AccountId: 011433970860
ContactId: 7494307a-a43e-42c2-9e1a-c85d27e29ff7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277359 ms
Total Talk Time (AGENT): 173718 ms
Total Talk Time (CUSTOMER): 85178 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/7494307a-a43e-42c2-9e1a-c85d27e29ff7_20250409T14:00_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting A. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was um calling to get some information about a patient's um dental plan that she just gave us.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I can help with benefits. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Policy number is 02596151.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, [PII] and her date of birth.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][POSITIVE] I appreciate that. I, I have to ask, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII].
[AGENT][NEUTRAL] OK, thank you. I'm just pulling that up now. OK, so it looks like uh she already heard [PII] is when it went into effect. Uh, now, what, um, how can I help you? What sort of benefits would you like to know about or is there anything in particular?
[CUSTOMER][NEUTRAL] Yeah, just her dental benefits when we look up online um it just gives us the fee schedule so I wasn't sure if this was just like a discount plan or if she we can get provided a full breakdown of benefits.
[CUSTOMER][POSITIVE] Absolutely fine thank you.
[AGENT][NEUTRAL] Well, the, the, um,
[AGENT][NEUTRAL] Uh, we don't actually have a copy of the, uh, um.
[AGENT][NEUTRAL] Uh, I'm sorry, what is it? It's, uh, the Carrington DPO fee schedule. Um, what we do is we have a program that, uh, that we utilize and it has that information in it. Now I do believe that it is online. Um, they do have their, their fee schedule, they do have it published online, but I don't have a copy of that. Uh, it's just a computer program that we use.
[CUSTOMER][NEUTRAL] No, I have that. I was just wondering how her yeah I have the fee schedule um I was just wondering how her plan works.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you mean whether there's a
[CUSTOMER][NEUTRAL] Like, does she have a maximum? Is the percentage covered?
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yes, um, so $500 for calendar year is the maximum. That's just a verification, not a guarantee of payment. Um, the, uh, um, policy, uh, pays 100% of the allowable for preventative services, 80% for basic and basic restorative, and there are no, there's no major coverage.
[AGENT][NEUTRAL] No ortho, no implants, um.
[AGENT][NEUTRAL] No endodontics, periodontal, no oral surgery, that sort of thing. So it's, it's very basic, um.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And you said the calendar year maximum is 500?
[AGENT][NEUTRAL] That's correct, yes, and, and everything goes towards that. Now, there is a $50 deductible per calendar year, um, that does not apply to the preventative services, but the preventative services, um, are those costs are taken out of that $500. So it all goes towards that $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect and so with the um you said no major coverage so then it would just be fillings um that are covered?
[AGENT][NEUTRAL] That's correct, yes, filling, simple extractions, um, that sort of thing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any frequency limits on the preventative and diagnostic services?
[AGENT][NEUTRAL] Uh, yes. Now, on the um
[AGENT][NEUTRAL] Uh, on the preventative, uh, that would be, um, cleanings or once every 6 months. It actually has to be 6 months between cleanings. The, uh, oral examinations, uh, evaluations, any of those, uh, oral evaluations, uh, 120, 140, 150, so on, 2 per calendar year.
[AGENT][NEUTRAL] Uh, the bite wings are once for 12 month period, and then the full mouth and pano are once every 5.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, I don't know whether you would already hurt and well, there is fluoride. It's actually for um uh patients uh [PII] and under. Let me just check here.
[CUSTOMER][NEUTRAL] Is there any fluoride?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yeah, it's gonna be, uh, for adults [PII] and under, for, um, uh, children, uh, [PII] and under, and sealants are, uh, [PII] and under.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I don't have any history for this individual.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK and then is there um oh no I see it on the card, the electronic payer ID.
[CUSTOMER][POSITIVE] Alrighty, I think that is all I needed.
[AGENT][POSITIVE] OK, well, if there's anything else that we can help with, please just let us know. Otherwise, thanks for contacting API. Have a good day.