTOMER][NEUTRAL] And 4910 is also not covered?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. 2391 fillings.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 2391 is covered under basic.
[CUSTOMER][NEUTRAL] Frequency
[AGENT][NEUTRAL] Maximum of 11 each tooth per 24 months.
[CUSTOMER][NEUTRAL] Does it downgrade?
[AGENT][NEGATIVE] We do not downgrade.
[CUSTOMER][NEUTRAL] OK. Ortho is code, orthodontics?
[AGENT][NEGATIVE] No, not covered.
[CUSTOMER][NEUTRAL] And is there any recent history for the patient?
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] OK. May I have your name and reference number, please?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Reference number is my name and today's date.
[AGENT][POSITIVE] And [PII], it's been a pleasure to assist you with that breakdown. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, [PII], that's all the information needed. Thank you very much for your help and patience. Have a great day. Bye-bye and take care.
[AGENT][POSITIVE] It's been my pleasure. And thank you for calling APL [PII]. You have a wonderful day as well and a very happy New Year. Take care.
[CUSTOMER][POSITIVE] Happy New Year, [PII]. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] And uh uh hello.
[AGENT][NEUTRAL] Yes, I'm still here.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, yeah, sorry, sorry for that. One last thing, uh, may I know the insurance mailing address and the PO ID?
[AGENT][NEUTRAL] Oh sure. The address is APL Claims.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And the payer ID is 60801.
[CUSTOMER][NEUTRAL] And could you please repeat the zip code?
[AGENT][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII]. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] My pleasure to assist you, [PII]. Thank you for calling APL. You take care as well. Have a wonderful day.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye-bye.