AccountId: 011433970860
ContactId: 69f20665-404c-432a-9c82-21d52c2c87f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1143770 ms
Total Talk Time (AGENT): 417152 ms
Total Talk Time (CUSTOMER): 500315 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/69f20665-404c-432a-9c82-21d52c2c87f9_20250130T14:28_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hey, hi, [PII]. This is [PII]. I'm calling from provider's office. I just need to verify the dental benefit for my patient. So, can you help me with that?
[AGENT][NEUTRAL] I can help you with that dental benefits, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A callback number that is going to be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Uh, the policy number is going to be 024.
[CUSTOMER][NEUTRAL] 972-58
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK. Patient's name is going to be [PII].
[CUSTOMER][NEUTRAL] Um, and the date of birth is [PII].
[AGENT][POSITIVE] All right. Thank you, [PII]. It would be my pleasure to assist you with those dental benefits for [PII]. I am showing that her policy is active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] And the detail I need for this one is, OK. May I know is it, uh, is it a calendar year or fiscal year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it runs from Jan to December.
[CUSTOMER][NEUTRAL] OK. All right. And for this one also, can you tell me if my provider is in or out of network?
[AGENT][NEUTRAL] Network participation is not required. This policy does participate in the Carrington PPO network.
[AGENT][NEUTRAL] But it's not required.
[CUSTOMER][NEUTRAL] OK, that's required.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Just a second, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That work
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Station is not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right participation not required. And, but you told me a fee schedule, right? What was that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It it participates in the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Carrington.
[AGENT][NEUTRAL] So if your provider is a Carrington provider, he would use the Carrington fee schedule. If not,
[AGENT][POSITIVE] The dental provider reduced their own fee schedule and we pay a percentage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Carrington
[CUSTOMER][POSITIVE] All right. Great. So for this one now, uh,
[CUSTOMER][NEUTRAL] Can you help me with the pay ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, also, can I have the group name and group number?
[AGENT][NEUTRAL] Yes, sir. The group name is.
[AGENT][NEUTRAL] Oxford, and that's O X F O R D.
[AGENT][NEUTRAL] Global resources.
[CUSTOMER][NEUTRAL] Global resources.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for this one.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The group number is
[AGENT][NEUTRAL] 70052
[CUSTOMER][NEUTRAL] 70052. OK.
[AGENT][NEUTRAL] Yes, who?
[CUSTOMER][NEUTRAL] 70052.
[CUSTOMER][NEUTRAL] And for now, yeah, can I have the percentage for the diagnostic preventative, basic in nature?
[AGENT][NEUTRAL] Now, major is not covered under this policy that does include oral surgery, prosthodontic repairs, endodontic services, and periodontal services. Those are not covered under this policy. This policy does cover preventative expenses at 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of allowable and radiographs, FMX basic and basic restorative expenses at 80% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, endeddontics, pedodontics, and oral surgeries is also not covered because of the major, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Only preventative and basics. Uh, so, um, may I have the annual maximum and the deductibles with the used amount?
[AGENT][POSITIVE] Yes, I, I can provide that for you. Also, [PII], just in case we do have a breakdown, I can fax for you if you're interested in that as well.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, but yeah, for, for timing, can, can I just get the details on the call, if possible? Yeah.
[AGENT][NEUTRAL] Verbal, sure. That's, that's not a problem at all. It's just going to offer that in case you were interested. Now, all benefits given over the phone is a verification of coverage, not a guarantee of payment. This policy provides a $500.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Per calendar year benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a $50 deductible up to $150 per family.
[AGENT][NEUTRAL] And the deductible does not apply to preventive services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, all right. Anything used?
[AGENT][NEUTRAL] At this time, for [PII], we have um no claims on file for [PII].
[CUSTOMER][NEUTRAL] OK. OK. Great. Now, can you help me with uh some questions like, is there any waiting period or missing tooth cloths?
[AGENT][NEGATIVE] There is a missing tooth cloth. There is no waiting period.
[CUSTOMER][MIXED] Yeah, waiting period, but there's a missing tooth cloth. OK.
[CUSTOMER][POSITIVE] And great.
[CUSTOMER][NEUTRAL] And is there any fee schedule? Uh, that's Carrington, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] If in
[AGENT][NEUTRAL] If in network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Carrington
[CUSTOMER][NEUTRAL] If out, so that would be UCR.
[CUSTOMER][NEUTRAL] Use
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, if it will be out of network, so it would be UCR, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] User and customary, OK, um, great. And for this one, can you tell me the assignment of benefit? Does the payment go to provider or patient?
[AGENT][NEUTRAL] It's standard, um, if provider files benefits go to pro provider.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Provider.
[CUSTOMER][NEUTRAL] And for this one,
[CUSTOMER][NEUTRAL] Maximum does apply to preventatives. Yes, they do. OK. Great. And it's going to be billed to the medical or dental?
[AGENT][POSITIVE] Yes, it does.
[AGENT][NEUTRAL] Dental.
[CUSTOMER][NEUTRAL] Dental Street, OK.
[CUSTOMER][NEUTRAL] And for this one, are there any fillings for the downgrade, uh, any downgrade for the fillings? I'm sorry.
[AGENT][NEGATIVE] Downgrade.
[AGENT][POSITIVE] Not a problem. We do, we do not downgrade.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, there's no downgrade. Great. And yeah, there's not applicable questions. OK. Now, can you provide me the or maximum and the deductible with the used amount, also the age limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ortho treatment is not covered under this policy.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] OK, great. Uh, so, can you help me with the preventative history, uh, from this year or from previous year if it's affecting the frequency?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see on.
[AGENT][NEUTRAL] 624 24.
[AGENT][NEUTRAL] Um, there was the.
[AGENT][NEUTRAL] Trophy
[CUSTOMER][POSITIVE] Perfect [PII], OK.
[AGENT][NEUTRAL] Bite wings.
[CUSTOMER][NEUTRAL] Like things.
[AGENT][NEUTRAL] An oral exam.
[CUSTOMER][NEUTRAL] Oral exam.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the history that would have, yeah, that's it. 624.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and there's no FMX or panel or anything which can affect the frequency.
[AGENT][NEUTRAL] That's correct. No history of FMX or Peno.
[CUSTOMER][NEUTRAL] OK, great. Um, now, I do have some procedure codes, so if you can help me with the codes also.
[AGENT][NEUTRAL] All right. How many kids do you have, Lucas?
[CUSTOMER][NEUTRAL] I don't know. There are like 38 maybe and uh most of them are basic, no, no, no. Uh it's major, right? After the basics, yeah. So,
[CUSTOMER][NEUTRAL] Fewer preventatives, few basics than nature.
[AGENT][NEUTRAL] OK, so the major is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh, which code should I provide you? Like, um,
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK. You told me the pre uh pre like periodics, antidontics, and oral surgery is also under major which is not covered. OK, I'll just provide you the preventative and basic. OK.
[AGENT][NEUTRAL] Mhm. And prosgenic repair.
[AGENT][POSITIVE] OK, if you wanna give them to me all at once we can do it that way.
[CUSTOMER][NEUTRAL] OK, all at once? Sure. So the codes are going to be, should I start?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. The codes are going to be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0230.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02 72.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And 0350.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0431
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 11:10
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 1206.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then 1351.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2391, I'm sorry, 2392.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then 2393.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 2394.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then these are like crowns.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] No crowds.
[CUSTOMER][NEUTRAL] OK, yeah. And SRPs will be not covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] OK, that will be not covered. Uh.
[CUSTOMER][NEUTRAL] What about scaling with inflammation 43, 46?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, um, and PO maintenance?
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] OK, then it's all um like.
[CUSTOMER][NEUTRAL] Surgical implants, no bone graft, TMJ's, OK.
[AGENT][NEGATIVE] TMJ is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Uh, what about the emergency, uh pain treatment?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9110. OK, that's not covered. Um, so yeah, I think this will be all.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh, excuse me, I'm sorry, the 9110 is covered.
[CUSTOMER][NEUTRAL] OK. That, that's correct?
[AGENT][POSITIVE] Yes, sir, it is. I apologize.
[CUSTOMER][NEUTRAL] OK. So that, that one got up. That's fine. OK. So, and uh deep sedation, like 92 to 23.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. So I think that will be all then after these, all the 9 codes or 6 calls, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. I am ready.
[AGENT][POSITIVE] Thank you. So,
[CUSTOMER][POSITIVE] Yeah, great.
[AGENT][NEUTRAL] For the frequencies, let me give you those so that might help you. Um, for the profies is once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By wings or once for 12 month period.
[CUSTOMER][NEUTRAL] Uh, 21, 0, just a second, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, OK. Yeah. 2 for 12 months. Bings were 1 per 12 months, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then FMX and panos are once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] FMXpan once every 5 years.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the 0 120 is under preventive.
[AGENT][NEUTRAL] And that's the oral evaluations to for 12 months. The 10,140 is under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, included with the the 0150 is under preventive.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 0210.
[AGENT][NEGATIVE] Is not covered.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, I'm sorry, that's the um 0210, the FMX, yes, that is covered under major.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Major
[AGENT][NEUTRAL] Mhm. I'm sorry, under basic.
[CUSTOMER][NEUTRAL] The F
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] I apologize
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] I was looking at too many things at once, I apologize. So that's under basic.
[CUSTOMER][NEUTRAL] OK. Yeah, that's fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 0220.
[AGENT][NEGATIVE] It's under basic, no.
[AGENT][NEUTRAL] Frequency that is for the 0 to 30 as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no frequency basic. OK.
[AGENT][NEUTRAL] 02 72, the bite wings are under major and it's one for 12 months.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh sorry. Well, is, is, is it basic or preventative? Not major.
[AGENT][POSITIVE] I said Major again. I am so sorry.
[CUSTOMER][NEUTRAL] Yeah, that's fine, yeah.
[AGENT][NEUTRAL] It's under preventive.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I do apologize. I was skipping ahead. The 0 3:30.
[CUSTOMER][NEUTRAL] That's fine. OK.
[AGENT][NEUTRAL] The pano is under basic.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Again, that's once every 5 years.
[CUSTOMER][NEUTRAL] Yeah, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0350 is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0431.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the 0110 is under preventive.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, that's once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The 1206 is not listed on this fee schedule, not covered.
[CUSTOMER][NEUTRAL] OK, not covered?
[AGENT][NEUTRAL] That's right, not the 12:06.
[AGENT][NEUTRAL] Now the 1208 is, but not 1206.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 1206 is not covered. OK.
[AGENT][NEUTRAL] Mhm. The 1351 is under preventive and it's under the years under the age of 14 permanent molars only once every 36 months.
[CUSTOMER][NEUTRAL] Under 14, once every 36 months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Uh, the 2392.
[AGENT][NEUTRAL] Is under basic.
[AGENT][NEUTRAL] And that is
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And get the frequency.
[AGENT][NEUTRAL] Maximum one time per tooth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2393 is the same frequency covered under basic.
[AGENT][NEUTRAL] As well as 2394.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then of course the 9110.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's covered under basic.
[CUSTOMER][NEUTRAL] Basic 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 80%, OK.
[CUSTOMER][NEUTRAL] Um, great. Uh, I just wanna confirm, uh, the frequency for 0150 is same as 0120, 2 for 12 months.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEGATIVE] OK, 2 for 12 months. And there is no frequency for
[AGENT][NEUTRAL] That's the 0 120.
[AGENT][NEUTRAL] I'm sorry, go ahead
[CUSTOMER][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] No, no, you can tell me.
[AGENT][NEUTRAL] It's the 0 120, 150 and 140.
[AGENT][NEUTRAL] They share frequencies.
[CUSTOMER][NEUTRAL] 0140 also shares?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. It's under basic and mhm.
[AGENT][NEUTRAL] For the oral evaluation, yeah.
[CUSTOMER][NEUTRAL] OK, OK. It's on the basic and the same frequency is 2 per 12 month, 0 140 also. OK, great.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I think we are all set. Um, no questions, nothing left. No.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] That's great. OK, yeah, that's all. Just can I have your name and the card reference number?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And [PII], it's been a pleasure to assist you with that breakdown. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, no, that's all for today. Thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day, [PII].
[CUSTOMER][NEUTRAL] Uh-huh, and the call reference number? I'm sorry.
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK, great. So thank you so much, [PII], again.
[AGENT][POSITIVE] My pleasure and thank you, [PII] for calling APL. Take care.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.