AccountId: 011433970860
ContactId: 9a5e9736-3a69-47da-9883-e4674b977649
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514217 ms
Total Talk Time (AGENT): 167642 ms
Total Talk Time (CUSTOMER): 85567 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/9a5e9736-3a69-47da-9883-e4674b977649_20250318T12:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I am calling to verify benefits for patient.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] option 2.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 02269775
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] First name [PII], last name [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active, and for the fee schedule and a list of benefits, I can fax that over to you.
[CUSTOMER][NEUTRAL] Um, for what, what, uh, network is it under?
[AGENT][NEUTRAL] Um, well, there isn't a network. We work with our providers, but the Carrington network is available also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And does it work like a PPO plan?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] What is the claims address?
[AGENT][NEUTRAL] The claim's address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And claims can also be faxed in and we also have a pair ID.
[CUSTOMER][NEUTRAL] OK, I do have some specific questions starting with what's the deductible and what does it apply to?
[AGENT][NEUTRAL] OK. The deductible is $50 per calendar year.
[AGENT][NEUTRAL] And it applies to all expenses except for the preventative expenses, and it covers up a annual maximum of $1500 per calendar year.
[CUSTOMER][NEUTRAL] Has any thing been used or met?
[AGENT][NEUTRAL] Let's see, one moment.
[AGENT][NEGATIVE] No, nothing's been used or met so far this year.
[CUSTOMER][NEUTRAL] OK. And what's the coverage for diagnostic, preventative, basic, and major?
[AGENT][POSITIVE] OK, for preventative, it's a 100 100% with no waiting period.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] And for the others, it's um 80%.
[AGENT][NEUTRAL] And what was the other one you said, diagnostic?
[CUSTOMER][NEUTRAL] Diagnostic preventative, basic and major.
[AGENT][NEUTRAL] Well, basic is covered at 80% and major is 40%.
[CUSTOMER][NEUTRAL] OK, and then what would endodontics, perdontics and oral surgery be considered at?
[AGENT][NEUTRAL] Those would be considered as major.
[CUSTOMER][NEUTRAL] Is there implant coverage?
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] No, ma'am. There's no coverage for implants.
[CUSTOMER][NEUTRAL] And then a 4910erial Maintenance was that considered that?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] One moment I'm still waiting on my system.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. That one is covered a maximum of 1 procedure every 6 months and let's see, that's considered.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's considered major.
[CUSTOMER][NEUTRAL] Alrighty and then what's the frequency for exams, cleanings, and lightings?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, for cleanings, um, one every 6 months.
[AGENT][NEUTRAL] For exams, 2 for 12 month period.
[AGENT][NEUTRAL] And for bite wings, 1 per 12 month period.
[CUSTOMER][NEUTRAL] What about FMX and Pan Am?
[AGENT][NEUTRAL] 1 every 5 years for both.
[CUSTOMER][POSITIVE] Perfect and then SRP what's that frequency?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Do you have a code for that one?
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] I'm sorry, please repeat the code.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] OK, there's a maximum of 1 each quadrant every 2-year period.
[CUSTOMER][NEUTRAL] And dentures, bridges and crowns.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, for crowns and bridges.
[AGENT][NEUTRAL] Um, 1 every 7 years per tooth, and for partials and dentures, 1 every 5 years.
[CUSTOMER][NEUTRAL] OK, are there any downgrades on the plan?
[AGENT][NEUTRAL] No, there isn't.
[CUSTOMER][NEUTRAL] And it's predetermination mandatory?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] Alrighty thank you so much. That was all I needed. Can I get a reference number?
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, ma'am, that is all.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too.