AccountId: 011433970860
ContactId: 6b564a32-1837-4b03-9b10-d13d7e96f39c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514158 ms
Total Talk Time (AGENT): 219673 ms
Total Talk Time (CUSTOMER): 194985 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/6b564a32-1837-4b03-9b10-d13d7e96f39c_20250212T15:40_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] Hi [PII], my name is [PII]. I'm calling from a dental office to um get some verification eligibility and benefits for patients.
[AGENT][NEUTRAL] OK, well, I can help you with both the eligibility and the benefits. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] [PII] and the policy is 02582673.
[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] You want the member or the patient?
[AGENT][NEUTRAL] Um, uh, either or.
[CUSTOMER][NEUTRAL] OK, so the patient is [PII] Broker. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII]. And let me see what type of policy they have. Hold on one moment.
[AGENT][NEUTRAL] And did you have particular questions about the fax back or you just needed a copy sent to you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, can I just get a a breakdown over the phone or do I have to get a fax?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no, it doesn't. It's the same information. I'm just reading it to you.
[CUSTOMER][NEUTRAL] OK, wait, yeah, let's just do it over the phone so I don't have to wait since the patient's already here. So is there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is there a particular um.
[CUSTOMER][NEUTRAL] Is there a name for the employers? Do they have a a group name?
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] The group name is Oxford.
[AGENT][NEUTRAL] Global Resources LLC.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and is Carrington the the name of the dental insurance or is it APL? I'm not really sure who it is.
[AGENT][NEUTRAL] So it is
[AGENT][NEUTRAL] So, American Public Life is the insurance company. The carrier is Carrington. It's on the Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so, so send claims to the [PII]?
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] Do you have a payer ID or do we have to mail claims?
[AGENT][NEUTRAL] No, we have a payer ID and a fax number. I can give you both if you need it.
[CUSTOMER][POSITIVE] That'd be great.
[AGENT][NEUTRAL] OK, so the payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So does this plan run on a calendar year or something else?
[AGENT][NEUTRAL] Yes, it is a calendar year. Um, the calendar year max is $500 per covered insured.
[CUSTOMER][NEUTRAL] Any deductible?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm. The deductible is $50 up to $150 per family and does not, does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods or missing tooth cloths?
[AGENT][NEUTRAL] There is a missing tooth cloth. There's no waiting period because the policy doesn't cover major expenses. Major for us is endodontic, periodontic, proteodontic, and oral surgery.
[CUSTOMER][NEGATIVE] So major is endo perio and oral surgery, so no coverage for those.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, since we're not in network with the Carrington network or whatever, um, how will you reimburse at the UCR or some type of other fee schedule?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's the same. The benefits are the same even if you're not a Carrington provider.
[CUSTOMER][NEUTRAL] So that's UCR.
[AGENT][NEUTRAL] 8% of allowable, um, so it's just a standard fee schedule.
[CUSTOMER][NEUTRAL] OK, alright, so your percentages for diagnostic and preventive?
[AGENT][NEUTRAL] So preventative is at 100%?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiograph, FMX, um, basic and basic restorative are all at 80%.
[CUSTOMER][NEUTRAL] Uh, let's see, and are your exams at 100 or are they at 80?
[AGENT][NEUTRAL] Exams, like the evaluation like 00120?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's preventative, 100%.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, and um you said for fillings do they downgrade uh the post the composite on the.
[AGENT][NEUTRAL] Um, so there's no downgrades.
[CUSTOMER][NEUTRAL] Um, moler's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see, so there's no plans.
[CUSTOMER][NEUTRAL] I take it there's no ortho or anything like that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Uh, do you allow any fluoride or sealants?
[AGENT][NEUTRAL] Yes, fluoride and sealants are both under preventative at 100%.
[CUSTOMER][NEUTRAL] Is that for any age?
[AGENT][NEUTRAL] Um, there's child and adult, um, depending on the code, uh, if it's a child, well, hold on, she's an adult, so hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] And how often?
[AGENT][NEUTRAL] Uh, one procedure for 12 months.
[CUSTOMER][NEUTRAL] And the sealants?
[AGENT][NEUTRAL] Seal, let me see.
[AGENT][NEUTRAL] Limited to dependent children under age [PII], 1 procedure per 36 months, and applications made to molar teeth only.
[CUSTOMER][NEUTRAL] OK, do you cover, um, a periodontal maintenance at all, the 4910?
[AGENT][NEUTRAL] 49 cents.
[CUSTOMER][NEUTRAL] Or do you just not do any perio?
[AGENT][NEUTRAL] No, no perio at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And as far as a simple extraction, the 7140, is that covered?
[AGENT][NEUTRAL] Mhm. Under basic at 80.
[CUSTOMER][NEUTRAL] That OK, and what's your frequency for exams and cleanings and the X-rays?
[AGENT][NEUTRAL] So pro fees are once every 6 months?
[AGENT][NEUTRAL] Oral evaluations are 2 for 12 month period.
[AGENT][NEUTRAL] Bite wings are once per 12-month period.
[AGENT][NEUTRAL] Full mouth X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] 106 OK.
[CUSTOMER][NEUTRAL] OK, well I think that's everything um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And [PII], uh.
[AGENT][NEUTRAL] And did you need a copy of the fax faxed to you?
[CUSTOMER][POSITIVE] Um, sure, that wouldn't hurt.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, well, I will go ahead and send this over to you now and [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Can I just get a reference number for our call? Oh, and also she hasn't used any benefits yet this year, has she?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[CUSTOMER][NEUTRAL] I forgot to ask that.
[AGENT][NEUTRAL] Um, no, she hasn't used any of the benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for the call reference number, it'll just be my name and today's date. Um, so that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][POSITIVE] You're welcome [PII]. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.