AccountId: 011433970860
ContactId: 7e2c441e-4244-4a2d-990b-3e171018f73e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 798900 ms
Total Talk Time (AGENT): 315671 ms
Total Talk Time (CUSTOMER): 195960 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/7e2c441e-4244-4a2d-990b-3e171018f73e_20250528T14:31_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, good morning. This is [PII]. I'm calling on behalf of the provider's office looking for dental benefits.
[AGENT][NEUTRAL] OK, [PII], so you're needing dental benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes, ma'am. And for our dental policies, we send fax back of the member's benefits, and I'll be happy to do that for you.
[CUSTOMER][NEUTRAL] So uh
[CUSTOMER][NEUTRAL] Mhm, so you don't provide them call for the benefits?
[AGENT][NEUTRAL] And what is
[AGENT][NEUTRAL] I'm so sorry, what was your question?
[CUSTOMER][NEUTRAL] So you don't provide on call for the benefits?
[AGENT][NEUTRAL] Are you, if you're wanting them over the phone instead of a fax back that has all of their benefit information on there, is that what you're asking?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. What is your callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02596488
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] And any information that is provided today will be a verification of benefits and not a guarantee of payment. You will use my name that I gave you and today's date as your call reference number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you will end up filing a claim for this member with APO once the claim has been processed, you can check claim status in our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and before we start, can I have the group name and the group number for this number?
[AGENT][NEUTRAL] Uh, not until I verify some additional information with you first. So just a moment.
[CUSTOMER][NEUTRAL] They kiss your.
[AGENT][NEUTRAL] OK. And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth I have it on [PII].
[AGENT][NEUTRAL] Thank you. So I do show here is the subscriber on this general plan and it is active. What's an effective date of [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group name is Management analysis.
[AGENT][NEUTRAL] And utilization incorporated.
[CUSTOMER][NEUTRAL] Is that management analysis.
[AGENT][NEUTRAL] Mhm. Again, it's management, analysis and Utilization Incorporated.
[CUSTOMER][NEUTRAL] Uh, can you spell it out for me, please?
[AGENT][NEUTRAL] The entire thing, the entire group name? or just one of the words?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, the second
[CUSTOMER][NEUTRAL] The second word
[AGENT][NEUTRAL] Analysis, A N A L Y S I S.
[CUSTOMER][NEUTRAL] And the last word is it incorporated or just corporated?
[AGENT][NEUTRAL] INC Incorporated Management analysis and utilization.
[AGENT][NEUTRAL] In.
[CUSTOMER][NEUTRAL] OK. And what about the group number?
[AGENT][NEUTRAL] 70056.
[CUSTOMER][NEUTRAL] OK, just to confirm, is that 70056?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and also can I have the claim mailing address and the payer ID number?
[AGENT][NEUTRAL] Yes, ma'am. All of that information should be on his ID card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, first, can you please check if
[AGENT][NEUTRAL] Do you have a copy of his ID card?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] OK. And also, can you please check if the provider will be in or out of network with the patient's phone?
[AGENT][NEUTRAL] Uh, you would need to speak to someone with Carrington to verify that this plan participates in the Carrington PPO network. However, they are not required to utilize a provider within the Carrington network.
[CUSTOMER][NEUTRAL] OK, so they will use the guaranting uh network, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And for
[AGENT][NEUTRAL] This plan participates with Carrington PPO network.
[CUSTOMER][NEUTRAL] OK, and for the check, will it goes to the patient's address of the provider?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] For the check, will it go to the patient's address or the provider?
[AGENT][NEUTRAL] It typically will go to whomever files the claim unless there's a different assignment of the benefits on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also, can I have the coverage for preventative, basic, and major?
[AGENT][NEGATIVE] There's no benefits for major. The only benefits on this plan are for preventative and basic.
[CUSTOMER][NEUTRAL] OK. So for endoper and or surgery also, it's not covered, right?
[AGENT][MIXED] That is correct. Only only benefits for preventative and basic.
[CUSTOMER][NEUTRAL] OK, and also I do have some quotes for the coverage and frequency. Could you please help me with that?
[AGENT][NEUTRAL] And those are under basic or preventative?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the first code?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] OK, are you wanting?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The coverage and frequency.
[AGENT][NEUTRAL] That falls under preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is limited to 2.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Limited to two oral evaluation procedures in any combination of 0 120, 0140, 0150, 0160 per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 0180 also, it's the same, right?
[AGENT][NEGATIVE] 01 is not covered.
[CUSTOMER][NEUTRAL] 0180.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] That falls under preventative?
[AGENT][NEUTRAL] And the limitation is max of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] OK. 4910.
[AGENT][NEUTRAL] That is not covered?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2991.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 0274
[AGENT][NEUTRAL] Preventative limited to one bite wing X-ray procedure 027002720274 per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0220
[AGENT][NEUTRAL] That's under basic with no limitation?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] That falls under the radiograph and FMX.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is also limited to one X-ray procedure, the same as I read you a while ago, 20,210, 0277, or 0330 per five-year period.
[CUSTOMER][NEUTRAL] OK. 1351.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] That's under preventative, maximum 1 procedure for 36 months, limited to dependent children under the age of [PII], and applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] 1208, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Is it due to age limit?
[AGENT][NEGATIVE] It's not covered at all under this plan.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me
[AGENT][NEUTRAL] I'm sorry, what was that one again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is that for?
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] Night guy
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's only again, only preventative and basic, no other services covered.
[CUSTOMER][NEUTRAL] 7953.
[CUSTOMER][NEUTRAL] OK. 7953.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And the last code that I have is 2391.
[AGENT][NEUTRAL] That falls under basic restorative.
[AGENT][NEUTRAL] And that is going to be
[AGENT][NEUTRAL] Replace existing only if in place for 24 months, and maximum 12th for 24 months.
[CUSTOMER][NEUTRAL] OK. And for the code 2391, do they downgrade?
[AGENT][POSITIVE] No, no downgrades.
[CUSTOMER][NEUTRAL] And is there any missing 2 calls in the waiting period?
[AGENT][NEGATIVE] There is a missing tooth cloth, no wedding periods.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also, can I have the history or any last date of service?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] There is no, uh, I don't believe there's any history. Let me double check that.
[AGENT][NEUTRAL] No history on file?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also uh for the code 43, 42, and 1110, can it be done on the same day?
[AGENT][NEUTRAL] Yes, uh 43.
[AGENT][NEUTRAL] 4342, is that correct? Was that one of them?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And thank you, that will be all for today.
[AGENT][NEGATIVE] And 43, 41 is not covered.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL [PII] and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.