AccountId: 011433970860
ContactId: 85aebe80-ed27-444c-adce-200db06b5f15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2197979 ms
Total Talk Time (AGENT): 430667 ms
Total Talk Time (CUSTOMER): 446647 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/85aebe80-ed27-444c-adce-200db06b5f15_20250411T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. I'm calling from Aspen Dental. I wanted to, um, get, um.
[CUSTOMER][POSITIVE] Benefits on the patient uh that's coming in tomorrow.
[AGENT][POSITIVE] OK, yes, I can help you with benefits today.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, do you, do you need the person's name or?
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So that is um 02599335.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. Let's see.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Mhm it is [PII] option two.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And then what's the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, perfect, thanks.
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] OK, and then were you just looking for the outpatient benefits?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Uh, I just, uh, needed to ask a few, uh, questions on the dental insurance on this plan.
[AGENT][NEUTRAL] OK, of course.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, so what is the, um, patient's effective date?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, the effective date is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, when we look
[CUSTOMER][NEUTRAL] And what's the group name?
[CUSTOMER][POSITIVE] Alright, well you take care, OK?
[AGENT][NEUTRAL] Let's see, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Piedmont Bennett.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Universal Trucking.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And what was the rest?
[AGENT][NEUTRAL] Piedmont, P I E D.
[AGENT][NEUTRAL] M O N T.
[AGENT][NEUTRAL] And Bennett, B E N N.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] ETT.
[CUSTOMER][NEUTRAL] Is that two T's at the end.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the group number?
[AGENT][NEUTRAL] It is 263-58.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 263-558
[AGENT][NEUTRAL] Mhm, that's it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And what's the plan product? Um, is it just uh American Public Life as well?
[AGENT][NEUTRAL] Yes, it's we're just APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, what's the claims address?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Sorry, I need to find it. It is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 24.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there an individual deductible?
[AGENT][NEUTRAL] Let me look into her deeper into her policy really quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it looks like deductibles are not covered.
[CUSTOMER][NEUTRAL] Um, what is the amount of the individual deductible?
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Sorry, you're fine.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I'm sorry, so it does say calendar year deductible is $50 per covered insured.
[AGENT][NEUTRAL] So, but it says deductibles are not applied to preventative expenses though.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just basic and major.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so, um, how much of the deductible has been paid?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So for this policy, nothing has been used as of this year.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, and what's the um individual maximum?
[AGENT][NEUTRAL] The maximum is $150.
[CUSTOMER][NEUTRAL] And nothing has been used, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And you said it was calendar?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, ma'am. It says calendar year deductible $50 per covered insured up to $150 per family.
[AGENT][NEUTRAL] And it looks like nobody has used anything as of this year, so.
[CUSTOMER][NEUTRAL] OK, um, so what is the individual's maximum, not deductible?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so it looks like per calendar year max is 1500 per covered insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also this is not a guarantee of payment, it's just a verification of coverage.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh doesn't it, is there ortho coverage?
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Sorry, I'm looking through her policy really quick.
[CUSTOMER][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] OK. So, it looks like orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what is the coverage?
[CUSTOMER][NEUTRAL] What's the coverage for um diagnostic and preventative services?
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So it looks like preventative expenses.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Is 100% of UCR.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, where are you going to that?
[CUSTOMER][NEUTRAL] Um, OK, uh.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And you need diagnostic as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] Diagnostic is 80% of UCR.
[CUSTOMER][NEUTRAL] OK, um, it's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on, uh, something, uh, it's only giving me a yes or no. It usually give me percentages, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes, I only have percentages um for this policy.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEGATIVE] It doesn't give me an exact dollar amount on some of these.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, and it shouldn't, um, it's just giving me a yes or no, so.
[CUSTOMER][NEUTRAL] Um, let me ask about this if you could just hold on for a minute.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, that's fine. Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, for anonics, is it covered or um.
[CUSTOMER][NEUTRAL] No, it's
[CUSTOMER][NEUTRAL] Just making me do drop downs for yes or no so we're just gonna go with that.
[AGENT][NEUTRAL] OK. Yes, it says orthodontic treatment is not covered. And I can also fax this over to you.
[CUSTOMER][NEUTRAL] Uh, endodontics.
[CUSTOMER][NEUTRAL] Uh, I don't know if it would get here in time. Uh, that's the reason why I'm asking, uh, yeah, because we close at, um, [PII] today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh wow, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So for inodontics, is that covered?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] In theontics, so.
[AGENT][NEUTRAL] I can't say yes or no. It says inodontic expense is 40% of UCR.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It should give a percentage.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just gonna write this down, and you said preventative was at 100 and diagnosis was at um 90 or was it 80?
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] That was at 80% of UCR.
[CUSTOMER][NEUTRAL] OK, so preventive was 100 and uh diagnostic was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 80.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry about this, this is just a weird thing.
[AGENT][POSITIVE] No, it's OK. Take your time.
[CUSTOMER][NEUTRAL] And for basic.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is the percentage?
[AGENT][NEUTRAL] Basic is at 80% of UCR.
[CUSTOMER][NEUTRAL] But we do need
[CUSTOMER][NEUTRAL] OK, that makes sense.
[CUSTOMER][NEUTRAL] And uh periodontics.
[AGENT][NEUTRAL] Periodontics is at 40% of UCR.
[AGENT][NEUTRAL] And the waiting period for that is 12 months. I don't know if that matters.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And what about major um services?
[AGENT][NEUTRAL] Major services.
[CUSTOMER][NEUTRAL] Is that at 40?
[AGENT][NEUTRAL] Yes, our 40% of UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that doesn't have any waiting period.
[AGENT][NEUTRAL] So that one is 12 month waiting period as well.
[CUSTOMER][NEUTRAL] OK, for oral surgery, um, what percentage is covered?
[CUSTOMER][NEUTRAL] If any.
[AGENT][NEUTRAL] Uh, oral surgery is 40% of UCR, but there's also a 12-month waiting period.
[CUSTOMER][NEUTRAL] You said 40, sorry.
[AGENT][POSITIVE] Mhm. No, that's correct.
[CUSTOMER][NEUTRAL] For crowns.
[CUSTOMER][NEUTRAL] For crown services.
[AGENT][NEUTRAL] Uh, crown services.
[AGENT][NEUTRAL] Fall under 80% of UCR?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, implant
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Sorry, I'm looking, let's see.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Sorry, there's a lot listed on here. I have to go through.
[AGENT][NEUTRAL] So I see tooth reimplantation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what percentages? Are they two different percentages?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, let me see it's.
[AGENT][NEUTRAL] It's
[AGENT][NEGATIVE] So it looks like implants are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about bridges and dentures?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] OK, bridges and dentures are covered 40% of UCR and there's a 12 month waiting period as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I just need some uh frequencies uh for.
[CUSTOMER][NEUTRAL] Do you need the codes or um.
[AGENT][POSITIVE] Yes, the codes would be helpful.
[CUSTOMER][NEUTRAL] Can I just do for like exam?
[AGENT][NEUTRAL] Uh, what's your code?
[CUSTOMER][NEUTRAL] OK, uh 0120.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the frequency for that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like for this code, it says limited to 2 oral evaluation procedures in any combination.
[AGENT][NEUTRAL] Per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for cleaning code 11:10.
[AGENT][NEUTRAL] So, cleaning is once every 6 months?
[CUSTOMER][NEUTRAL] And for bite wings code 270.
[AGENT][NEUTRAL] Is once per per 12-month period.
[CUSTOMER][NEUTRAL] OK, and code 0210.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] And then what is that one for?
[CUSTOMER][NEUTRAL] Uh, 4 mouth.
[AGENT][NEUTRAL] Full mouth. OK.
[CUSTOMER][NEUTRAL] X-ray.
[AGENT][NEUTRAL] OK, so full mouth X-ray is once every 5 years.
[CUSTOMER][NEUTRAL] And for panel that's uh 0330.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for crowns and bridges, once every 7 years per tooth.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] For panel, is it the same as full mouth?
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Yes, it is once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh Flora 1208.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm you said code 1208?
[AGENT][NEUTRAL] Perfluoride.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like fluoride. This is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And maximum of 1 procedure per 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for pay maintenance, uh 4910.
[CUSTOMER][POSITIVE] taken care of
[CUSTOMER][NEUTRAL] All of my life.
[CUSTOMER][NEUTRAL] Just be careful you can let that out.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so for perioonal maintenance, maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] And what's the um percentage for that?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 40%
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I could just get
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] What category uh is uh simple instructions considered?
[AGENT][NEUTRAL] Can you say that again? Sorry.
[CUSTOMER][NEUTRAL] Uh, what coverage category are simple distractions considered?
[CUSTOMER][NEUTRAL] If you just have the um percentage I can um.
[CUSTOMER][NEUTRAL] Figure it out from there.
[AGENT][NEUTRAL] OK. Do you have the code for that one?
[CUSTOMER][NEGATIVE] Uh, I do not, um, why is it giving me the code?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So it looks like simple extractions are a maximum one time per tooth.
[AGENT][NEUTRAL] And that falls under.
[AGENT][NEUTRAL] 80% of UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, does this policy have policy have a um missing tooth cloth?
[AGENT][NEUTRAL] This policy does have a missing tooth clause.
[CUSTOMER][NEGATIVE] It doesn't.
[AGENT][NEUTRAL] It does.
[CUSTOMER][POSITIVE] It does OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have code 4341 and I need the frequency on that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you want me to lock my door?
[CUSTOMER][NEUTRAL] I see
[AGENT][NEUTRAL] OK, so it looks like a maximum of 1 each quadrant per 24 months.
[CUSTOMER][POSITIVE] Good night lady. I'll see you all tomorrow Monday.
[CUSTOMER][NEUTRAL] I'm sorry, how much was it?
[AGENT][NEUTRAL] Maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] What about um 0431 for oral cancer screening, is that covered?
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So I'm just gonna put in
[AGENT][NEUTRAL] Sorry, I'm not seeing this one. Just a moment.
[CUSTOMER][NEUTRAL] It's usually not covered.
[AGENT][NEUTRAL] Yeah, I'm not seeing this code on here.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And it was just 0431. OK.
[CUSTOMER][NEGATIVE] Yeah, it's probably not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] You have a question.
[AGENT][NEUTRAL] Are you sure you don't want me to fax you?
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] This over?
[CUSTOMER][NEUTRAL] Uh, yeah, I can uh get a fax, um, that the, I only have like 4 more questions.
[AGENT][NEUTRAL] OK, you can go ahead
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, for dentures, is it that 1 in 7 just like for crown of bridges?
[AGENT][NEUTRAL] So it looks like for partials and dentures is once every 5 years.
[CUSTOMER][NEUTRAL] Once every 5.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] OK, for, um, my next, uh, couple of questions, are crown bridge, uh, restorations on molars downgraded to cast predominantly based, uh, metal restorations?
[AGENT][POSITIVE] There are no downgrades.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, our posterior, um, composite fillings downgraded to a MO.
[CUSTOMER][NEUTRAL] Yeah I'm feeling.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, is premium termination mandatory?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get a uh reference number for this call?
[AGENT][NEUTRAL] Of course, it is my first name, which is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Last initial [PII] and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the um reference number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] No, that's all um thank you so much.
[AGENT][POSITIVE] OK. Of course. Thanks for calling APO. Hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] You too. OK, bye.
[CUSTOMER][NEUTRAL] OK