AccountId: 011433970860
ContactId: 9a15c5f3-921c-4945-beb6-6f830d41bede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 955020 ms
Total Talk Time (AGENT): 263390 ms
Total Talk Time (CUSTOMER): 428455 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/9a15c5f3-921c-4945-beb6-6f830d41bede_20250107T23:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon. This is [PII], and I'm calling you on behalf of a dental office. On the recorded line. I would like you to help me with the personal eligibility and benefits. But before that, may I have your good name and your last name initial, please?
[AGENT][NEUTRAL] My name again is [PII], that is spelled [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] Hey [PII], how are you doing today?
[AGENT][POSITIVE] I'm good, [PII], thank you so much. May I have the policy number?
[CUSTOMER][NEUTRAL] Mm, surely it's 023.
[CUSTOMER][NEUTRAL] 81225.
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] You can reach me on [PII]. It's a direct line and we don't have extensions for this.
[AGENT][NEUTRAL] Thank you. May I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII] Last name [PII] Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. So the patient's effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The patient's plan has lapsed as of [PII]. They do not have any other active coverage with us at this time.
[CUSTOMER][NEUTRAL] So, [PII] was the termination date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just a moment in that case, just a moment.
[CUSTOMER][NEUTRAL] [PII] and your initial is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much for the information you provided me.
[CUSTOMER][POSITIVE] And I really appreciate your help.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And said that that's all for today for this particular patient. And can you help me with another patient if I'm having?
[AGENT][NEUTRAL] Oh, what's the policy number?
[CUSTOMER][NEUTRAL] Mhm. OK, I will help you with that. But before that, can you help me with the call reference number to our call for this particular patient, please.
[AGENT][NEUTRAL] Call references my name with my last initial and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment, let me just.
[CUSTOMER][NEUTRAL] No it down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just give me a quick couple of minutes. Let me just grab out the information for another patient as well. And I'll just get back to you. So meanwhile, can I place your call on hold for a quick couple of minutes?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is that OK for you?
[CUSTOMER][NEUTRAL] OK, thank you. I just follow up.
[CUSTOMER][POSITIVE] OK, [PII], thank you for holding the line and I really appreciate your patience as well, [PII]. So, are you ready for the another member ID?
[AGENT][NEUTRAL] Mhm go ahead.
[CUSTOMER][NEUTRAL] Mhm. So the next member ID I'm having is.
[CUSTOMER][NEUTRAL] 02450886.
[CUSTOMER][NEUTRAL] First name, [PII] Last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth I'm having is uh [PII].
[AGENT][POSITIVE] Alright thank you so much. So patient plan is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm. Is it a calendar year plan or a benefit year plan?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] And what are the coordination benefits?
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] OK. And can you please, uh,
[CUSTOMER][NEUTRAL] Double check and let us know what are you like uh
[CUSTOMER][NEUTRAL] I'm sorry. So can you just double check and let me know, are we in-network with you or out of network? And do you pay for out of network benefits as well? Or, and what is the fee schedule that is to be followed?
[AGENT][NEUTRAL] There is um no network required for usage of the plan, however, this policy does participate in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm mhm.
[CUSTOMER][NEUTRAL] OK. And we can use any network, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This plan pays off of a UCR fee schedule.
[CUSTOMER][NEUTRAL] OK, so Care Platinum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a moment in that case.
[CUSTOMER][NEUTRAL] Just give me a quick one minute. So
[CUSTOMER][NEUTRAL] And can you help me with the uh claims mailing address as well?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and can you help me with the group name and the group number as well?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Group name is Oxford Global Resources.
[CUSTOMER][NEUTRAL] Just a moment, the system is loading.
[CUSTOMER][NEUTRAL] Oxford Global Resources, that's what you said and the group number is?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 70052.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information provided by you and I really appreciate that, sir. Uh, now, can you help me, uh,
[CUSTOMER][NEUTRAL] What are the benefits go under this plan? What are the annual max, what are the deductibles? Are they met or not, and what is the accumulated or the used amount out of it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the calendar year maximum is going to be $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The calendar year deductible is going to be $50 per insured.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there a family deductibles?
[AGENT][NEUTRAL] Uh, it's up to 150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient still has left the $50 deductible in the $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, $450 has been used out of $500.
[AGENT][NEGATIVE] Nothing has been used for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any auto coverage, orthodontic benefits, uh, maximum?
[AGENT][NEUTRAL] There is no orthodontic treatment covered on this policy?
[CUSTOMER][NEUTRAL] Oh, is there a missing tooth cloth?
[AGENT][NEUTRAL] Uh, this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Mhm. Andriities basics and majors are covered it.
[AGENT][NEUTRAL] This plan covers preventative and basic expenses only. Preventative are covered at 100%. FMX and radiographs are at 80%, and basic expenses at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][POSITIVE] Thank you so much for the information. So, I have some uh dental codes and I want you to help me with the frequency and the history. So would you be able to help me with that?
[AGENT][NEUTRAL] Yeah, I can help you with that. Um, give me just a second here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the first code?
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] There are 120s covered under preventative that would be at 100% limited to two oral evaluation procedures in a 12 month period. It does say share the same frequency as 0140, 01500160.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mhm. And what about the 0210?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0210.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Looks like 0210 is covered at 80%. It is limited to one X-ray procedure for 5 years.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what about 0274?
[AGENT][NEUTRAL] You said 074.
[CUSTOMER][NEUTRAL] Mhm. 0274.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's covered under preventative at 100%. It is limited to one bite X-ray procedure for 12 months.
[CUSTOMER][POSITIVE] OK, thank you so much. And what about the panel, 0330?
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] 4399.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That's gonna be covered under basic at 80%. There is no limitation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it does not shift.
[CUSTOMER][NEUTRAL] I'm sorry, God bless us all. Does it share the frequency with the 0210?
[AGENT][NEGATIVE] I don't show that it shares the same limitation as far as frequency, no.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, now what about 11:10?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1110 is covered under preventative at 100%. It's a maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. And for
[CUSTOMER][NEUTRAL] Fides 1206, 1208 and 1351 seats I do believe due to age limit, the, it is not covered benefits.
[AGENT][NEUTRAL] Yeah, so there are an age limit on fluoride and sealant. It looks like uh fluoride is limited to dependent children under the age of [PII]. It is covered at 100% under preventative, and then sealant is limited to dependent children under the age of [PII]. It is covered at 100%.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Now, what about the fillings 2393? Are they covered or they are upgraded?
[AGENT][NEUTRAL] Uh, there is no downgrade. 2393 is covered for basic at 80%. It looks like it's uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A maximum of 1 tooth or maximum of 1 each per tooth in a 24 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's a replace for only existing, yup.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Mhm. Thank you so much for all the information you provided me, and I really appreciate that. All the information provided by you, [PII], is very useful to me. So, thank you so much and I really appreciate that. And before we end up this call, I would like you to help me with the history for the patient. Is there any history that is going to affect the frequency for the
[CUSTOMER][NEUTRAL] Procedures like can you cross-check for
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 0210 and 0330 please.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Last date of service for 0.
[AGENT][NEUTRAL] 33 you said 0330.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The last evaluation the patient has had where I see that they had um an oral evaluation 0140 and by wing 0270 was [PII]. There's no other history on file.
[CUSTOMER][NEUTRAL] So I.
[CUSTOMER][POSITIVE] OK. So the patient is eligible as of now for all the procedure codes. Thank you so much for the information, [PII], and I really appreciate that. And before we end up the call, can you help me with the call reference number to call for this particular patient?
[AGENT][NEUTRAL] Call reference would be my name with my last initial and today's date. Again, that's [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for all the information. Bye-bye, take care. Have a great day ahead.