AccountId: 011433970860
ContactId: 6cfb9592-aeff-42ea-8428-f8d226ef149d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451179 ms
Total Talk Time (AGENT): 180077 ms
Total Talk Time (CUSTOMER): 138121 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/6cfb9592-aeff-42ea-8428-f8d226ef149d_20250609T18:53_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from South Loop Dental Specialists, and I was calling to um receive benefit and eligibility information for patients.
[AGENT][NEUTRAL] Hey, [PII], happy to check benefits and eligibility. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 50576
[AGENT][NEUTRAL] Thank you. And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right. Thank you.
[CUSTOMER][NEUTRAL] Oh sorry, patient's name, uh, patient's birthday is [PII]. Sorry about that. I think I gave you the policy holder's birthday.
[AGENT][NEUTRAL] No, that's OK. Yeah, that was the policyholder, it's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so patient is active. Uh, the effective date on here is gonna be [PII].
[AGENT][NEUTRAL] And if you guys need us to send a fax back we can or I can verbally give you a breakdown whatever works best.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, sure, now, um, I can definitely take the fact that, um, now, does it have procedure codes listed there because we're specialty office, so most of our verification is to the procedures that we render.
[AGENT][NEUTRAL] It does have a list of all the procedure codes that are covered under the member's plan. Um, if it's not listed on the fax back then it's not a covered benefit.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Got it OK and then can you um let us know if we're within the network for the plan?
[AGENT][NEUTRAL] See here.
[AGENT][NEUTRAL] All right, so it looks like this patient's policy does not require a network for usage. It does, uh, participate in the Carrington PPO network plan pays that looks like by UCR.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] All righty. And uh history is there for us as well.
[AGENT][NEUTRAL] And so I'm gonna show you his.
[CUSTOMER][NEUTRAL] Um, previous treatment history.
[AGENT][NEUTRAL] No, the fax back won't have history. I can check history for you if you need me to.
[CUSTOMER][NEUTRAL] Um, yes, um, if you can let me know if the patient is eligible for a full mouth X-ray or a panoramic X-ray.
[AGENT][NEUTRAL] OK, let's see last time that phone.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like they did have X-rays back on [PII].
[AGENT][NEUTRAL] Um, FMX does have a limitation on frequency of once every 5 years, so they would not be eligible.
[CUSTOMER][NEUTRAL] OK. Uh, how about for, uh, limited, uh, problem focus exam, 0140?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, uh, there's one let me see OK.
[AGENT][NEUTRAL] Alright, so that does carry a limitation of once every.
[AGENT][NEUTRAL] Gracious, uh, once or limited to 2 for 12 months. Let me see if I see any of those on file. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so looks like they would be eligible for um that I don't see that history on file at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um on the fact that does it have like frequencies for um those services and like um for like scaling and plant ro planning does it let us know if all four quads are allowed in the same visit?
[AGENT][NEUTRAL] Um, I will tell you it does generally this patient plan is only preventative and basic, so any per maintenance is gonna be considered major. It's not gonna be covered.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Alrighty, um, it is something else I am forgetting to ask you.
[CUSTOMER][NEUTRAL] Oh, I can't help it when I forget.
[AGENT][NEUTRAL] Do you need the allowed amount for the year or anything like that?
[CUSTOMER][NEUTRAL] Is that, is that gonna be on the fax back too?
[AGENT][NEUTRAL] It'll give the calendar your max and deductible, but I can let you know what they've met it, yeah, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, got you. I, I can, uh huh.
[AGENT][NEUTRAL] The calendar year maximum is $500 per covered person with a $50 deductible.
[AGENT][NEUTRAL] Uh, this patient has met their deductible out of the $500 balance or max, excuse me, they have $45.20 remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if I can have your claims mailing address.
[AGENT][NEUTRAL] Yeah, absolutely. claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII] City, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is gonna be [PII].
[CUSTOMER][NEUTRAL] And how about the e-claims payer ID?
[AGENT][NEUTRAL] Payer ID is gonna be 60801.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And yes, I'll take that fax back for us.
[AGENT][POSITIVE] Perfect. What's a good fax?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright, give me about 5 minutes and you should have that. Is there anything else I can check on for you?
[CUSTOMER][POSITIVE] Uh, no, that'll be it for me. Thank you so much. I appreciate your time.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.