AccountId: 011433970860
ContactId: 7ae21b38-da58-4b42-b1d1-0fe483b5eb14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380950 ms
Total Talk Time (AGENT): 124844 ms
Total Talk Time (CUSTOMER): 156285 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/7ae21b38-da58-4b42-b1d1-0fe483b5eb14_20250430T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. This is [PII] calling on behalf of dental office to check on eligibility and benefits on a patient. Can you help me on that?
[AGENT][POSITIVE] I'm happy to check on eligibility and benefits. What's the patient policy number?
[CUSTOMER][NEUTRAL] Uh, uh, I have 02604976.
[AGENT][NEUTRAL] And if I could get patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have the patient as [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. So, patient is active, uh, effective date is [PII].
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] 325. And sir, this will be a single coverage of family?
[AGENT][NEUTRAL] Single?
[CUSTOMER][NEUTRAL] And group name?
[AGENT][NEUTRAL] I'm sorry, what was your question again?
[CUSTOMER][NEUTRAL] Uh, uh, group name.
[AGENT][NEUTRAL] Management analysis and utilization.
[CUSTOMER][NEUTRAL] analysis.
[CUSTOMER][NEUTRAL] And utilization.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] The group number.
[AGENT][NEUTRAL] 70056.
[CUSTOMER][NEUTRAL] Mm, OK. Got it. And sir, this is a dental policy for this patient, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And uh for this type of plan, is it uh like the plan for the network, like can you check the provider you will be in or out of network like that?
[AGENT][NEUTRAL] There's no network required for utilization. It does participate in the Carrington PPO network planned hay by UCR.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so it's a UCR plan, right? by Kennington, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Carrington UCR where are you just a moment.
[CUSTOMER][NEUTRAL] Mm, [PII]. Thank you for your patience. Let me select that. Kennington UCR. And yeah, what will the claim's mailing address here?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Let's see. [PII]. OK. [PII] [PII]. Thank you. Got it too. And [PII], for this plan, this plan runs on a calendar year?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Deductible and maximum, please.
[AGENT][NEUTRAL] Uh, the yearly maximum is $500. The calendar year deductible is $50 per covered insured. Patient has both remaining.
[CUSTOMER][NEUTRAL] OK. And deductible applies to basic and major year?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And for the patient orthodontics, is that a covered benefit?
[AGENT][NEGATIVE] Uh, no, it is not.
[CUSTOMER][NEUTRAL] OK. And any waiting period or missing tooth loss?
[AGENT][NEUTRAL] Uh, policy does have a missing tooth clause. There's no waiting period.
[CUSTOMER][NEUTRAL] Understood. And, and the major service, implant service, is it a covered benefit here?
[AGENT][NEGATIVE] This plan has no major services and plants are not covered.
[CUSTOMER][NEUTRAL] No major services. OK. I just want to make sure services like endodontics, periodontics, oral surgeries and extraction, are they covered or no?
[AGENT][NEUTRAL] No, they are not only simple extraction.
[CUSTOMER][NEUTRAL] Only simple extraction. Thank you for clearing that. OK. Now, frequency uh for the periodic exam and cleaning.
[AGENT][NEUTRAL] Uh, Profy is once every 6 months, oral evaluation, 2 for 12 months.
[AGENT][NEUTRAL] Fight wings once.
[CUSTOMER][NEUTRAL] OK. What about by rings?
[AGENT][NEUTRAL] Once for 12 months, full mouth X-rays and panos or once every 5 years.
[CUSTOMER][NEUTRAL] OK. And is the patient is eligible for fluoride?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Florida is limited to dependent children aged [PII], so patient would not be eligible for that.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. And I have a service as oral cancer screening. Is it a covered benefit?
[AGENT][NEUTRAL] Do you have a code for that?
[CUSTOMER][NEUTRAL] 0431.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] 0431 is not listed therefore it's not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK. Uh, P maintenance, is it a covered benefit 4910?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEGATIVE] OK, not a good one.
[CUSTOMER][NEUTRAL] OK. And SRP as well, not covered here, right? 4341.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. And any downgrades on this one?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] For fillings like that? OK. And for the whole plan, the predetermination, it's mandatory or just recommended?
[AGENT][NEUTRAL] Um, you can do a predetermination, it's not required.
[CUSTOMER][NEUTRAL] OK, understood. So that's all, sir, uh, on this one, now you can just provide me the reference number.
[AGENT][NEUTRAL] Call references my name with my last initial, then today's date. My name again is [PII], that's [PII] initial to my last name is [PII] and then today, today's date.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, understood. So once again, thank you so much for your help. That's all the questions I have for today. Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.