AccountId: 011433970860
ContactId: 84073aa5-6719-4da7-970f-ae3d3c80db2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592400 ms
Total Talk Time (AGENT): 133423 ms
Total Talk Time (CUSTOMER): 149291 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/84073aa5-6719-4da7-970f-ae3d3c80db2e_20250423T15:00_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] here. And I'm calling on behalf of the dental office to check benefits and eligibility for one patient today. Can you please help me with that?
[AGENT][POSITIVE] Yes, I can help with benefits and eligibility, and I'm sorry, I missed your name.
[CUSTOMER][POSITIVE] Thank you. My name is [PII].
[AGENT][POSITIVE] [PII]. OK, thank you.
[AGENT][NEUTRAL] Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Sure. It is [PII] and it's a direct line.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, policy number is 02592893.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's a basic outline of the policy. Um, I can send a fax that contains everything that's covered under the policy if you would like me to do that or we can go over it too on the phone.
[CUSTOMER][NEUTRAL] Uh yes, actually, I would like to verify over the call because uh I just called for this patient, uh, then they told me that uh they'll send me a fax, but I have not received it till now, and the patient is already on the clinic, so like would like to verify for the call.
[AGENT][NEUTRAL] OK, um, effective date [PII]. Currently active, no term date?
[AGENT][NEUTRAL] And then do you need benefits?
[CUSTOMER][POSITIVE] Thank you. And uh
[CUSTOMER][NEUTRAL] Oh yes. Actually, can you help me if the dentist is in or out of network?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, so I don't have network information. Um, they do utilize Carrington.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I, I, I don't know if you're in or out of network with Carrington. I can give you their number.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And the group name, group number?
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] Group number is 70,070.
[AGENT][NEUTRAL] And group name is Carlton Bay.
[CUSTOMER][POSITIVE] Thank you. And just to
[CUSTOMER][NEUTRAL] Thank you. And [PII], just to confirm, the annual max is $500 and the deductible is $50. Nothing has been used or met, right?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the offer and the media services are not covered, right?
[AGENT][POSITIVE] Uh, that's correct.
[CUSTOMER][NEUTRAL] Thank you. And I have a set of procedure code. Just wanted to check the percentage and frequency. Can I provide you one at a time or all that works?
[AGENT][POSITIVE] Uh, one at a time is good.
[CUSTOMER][NEUTRAL] [PII]. Thank you. 0120.
[AGENT][NEUTRAL] Uh, one time, 0120. Let me see.
[AGENT][NEUTRAL] 2 evaluations in a 12-month period.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] A max of 1 for 6 months.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] Um, that is once per twelve-month period.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] Uh, one per 5-year period.
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, it's basic. There's no frequency.
[CUSTOMER][POSITIVE] Thank you. 4 1208.
[AGENT][NEUTRAL] I don't show that code listed.
[CUSTOMER][NEUTRAL] 1208 not listed? OK. 1351.
[AGENT][NEUTRAL] And that is
[AGENT][NEUTRAL] Preventative 1 for 36 months, limited to children under age [PII], permanent molars only.
[CUSTOMER][NEUTRAL] Sorry, what was the frequency again?
[AGENT][NEUTRAL] Uh, one for 2 or 36 months, I'm sorry.
[CUSTOMER][NEUTRAL] That is yes. And the uh and the age limit?
[AGENT][NEUTRAL] 14, children under 14, permanent molars only.
[CUSTOMER][POSITIVE] Thank you, thank you. 1206.
[AGENT][NEUTRAL] I don't have that code listed.
[CUSTOMER][POSITIVE] Thank you. 4341.
[AGENT][NEUTRAL] I don't have that code listed.
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] I don't show that code listed.
[CUSTOMER][NEUTRAL] 70 to 10 at least 7140.
[AGENT][NEUTRAL] Um, it's basic.
[CUSTOMER][NEUTRAL] 46. 3330?
[AGENT][NEUTRAL] 1 for 5-year period.
[CUSTOMER][NEUTRAL] 5 years.
[CUSTOMER][NEUTRAL] Just to confirm, 3330 is basic.
[AGENT][NEUTRAL] Oh, OK, 3330, that's, I don't show that code listed.
[CUSTOMER][NEUTRAL] 4260.
[AGENT][NEUTRAL] I don't show that code listed.
[CUSTOMER][NEUTRAL] Mhm. 9248.
[AGENT][NEUTRAL] I'm sure that code listed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 1354.
[AGENT][NEGATIVE] Don't show the code listed.
[CUSTOMER][NEUTRAL] 110
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] 1510
[AGENT][NEUTRAL] That's preventative and
[AGENT][NEUTRAL] Limited to children under age [PII], max of 1 per lifetime per quadrant or arch.
[CUSTOMER][NEUTRAL] Preventive you told me.
[AGENT][NEUTRAL] Yes, per.
[CUSTOMER][NEUTRAL] 1575.
[AGENT][NEUTRAL] I don't have that code listed.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEUTRAL] That listed.
[CUSTOMER][NEUTRAL] Not listed means not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And is there any history for this patient?
[AGENT][NEUTRAL] Or what?
[CUSTOMER][NEUTRAL] Um, history, anything on the preventive service?
[AGENT][NEUTRAL] Uh, no, I don't have anything listed.
[AGENT][NEUTRAL] Oh no history.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for helping me. Can you help me with the reference number?
[AGENT][NEUTRAL] That's just my name and today's date.
[CUSTOMER][POSITIVE] Perfect and I hope you have a wonderful day ahead. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APLU as well. Bye-bye.