AccountId: 011433970860
ContactId: 85746a73-63cb-4040-a0c5-6695a229cfbf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427350 ms
Total Talk Time (AGENT): 120348 ms
Total Talk Time (CUSTOMER): 157407 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/85746a73-63cb-4040-a0c5-6695a229cfbf_20250407T20:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] at Aqua Springs Dental. Um, I was calling about a patient's benefits.
[AGENT][NEUTRAL] OK, do you have a phone number in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, I have 02608912.
[AGENT][NEUTRAL] Thank you. Didn't you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And what's that patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII], and you were just needing benefits.
[CUSTOMER][NEUTRAL] Yes ma'am, I just wanted to see if she was active and we are in network.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date is [PII]. It is active in our network. We use Carrington's network.
[CUSTOMER][NEUTRAL] OK perfect and this is a PPO plan?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] Has she used any of her benefits?
[AGENT][NEUTRAL] Hold on just a moment now too.
[AGENT][NEUTRAL] No, ma'am, she has not.
[CUSTOMER][NEUTRAL] OK, and what is her, uh, maximum and deductible?
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment. Her deductible is $50 on everything except for preventative.
[AGENT][NEUTRAL] And the maximum is 500.
[CUSTOMER][NEUTRAL] Does that maximum go towards preventative services?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 650 is there um a family deductible?
[AGENT][NEUTRAL] 150.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um, is this gonna be based off of a calendar year or benefit year?
[AGENT][NEUTRAL] Calendar year
[CUSTOMER][NEUTRAL] OK, and is there a missing tooth clause?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, ma'am, it's not a missing tooth cloth. I'm sorry, not on this policy because major work is not covered on this policy.
[CUSTOMER][POSITIVE] OK, um perfect.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] OK, um, and then preventive is 100, what is basic?
[AGENT][NEUTRAL] 80
[CUSTOMER][NEUTRAL] 80.
[AGENT][NEUTRAL] And that is just fillings and simple extractions. Everything else is not covered.
[CUSTOMER][NEUTRAL] OK, and then for limited exams, is that included with the exam frequency?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is that gonna be twice a calendar year?
[AGENT][NEUTRAL] Every 12 months, 2 per 12 months.
[CUSTOMER][NEUTRAL] for 12 months. OK, perfect. And then for a limited is same day treatment allowed?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what is the frequency for a PA?
[AGENT][NEUTRAL] There's no frequency. It's under basic.
[CUSTOMER][NEUTRAL] Is that gonna be the same for bite wings?
[AGENT][NEUTRAL] By wings are under preventative 1 in 12 months.
[CUSTOMER][NEUTRAL] OK perfect and then uh what about an FMX?
[AGENT][NEUTRAL] Alpha Max pano and code 277, they're all under basic. They are all combined 1 in 5 years.
[CUSTOMER][NEUTRAL] OK mm.
[CUSTOMER][NEUTRAL] And then, uh, routine cleanings also gonna be 2 every 12 months.
[AGENT][NEUTRAL] They're every 6 months.
[CUSTOMER][NEUTRAL] Every
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then our sea covered benefit.
[AGENT][NEUTRAL] Did you say fiance?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Silants are for children under [PII] once every 3 years. Permanent molars only preventative.
[CUSTOMER][NEUTRAL] OK, and then what about uh silverdi fluoride code 1354?
[AGENT][NEUTRAL] 1354 is not covered.
[CUSTOMER][NEUTRAL] OK, what about uh Floyd Varage 1206?
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK, and is there a waiting period with the basic services?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, and then, um, is there a frequency for filling?
[AGENT][NEUTRAL] Fillings for every 24 months, we do not downgrade on anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you said crowns are not covered.
[CUSTOMER][NEUTRAL] Um, what about periodonte?
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] And then I know you said oral surgery was considered um basic, um, with.
[AGENT][NEGATIVE] Not not cover.
[CUSTOMER][NEUTRAL] OK, so not even the simple extractions?
[AGENT][NEUTRAL] The simple extraction is, but the, uh, surgical extractions are not covered.
[CUSTOMER][NEUTRAL] OK, so that's code 7140, is that correct?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, that's covered, but the 7210 is not a covered benefit.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, is there any type of ortho or night guard coverage?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] No? OK, perfect. Well I think that is everything that I have um thank you so much for your help I appreciate it.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.