AccountId: 011433970860
ContactId: 9b946f00-9d90-49c8-abfd-3df3c62c5776
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437489 ms
Total Talk Time (AGENT): 182908 ms
Total Talk Time (CUSTOMER): 134615 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/9b946f00-9d90-49c8-abfd-3df3c62c5776_20250205T17:30_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes. Good day. My name is [PII] calling from New Smile Dentistry, and I would just like to ask about eligibility and benefits for a patient.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with eligibility and benefits. What is a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, it's 02354913.
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] It's gonna be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with eligibility and benefits for [PII], I am showing that his policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And this is a, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Yes, by the way, may I have the patient's um group number?
[AGENT][NEUTRAL] Yes, ma'am. The group number is 70,030.
[CUSTOMER][NEUTRAL] 70030.1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the group name?
[AGENT][NEUTRAL] The group name is Creative Circle.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] And may I have the fee scheduled for this one?
[AGENT][NEUTRAL] It participates in the Carrington PPOV schedule.
[CUSTOMER][NEUTRAL] This in network.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Network participation is not required for benefits.
[CUSTOMER][POSITIVE] Thank you so much. And um is there any waiting period as well as missing the class?
[AGENT][NEUTRAL] There is no waiting period. There is a missing tooth cloths.
[CUSTOMER][POSITIVE] Thank you. And the coordination of benefits?
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] Thank you. And may I have the maximum low fee deductible for this patient?
[AGENT][NEUTRAL] There is a $500 calendar year max, with a $50 deductible. It does not apply to preventive services, and that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Thank you. And maximum does not apply to preventive as well.
[AGENT][NEUTRAL] The maximum does apply to preventive the deductible does not apply to prevented.
[CUSTOMER][POSITIVE] Thank you so much. And um how about the co-insurance for this patient?
[AGENT][NEUTRAL] Uh, it's the, the preventive is covered at 100%. Basic is covered at 80%, and that does include radiographs, FMX, basic, and basic restorative expenses. And I do have a breakdown that I can fax to you if you would like.
[CUSTOMER][NEUTRAL] Yes, and the fax ID, oh sorry, the fax number is one second let me just see.
[CUSTOMER][NEUTRAL] It's gonna be 760.
[CUSTOMER][NEUTRAL] 941
[CUSTOMER][NEUTRAL] 965 9.
[AGENT][POSITIVE] Thank you, Miss [PII]. If you'll hold just one moment.
[CUSTOMER][NEUTRAL] Yes, and by the way, for this patient, may I have, uh, may I ask for additional questions, just a few questions.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Sure, let me get this faxed over to it for you so you don't have to wait for that because I can do that right now.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] All right. Thank you so much. And um
[CUSTOMER][NEUTRAL] How many films does it take to make an FMX?
[AGENT][NEUTRAL] Um, bear with me just one second and I can provide that information.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, it's going to depend on the code that it is.
[AGENT][NEUTRAL] Issue.
[CUSTOMER][NEUTRAL] 0220
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 0220.
[AGENT][NEUTRAL] 0220 is there's no frequency and that is paid under basic at 80%. So it's gonna be different than an FMX.
[CUSTOMER][NEUTRAL] And may I know how many films does it take to make an Aroma?
[AGENT][NEUTRAL] The FMX is under the 002 10.
[AGENT][NEUTRAL] So that's a complete series including by Wings.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] And the shares frequency with pano, right?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] Thank you. And um how many films does it take again to make an SMS?
[AGENT][NEUTRAL] I, I don't have that information.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And um up to what age is considered for 1120?
[AGENT][NEUTRAL] 11:20.
[AGENT][NEUTRAL] Under the age of [PII].
[CUSTOMER][NEUTRAL] [PII]. And how about the fluoride and feelings?
[AGENT][NEUTRAL] Uh, fluoride is under the age of [PII]. Sean is under the age of [PII].
[CUSTOMER][NEUTRAL] Thank you. Is there any downgrade for crowns and filling?
[AGENT][NEUTRAL] We don't downgrade.
[CUSTOMER][POSITIVE] Oh no. All right. Thank you so much. And it's 4355 days that's 1110.
[AGENT][NEGATIVE] It's not covered. That's considered a major procedure. Major is not covered.
[CUSTOMER][NEUTRAL] Thank you. And that 4910 shares frequency with 1110?
[AGENT][NEUTRAL] A 4910 is not a covered benefit.
[CUSTOMER][POSITIVE] All right. Thank you so much. And yes, um, it's fast on the way.
[AGENT][POSITIVE] It is on the way. You should be receiving that shortly.
[CUSTOMER][POSITIVE] OK. Thank you so much. May I have your reference number for this call?
[AGENT][NEUTRAL] The reference number is my name and today's date, and I spell my name [PII].
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that breakdown. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that would be all. Thank you so much. Have a great day evening. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL [PII]. Take care. Bye-bye.