AccountId: 011433970860
ContactId: 75a80cdc-e8b7-4c18-a588-b74448f3265a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694119 ms
Total Talk Time (AGENT): 310050 ms
Total Talk Time (CUSTOMER): 301286 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/75a80cdc-e8b7-4c18-a588-b74448f3265a_20250502T13:22_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Aspen Dental. I have a new patient like walking and I need to verify the insurance to be sure that we are in network if you can help me out.
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII], option 2.
[AGENT][NEUTRAL] OK. And I'm sorry, can I get the spelling of your name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK, thank you, Mr. [PII], and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It's uh 5 consecutive zeros after that is 2477576.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and uh the name is [PII], [PII].
[AGENT][NEUTRAL] I thank you. OK, so this is one of our basic dental policies and um let's see, so this one doesn't have any network, sure.
[CUSTOMER][NEUTRAL] Only 1 2nd. 1 2nd.
[CUSTOMER][NEUTRAL] I'm sorry. I was answering the phone. Uh, what did you say, ma'am? I'm so sorry.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, it's OK. Uh, this is one of our basic dental policies, but this one, if the provider participates with Carrington PPO, they can use their fee schedule. If they don't, it's OK, we still take it. OK.
[CUSTOMER][POSITIVE] Yes, we do.
[AGENT][NEUTRAL] All right, um, do you need?
[CUSTOMER][NEUTRAL] We do. Do you want me to give you the provider MPI just to check, but we have patients with K and PPO.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um it's OK because we're not contracted, but if you are, you can use their fee schedule so we don't have a way of, you know, looking for that. It is OK. You're welcome. Do you need any benefits or eligibility information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, yes, it's like template to view report for effective date.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you need it, um, verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Uh, yeah, I can go with you because she's waiting for me to see if we accept it if you can help me.
[AGENT][NEUTRAL] OK. OK. All right. Sure, no problem. Bear with me just a second. Let me go ahead and pull that benefit amount, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And with this one, we have a maximum of $500 per year with the $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, I cannot move to the next page. It's showing like first the effective date. I cannot go to the next page. It's like template. I'm sorry.
[AGENT][NEUTRAL] Oh, OK, OK, let me just, OK, OK. All right. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and what is her group name?
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] The group name is the.
[AGENT][NEUTRAL] OK, Creative Circle LLC.
[CUSTOMER][NEUTRAL] You said creative creative circle? I'm sorry.
[AGENT][POSITIVE] Yes, Creative circle. Mhm.
[CUSTOMER][NEUTRAL] Create
[CUSTOMER][POSITIVE] OK, creative, uh, circle.
[CUSTOMER][NEUTRAL] LLC or INC I didn't hear the last.
[AGENT][NEUTRAL] Mhm. Oh,
[AGENT][NEUTRAL] LLC
[CUSTOMER][NEUTRAL] LLC and the plan is individual or family?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me check on this one.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] This is gonna be single parent.
[CUSTOMER][NEUTRAL] Well, I just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEGATIVE] OK, let me put there asking for your phone number [PII] sorry because they're not giving me chance the next uh OK [PII].
[AGENT][NEUTRAL] Mhm it's OK.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] [PII] and this is and the insurance name you said Carrington 5 schedule, right?
[AGENT][NEUTRAL] Um, for the, I'm sorry, for the benefits you can use the Carrington fee schedule, but it's through American Public Life. So the, the claims will come to us, American Public Life. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, let me put, uh, caring, and this is PPO plan, right? Carrington PPO on the schedule. OK. And what is the claim address?
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be PO Box.
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, only one second to find it on the drop down. It's too many of them you said [PII]. OK, let me find it so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK, [PII] correct? And the payer ID is 60801?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, 60801 is the PO ID. Can you repeat that PO box?
[CUSTOMER][NEUTRAL] 248,950.
[AGENT][POSITIVE] That is correct, yeah. Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Let me go and now they're asking questions. Do you accept assignment of benefits to a non-participating provider?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and if benefits are exhausted, do participating provider discount apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK. And what is the individual deductible for the plan?
[AGENT][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] OK, and the maximum?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500? OK. The
[AGENT][NEUTRAL] Yes, 500.
[CUSTOMER][NEUTRAL] Uh, 500, did she use anything from this amount for this year?
[AGENT][NEUTRAL] Um, let me.
[AGENT][NEUTRAL] OK, so as of today for [PII], she has used $67. She has a remaining of 433 and she still has $35. Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] OK, she used
[CUSTOMER][NEUTRAL] OK, she used only I need only benefits use 67. OK, and the plan run on calendar or contract year?
[AGENT][NEUTRAL] U 67.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Calendar.
[CUSTOMER][NEUTRAL] Calendar, OK. Did she has any auto coverage or no auto?
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No. And what is the percentage for diagnostic, preventative, basic, and major?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, for this one, we have a preventative y cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic expense and basic restorative is cover 80%.
[AGENT][NEUTRAL] And there is no major, yes, 80% is for basic and basic restorative.
[CUSTOMER][NEUTRAL] 80, OK.
[AGENT][NEUTRAL] And then there's no major service are covered, so endodontics, periodontics, prosthodontic repair, and or surgeries are not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, endoperioal surgery, they're not covered. Implant is not covered, correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEGATIVE] In no crown bridges and dentures is not uh cover.
[AGENT][NEGATIVE] Correct, it's not correct.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] You said diagnostic preventative is 100, uh, basic is 80, no waiting period?
[AGENT][NEUTRAL] No, no waiting period on this one.
[CUSTOMER][NEUTRAL] And and perio maintenance 4910 coat, it's covered under preventative or it's not covered at all 4 91s not covered? OK. Do, uh, what about missing tooth cloths? Do they have missing tooth cloths?
[AGENT][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] They do? OK. And uh now I need to put not cover for crown bridges dentures, uh, SRP 4341 is not covered too, right?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Correct, it's not covered.
[CUSTOMER][NEUTRAL] OK. And now they're asking for um only frequency for exam, 01200150.
[AGENT][NEUTRAL] OK, let me get that for you. One moment.
[AGENT][NEUTRAL] OK. 90.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that is limited to two oral evaluation procedures in any combination of 120, 140, 150, or 160 per 12 month period.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, you said how many of them, for example, 2 per calendar year?
[AGENT][NEUTRAL] 2, yes.
[CUSTOMER][NEUTRAL] OK. And uh 11:10, the profy is covered under preventative, right?
[AGENT][POSITIVE] Yes, pro on the preventative, mhm.
[CUSTOMER][NEUTRAL] And the frequency for them?
[AGENT][NEUTRAL] And prop is a maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] 04 procedure, OK, 4 per 2.
[AGENT][NEUTRAL] What is 11 procedure every 6 months.
[CUSTOMER][NEUTRAL] 01 in every 6 months. I'm sorry. And by wings?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bite wings is going to be, let's see, limited to one bite wing X-ray procedure and any combination of 270, 272 or 274 per 12 months.
[CUSTOMER][NEUTRAL] OK, and FMX and panel.
[AGENT][NEUTRAL] Limited to one X-ray procedure in any combination of 2102 77 or 330 per 5-year period.
[CUSTOMER][NEUTRAL] 5 year. And Fluoride 1208, is it cover benefits or not due to the age?
[AGENT][NEUTRAL] OK, and um that one has um let's see, let me get it done.
[AGENT][NEUTRAL] OK, so for the fluoride, it's under preventative, maximum of 1 procedure for 12 months and limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Oh she's not covered. OK um thank you so much and OK and what is the reference number for the call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] OK, uh, what was your name? I'm sorry if you can spell it for me. I didn't get it.
[AGENT][NEUTRAL] It's OK. My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Thank you. So, and today that you said, OK, thank you and have a good day.
[AGENT][POSITIVE] Mm, OK. You're welcome. You as well. Thank you for calling APM. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.