AccountId: 011433970860
ContactId: 7ac270e2-5556-4c8d-8e7d-cd8a5bd35c10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514217 ms
Total Talk Time (AGENT): 229344 ms
Total Talk Time (CUSTOMER): 153615 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/7ac270e2-5556-4c8d-8e7d-cd8a5bd35c10_20250616T13:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. How are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm good. I'm just trying to see if um this patient has dental benefits and um if you have out of network benefits.
[AGENT][POSITIVE] OK, I'm happy to check benefits for you, [PII]. What is the patient's policy number? Do we have that?
[CUSTOMER][NEUTRAL] 02609027
[AGENT][NEUTRAL] All right. And then, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so patient is active. Their effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like the member's plan does participate in the Carrington PPO network. However, a provider within that network is not provided, um, otherwise it looks like it just pays off of UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you do a breakdown for me for dental benefits?
[AGENT][POSITIVE] Yeah, absolutely I can verbally give you one, send you a fax back, whatever works best for you.
[CUSTOMER][NEUTRAL] Can we do both?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Um, and for out of network benefits, uh, they're different frequent, uh, percentages.
[AGENT][NEUTRAL] No, it would just run off of UCR like there's because there's no network required.
[CUSTOMER][NEUTRAL] OK, and would he be responsible for the difference that it doesn't pay at?
[AGENT][NEUTRAL] Yeah, I mean, generally we don't advise on patient responsibility we leave that up to the provider facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just trying to make it as easy as possible and for the patient to understand.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, no, no worries. And then what else did you need from the fax back just the um percentages and.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The percentages, the frequencies, the annual max, and the payer ID?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, so the calendar year maximum, let me get that for you.
[AGENT][NEUTRAL] All right, calendar year max is gonna be $500 and then they do have a $50 deductible. Uh, patient has not met either, so they have both remaining for the year so far.
[CUSTOMER][NEUTRAL] OK, does the deductible apply to all services or just basic and major?
[AGENT][NEUTRAL] Just a basic and this plan does not have major, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, preventative is gonna be covered at 100% of UCR.
[AGENT][NEUTRAL] And then basic is gonna be at 80%.
[CUSTOMER][NEUTRAL] OK, is there a waiting period?
[AGENT][NEUTRAL] No, no waiting period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, go ahead.
[CUSTOMER][NEUTRAL] Uh, do fillings downgrade or do you, um, they pay ass?
[AGENT][NEUTRAL] Um, pay as is, there's no downgrade.
[CUSTOMER][NEUTRAL] OK, and do they have a frequency?
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] No frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is covered at basic?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Basic is pretty much.
[AGENT][NEUTRAL] Do you have any codes that you need me to check specifically or?
[CUSTOMER][NEUTRAL] Yeah, um, PA is the 0220.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] 4346.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] And um 4355.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 7210 or 7140?
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] OK, so 0220 is gonna be covered under basic, so that's gonna be at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How many are allowed?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, there is no
[CUSTOMER][NEUTRAL] Because other code would be 0230.
[AGENT][NEGATIVE] Yeah, it doesn't show any sort of limitation, just that it falls under basic at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 4346.
[AGENT][NEGATIVE] I do not see 4346 listed, so therefore it would not be covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Uh, the same for 4910, not listed, so therefore it's not covered.
[AGENT][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] I'll just assume
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, pero is not covered.
[AGENT][NEUTRAL] Yeah, no, that would all be considered major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's easy for me.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What about the um the extraction 7140 and 7210.
[AGENT][NEUTRAL] Let's see, 7140 is covered um under basic at 80%. It looks like it does carry a limitation, maximum one time per tooth.
[CUSTOMER][POSITIVE] I hope so.
[AGENT][NEUTRAL] Yeah, I know, right?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] When, uh, asked me, she goes, they don't grow back, sweetie. I was like, oh, good point.
[AGENT][NEUTRAL] I know, right? I know, it's, yeah, like silly why they have to put that in there, but yeah, that's, that's what it says.
[CUSTOMER][NEUTRAL] And then uh the surgical extractions, I'm assuming that's major.
[AGENT][NEUTRAL] Yeah, that's major, so it's not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does the FMX or panel fall under um basic?
[AGENT][NEUTRAL] Yes, it does. So it's all, yeah, it's at 80%. Uh-huh.
[CUSTOMER][NEUTRAL] The 02 OK.
[CUSTOMER][NEUTRAL] And what about the limited exam, the 0140?
[AGENT][NEUTRAL] 01400.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't show 0140 listed on here.
[CUSTOMER][NEUTRAL] We'll take that as it's not covered.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then you did ask for the, the payer ID. Did you still need that, you know? I'm sorry.
[CUSTOMER][NEUTRAL] And um are there is.
[CUSTOMER][POSITIVE] Yes, please, you're good.
[AGENT][NEUTRAL] It's, it's 60801.
[CUSTOMER][NEUTRAL] OK, and the frequencies, is it twice in the calendar year or once every 6 months or 2 and 12 months?
[AGENT][NEUTRAL] So for cleanings it's once every 6 months, oral evaluations are 2 for 12 months.
[AGENT][NEUTRAL] Bite wings or once per 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then FMX and Pao or once every 5 years.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, and can I get it, oh, do you need the fax number?
[AGENT][NEUTRAL] Mhm. Absolutely. Go ahead.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2251.
[AGENT][NEUTRAL] OK. Give me about 5 minutes and you should have that. Anything else I can check?
[CUSTOMER][NEUTRAL] No, that was it. Can I get a reference number please [PII]?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with today's date. My name again is [PII], so that's [PII] [PII], and then today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Perfect thank you and you have a great day.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye.