AccountId: 011433970860
ContactId: 86b62d4a-f439-4937-a537-83ba3076091f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587710 ms
Total Talk Time (AGENT): 125081 ms
Total Talk Time (CUSTOMER): 243997 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/86b62d4a-f439-4937-a537-83ba3076091f_20250506T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from Jefferson Dental. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Yes, I'm doing well, thank you so much for asking. So yeah, actually I need the patient's eligibility as well as the network dental benefits. Could you please help me on that?
[AGENT][POSITIVE] Yes, I can help with benefits and eligibility. [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, I have a callback number would be [PII]. This is a direct line. There is no extension.
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, it would be 206-098-26.
[AGENT][NEUTRAL] 206-0981?
[CUSTOMER][NEUTRAL] 206-098-26.
[AGENT][NEUTRAL] I'm not pulling up that number. Do you have a different number or a last name of the patient?
[CUSTOMER][NEUTRAL] Yes, yes. I have the patient's last name [PII]. And coming to the first name, [PII], and coming to the birth date, it would be [PII].
[AGENT][NEUTRAL] OK, yeah, if you're going too fast. What was the first name?
[CUSTOMER][NEUTRAL] First name, [PII]. Hope you got it now.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it would be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's pulling it up. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the birthday?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK so the policy is effective [PII].
[AGENT][NEUTRAL] It's currently active?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh. And the plan that would be dental PP, right?
[AGENT][NEUTRAL] You can
[AGENT][NEUTRAL] Uh, yes, hold on, let me pull it up. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's not a guarantee of payment basic outline of the policy. Um, I can send a fax back that outlines everything covered under the policy unless there's something you need to go over on the phone.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am. So yeah, before going to send the fast one, actually from my side, uh, the patient, uh, is also the policyholder. Could you please confirm this?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Thank you. Thank you so much. And uh yes, uh, you told me that the patient's policies effective date [PII] and the currently plan status is active and the plan that would be dental PPO, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Thank you. Uh, now, please go ahead with the in-network deductibles as well as an all max.
[AGENT][NEUTRAL] And the calendar year maximum is 500.
[AGENT][NEUTRAL] And then the deductible, which applies to radiographs, basic and basic restorative, is $50 per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What, what was the other question?
[CUSTOMER][NEUTRAL] How about the network coincidence percentage for preventive to basic and major?
[AGENT][NEUTRAL] Preventative services pay 100%, Radiographs, FMX, Basic and Basic restorative pay 80% after the $50 deductible is met. There is no major coverage.
[CUSTOMER][POSITIVE] Thank you. Thank you so much, ma'am. Uh yes. Can I have the group number?
[AGENT][NEUTRAL] My number is
[AGENT][NEUTRAL] 70083
[CUSTOMER][NEUTRAL] Uh-huh. Group name.
[AGENT][NEUTRAL] Lark, LLC.
[AGENT][NEUTRAL] L as in Lima, A as in apple.
[CUSTOMER][POSITIVE] Mhm thank you so much.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's no need to spell, no need to spell, ma'am. So any accumulations by the patient from the deductibles as well as on all banks.
[AGENT][NEUTRAL] Um, no, there's no history at all.
[CUSTOMER][NEUTRAL] So nothing has been used. Thank you. Uh, how about the Arranty coverage regarding the network?
[AGENT][NEGATIVE] There's no ortho coverage.
[CUSTOMER][NEUTRAL] For the patient's entire plan, there is no other the coverage, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. So yeah, um, and the period is gonna be 60801, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. Um, is there any waiting period?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] How about missing tooth class?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, how about the processor code 6104? I need the frequency and percentage if it is covered.
[AGENT][NEGATIVE] I can send you a fax back that has all the codes listed endo, major, pero, none of that is covered. Implants aren't covered.
[CUSTOMER][NEUTRAL] No, no, ma'am. Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Oh, implants not caught. Uh-huh.
[CUSTOMER][NEUTRAL] Yes, yes, yes, and, uh, coming to, uh, even, oh, what else are the results are not good, yeah. How about the procedure code 7953 bone replacement graft.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][POSITIVE] Thank you. And uh coming to so X SMX and pan right once in 5 years at basic 8T.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Mhm and coming to fillings, uh, uh, could you please help me with the frequency?
[AGENT][NEUTRAL] Or fillings
[CUSTOMER][NEUTRAL] 2391 yes composite feelings.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months.
[AGENT][NEUTRAL] Maximum of 1 each 2 per month.
[CUSTOMER][NEUTRAL] Is there any downgrades?
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Uh-huh. Is there any, yeah, is there any downgrades, ma'am, regarding 2391 composite feelings like, uh, does alternate benefits will apply?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] There is none. Uh-huh, thank you. And coming to.
[CUSTOMER][NEUTRAL] Uh, yeah, Full mouthrebriment.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] Not covered. Thank you. So, you told me that there is no major coverage in the sense, uh, bridges, dangers, partial dentures, and even nitros anesthesia is also not caught, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. Yes, so.
[CUSTOMER][NEUTRAL] Uh, finally, uh, last code 2920, ma'am. Raman of Crown 2920.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII]. How about the reference number for our call?
[AGENT][NEUTRAL] That's my name and today's date.
[CUSTOMER][NEUTRAL] What is the fee schedule to be followed for the network providers?
[AGENT][NEUTRAL] It's usual and customary.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Still no? uh.
[CUSTOMER][NEUTRAL] Which use
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So there is no network, right?
[AGENT][NEUTRAL] The network is Carrington.
[CUSTOMER][NEUTRAL] No, no, sorry for Carrington.
[AGENT][POSITIVE] Correct. Carrington is the network, yes.
[CUSTOMER][NEUTRAL] So, uh, yeah, I just want to confirm still now you have provided the in-network dental benefits, right, for this patient.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So I'm asking, so you have provided the benefits for this patient or in network only, right?
[AGENT][NEUTRAL] They have in and out of network. It, it covers either way. All the benefits I quoted would be for out of network as well.
[CUSTOMER][POSITIVE] So, so both in and out and benefits the same. Thank you. Thank you so much. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Thanks for calling APL as well. Bye bye.