AccountId: 011433970860
ContactId: 86a55123-4c05-480f-a3a9-d5ee7284c295
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 909549 ms
Total Talk Time (AGENT): 238388 ms
Total Talk Time (CUSTOMER): 365927 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/86a55123-4c05-480f-a3a9-d5ee7284c295_20250428T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII]. I'm calling from Aspen Dental to get benefits on a member.
[AGENT][POSITIVE] All right, [PII], I'm happy to get uh benefits for you. Do we have their policy number?
[CUSTOMER][NEUTRAL] Uh, I have their member ID if that helps.
[AGENT][NEUTRAL] OK, yeah, what's that?
[CUSTOMER][NEUTRAL] OK, it's gonna be 022.
[CUSTOMER][NEUTRAL] 83,230.
[AGENT][NEUTRAL] Alright, and then [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, uh, callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. And then if I can get the patient's name and date of birth.
[CUSTOMER][NEUTRAL] O
[CUSTOMER][NEUTRAL] Of course her name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is gonna be [PII].
[AGENT][POSITIVE] All right, thank you so much. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the patient is active. Effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK. Perfect. Uh, is the coverage individual or family?
[AGENT][NEUTRAL] Uh, looks like this is individual for the insured only.
[CUSTOMER][NEUTRAL] OK perfect uh would you happen to have the group name and group number?
[AGENT][POSITIVE] Yeah, absolutely. So it looks like the group name is going to be Hospitality Staffing Solutions.
[CUSTOMER][NEUTRAL] Sing solutions OK.
[CUSTOMER][NEUTRAL] OK, got that and then.
[AGENT][NEUTRAL] And then the uh group number if you need that is 70072.
[CUSTOMER][NEUTRAL] 70072 OK perfect let me write that here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The procedure done
[CUSTOMER][NEUTRAL] OK, sorry, I'm just writing a bunch of stuff.
[AGENT][POSITIVE] Oh, no worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what would officially be the insurance name?
[AGENT][NEUTRAL] Oh, the insurance name is American Public Life.
[CUSTOMER][NEUTRAL] Megan.
[CUSTOMER][NEUTRAL] OK, American Public Life and then what's gonna be the fee schedule? American Public Life also?
[AGENT][NEUTRAL] Mhm, mhm. And it looks like this plan pays by UCR.
[CUSTOMER][NEUTRAL] So I'm not sure maybe those
[CUSTOMER][NEUTRAL] OK, perfect. uh, do you happen to have the claims address?
[AGENT][NEUTRAL] Mhm, claims mailing address is gonna be [PII].
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] There's no way
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Perfect, I have a payer ID here. It's 60801.
[AGENT][POSITIVE] Mhm, that is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK perfect and then is there any deductibles on this plan?
[AGENT][NEUTRAL] Uh, it looks like there is a $50 deductible which the patient does have left.
[CUSTOMER][NEUTRAL] OK, they haven't met it so far this year, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and then would this apply to preventative or basic and major?
[AGENT][NEGATIVE] Uh, deductible only applies to basic or yes, basic and major preventable does not apply.
[CUSTOMER][POSITIVE] Got you, perfect. Uh, any maximum on the plan?
[AGENT][NEUTRAL] It looks like their calendar year max is 500, and they have the full 500 remaining.
[CUSTOMER][POSITIVE] Perfect, that calendar OK.
[CUSTOMER][NEUTRAL] And then is there any ortho coverage on the plan?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then what's gonna be the coverage percentage for diagnostic, for basic, and for major?
[AGENT][NEUTRAL] So this plan is preventative and basic only. Preventative is at 100% and then basic is gonna be at 80%. That's also for FMX.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Got you perfect and then is there any crown and bridge coverage on the plan, or would that be under major?
[AGENT][NEGATIVE] That's under major, so that, yeah, there's no coverage.
[CUSTOMER][NEUTRAL] Got you and then also same for implants and dentures.
[AGENT][NEUTRAL] Correct, and plants are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then no waiting period for any of it, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. Is there any endodontics coverage on the plan?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK. Uh, no per and no oral surgery too, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just making sure and then OK, any frequency on exams? I have code 0120.
[CUSTOMER][POSITIVE] We like us over here at this office.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So they're limited to two oral evaluations in a 12 month period. It shares frequency with 0 140 as well.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is there any coverage for uh bite wings, any frequency?
[AGENT][NEUTRAL] Uh, let's see here. Yeah, that'll be a frequency one moment.
[AGENT][NEUTRAL] My wings are once for 12 months.
[CUSTOMER][POSITIVE] OK perfect and then how about FMX and Pano?
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And do they share frequency by any chance?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, is there any coverage for fluoride code 1208?
[AGENT][NEGATIVE] 108 is not listed, therefore it's not covered.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just double checking, uh, there's no period maintenance coverage, right? Code 4910? OK, got you, just making sure.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, are simple extractions covered by any chance or would that also be considered as major?
[AGENT][NEGATIVE] No, simple extractions are covered under basic at 80%.
[CUSTOMER][POSITIVE] Perfect. OK, perfect. Uh, is there any missing tooth loss on this plan?
[AGENT][NEUTRAL] Uh, let's see, this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, uh.
[CUSTOMER][NEUTRAL] By any chance is SRP covered, uh, that would be code 4341.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I do not see that listed.
[CUSTOMER][NEUTRAL] OK, then probably not. Let's go ahead not covered.
[CUSTOMER][NEUTRAL] Uh, by any chance any coverage for code 0431?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Is there an email
[CUSTOMER][NEUTRAL] And you know so we have to refile the claim.
[AGENT][NEUTRAL] Not seeing 0431.
[CUSTOMER][NEUTRAL] No, OK, got it.
[AGENT][NEUTRAL] And if you'd like I can send you a copy of the fax back if you guys want one for your records as well.
[CUSTOMER][POSITIVE] Yeah that'd be great, uh.
[CUSTOMER][NEUTRAL] How long would it take to arrive if you know?
[AGENT][NEUTRAL] Um, I can fax it over to you. Give me about 5 minutes if that works.
[CUSTOMER][POSITIVE] Yeah yeah you're good.
[AGENT][NEUTRAL] Alright, what's a good fax number?
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Should we mark that attention to anybody?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Alright, so I'll send that right now. Is there anything else I can check for you?
[CUSTOMER][NEUTRAL] Yes, please. Uh, I wanted to check, uh, actually, in this case, uh, by any chance, any posterior composite fillings included on the plan?
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you have a code for any of that?
[CUSTOMER][NEUTRAL] Uh, do do do do, I do have some codes if you can check them for me, uh, I have code.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4381.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 492 1.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9972 and then 7953.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Give me a second
[CUSTOMER][NEUTRAL] I got
[AGENT][NEUTRAL] 4381 is not listed, therefore not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I do not see 4921 listed either, therefore not covered.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] And then 9972.
[AGENT][NEUTRAL] 9972. I'm not showing listed therefore not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 7953.
[AGENT][NEUTRAL] 7953 is not listed, therefore not covered either.
[CUSTOMER][NEUTRAL] Got you and just one more question, uh, is predetermination mandatory?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] OK, and then by any chance, uh, is it, um, is predetermination only suggested for a certain amount of services like of services over 100, 200, something like that?
[AGENT][NEUTRAL] Yeah, it's not required or, I mean, if the patient were, you know, obviously would like that, we can give um a predetermination, but we don't require it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Got it here. OK, perfect then. And by any chance would you have a reference number for today's call?
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initials and today's date. My name again is [PII], which is [PII] Last initial is gonna be [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect thank you so much, [PII]. I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][NEUTRAL] Bye bye.