AccountId: 011433970860
ContactId: 74e0bc1a-9e61-494c-9e38-31ab7ca7f3e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 800590 ms
Total Talk Time (AGENT): 245198 ms
Total Talk Time (CUSTOMER): 150944 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/74e0bc1a-9e61-494c-9e38-31ab7ca7f3e8_20250508T21:00_UTC.wav
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[CUSTOMER][NEUTRAL] you know.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. This is [PII] calling from today'sent. Can you please check on patient eligibility and benefits for dental services?
[AGENT][NEUTRAL] Uh, sure, I can assist you with the eligibility and benefits. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] Thank you. What's the name of the facility you're calling from, from my notes?
[CUSTOMER][NEUTRAL] Uh, the, uh, today's dental.
[AGENT][NEUTRAL] What's the name again? I'm sorry.
[CUSTOMER][NEUTRAL] Today's dental, today, today's dental.
[AGENT][NEUTRAL] Today, today's dental, OK.
[AGENT][NEUTRAL] All right, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Patient ID number is 02558891.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have a specific questions or you need a full breakdown of benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am. Is this plan is active?
[AGENT][NEUTRAL] Um, yes, we have an effective date of [PII]. Bear with me. That is [PII]. [PII] is the effective date. It is active at the moment and this is a basic dental.
[CUSTOMER][NEUTRAL] OK, ma'am. What is the uh endodontics, periodontics, oral surgery are covered or not, ma'am?
[AGENT][NEUTRAL] No, Major service is not covered. So endodontics, periodontics, prosthodontic repair, and oral surgery, crowns, bridges, or um any implants or ortho are not covered.
[CUSTOMER][NEUTRAL] Restorative services are covered or not?
[AGENT][NEUTRAL] Which service?
[CUSTOMER][NEUTRAL] Restorative services, fillings.
[AGENT][NEUTRAL] Uh, fillings, yes, yes. That's part of the basic.
[CUSTOMER][NEUTRAL] Uh, 80% or uh?
[AGENT][NEUTRAL] OK, let me go ahead and give you a breakdown. So for preventative this cover 100%, radiograph FMX is 80, basic expense and basic restorative is 80.
[CUSTOMER][NEUTRAL] Oh, radiographic X-rays are 80%. Am I correct, ma'am?
[AGENT][NEUTRAL] Radiograph FMX and basic expenses 80% correct.
[CUSTOMER][NEUTRAL] Oh, OK, ma'am. Diagnostic and routine preventative is 100%.
[AGENT][NEUTRAL] Preventative is 100%.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, what is the annual max for the plan?
[AGENT][NEUTRAL] OK, let me get that information. One moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. We have a calendar year maximum of $500 with the $50 deductible.
[CUSTOMER][NEUTRAL] OK, ma'am. What is the remaining maximum available for this patient?
[AGENT][NEUTRAL] OK. As of today, she has not used her benefits for [PII]. She still has the full amount available.
[CUSTOMER][NEUTRAL] OK. Any history on file for this patient which affects the frequency?
[AGENT][NEUTRAL] You said any history?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the last um x-ray 2:30 was done on
[AGENT][NEUTRAL] It's the [PII].
[AGENT][NEUTRAL] The last prophy was done on [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The last panel was [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The last bite wing was [PII], and the last oral evaluation was on [PII].
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, so, uh, is 0140 is eligible or not?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it's limited to two or evaluation procedures and any combination of 120, 140, 150, or 160 per 12 month period.
[AGENT][NEUTRAL] Um, so let me see.
[AGENT][NEUTRAL] OK, so she did the last one on [PII], and it's two for 12 month period. So yeah, she's, she can do another one.
[CUSTOMER][NEUTRAL] OK, ma'am. 23911 2392 is eligible?
[AGENT][NEUTRAL] 2391.
[AGENT][NEUTRAL] So 2391, which is um gonna be under basic restorative, is 80% and it replaced is existing in place for 24 months. So replace existing only in place for 24 months.
[CUSTOMER][NEUTRAL] So 2391 is not eligible now.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] It is a
[AGENT][NEUTRAL] It is because to
[CUSTOMER][NEUTRAL] Uh sorry, ma'am. It is eligible or not, ma'am?
[AGENT][NEUTRAL] Yes, 2391 is a filling, which is under the basic restorative and it replace existing only in place for 24 months.
[AGENT][NEUTRAL] And I don't see one in the history.
[CUSTOMER][NEUTRAL] Oh, it is eligible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Eligible for 80%.
[AGENT][POSITIVE] 80%, correct.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, 2392 also eligible for 80%.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, OK. So the remaining is also 500 max.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] $500 max.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, ma'am. Can you please send me the details through fax?
[AGENT][NEUTRAL] Sure, what's the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yes, ma'am. What is the fee schedule for this plan, ma'am? Yeah, is this comes under uh connection dental or?
[AGENT][NEUTRAL] And you're looking for a network?
[CUSTOMER][NEUTRAL] No, appreciate it.
[CUSTOMER][NEUTRAL] See, fish head.
[AGENT][NEUTRAL] Mm, I'm not understanding you.
[CUSTOMER][NEUTRAL] Fish, uh, F, F for uh uh.
[AGENT][NEUTRAL] Reschedule.
[AGENT][NEUTRAL] Fee schedule? OK, for the fee schedule, if the provider participates with Carrington, they can use their fee schedule for Carrington.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you today?
[CUSTOMER][NEUTRAL] That's it, ma'am.
[AGENT][POSITIVE] OK, thank you for calling APO. Have a good day. Bye-bye.