AccountId: 011433970860
ContactId: 9cd14399-94da-4e34-9ab1-607011dff1e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 788090 ms
Total Talk Time (AGENT): 205233 ms
Total Talk Time (CUSTOMER): 347678 ms
Interruptions: 0
Overall Sentiment: AGENT=-1.7, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/9cd14399-94da-4e34-9ab1-607011dff1e6_20250501T18:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII], calling on behalf of the provider's office to check on dental eligibility and benefits for only one patient. Could you please help me with that?
[AGENT][NEUTRAL] And you said your name was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][POSITIVE] Yes, thank you so much. Uh, callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, sure. It's 025.
[CUSTOMER][NEUTRAL] 63
[CUSTOMER][NEUTRAL] 335.
[AGENT][NEUTRAL] What was the patient name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, patient name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] I show that policy is effective [PII].
[CUSTOMER][POSITIVE] Thank you so much. For this plan, uh, provider is an in-network or out of network?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see, uh, so they use the Carrington network. I don't know who's in network. You would have to contact Carrington.
[CUSTOMER][NEUTRAL] Oh, Carrington, we are using in-network. OK, OK, thank you. No problem. And uh um once again, sorry, plan effective from [PII], right? Sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Is there any waiting period and missing tooth loss?
[AGENT][NEUTRAL] Uh, this is not a guarantee of payment. It's a basic outline of the policy. There's no waiting period, there is a missing who clause, yes.
[CUSTOMER][POSITIVE] Thank you so much. Uh, for missing tooth clots, any time limit, or, or it's a permanent missing tooth clot? Sorry.
[AGENT][NEGATIVE] Permanent missing tooth cloth.
[CUSTOMER][POSITIVE] Thank you so much. Coordination of benefits is standard COB.
[AGENT][NEUTRAL] Standard COB.
[CUSTOMER][POSITIVE] Thank you so much. Do you accept assignment of benefits as well as signature on?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. Our plan runs in a calendar year from January to December.
[AGENT][NEUTRAL] Yes, calendar year, yes.
[CUSTOMER][POSITIVE] Thank you. Can I have the group name, group number, please?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] A group name is [PII]. It's [PII]
[AGENT][NEUTRAL] Group number is 70.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sorry, sorry.
[AGENT][NEUTRAL] Group number 70029.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Can I have the annual maximum and deductible amount please for the network?
[AGENT][NEUTRAL] The annual maximum amount payable is $500 per calendar year. There is a $50 deductible.
[AGENT][NEUTRAL] For radiographs, FMX, basic and basic restorative services.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, $500 nothing has been met, sorry.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you. Uh, sorry, $500 applies to all services preventative basic measure.
[AGENT][NEUTRAL] Yes, uh, there's no major coverage. There are no major services.
[CUSTOMER][NEUTRAL] OK. So $500 applies to preventative and basic, right, sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Deductible applies to
[CUSTOMER][NEUTRAL] Basic only, not for preventative or major.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] It applies to basic and X-rays, so any type of radiographs or X-rays.
[CUSTOMER][NEUTRAL] OK, thank you so much. Uh, one moment, please. Thank you. So deductible not met. OK. Family deductible? Is there any family deductible? Sorry.
[AGENT][NEUTRAL] 150.
[CUSTOMER][NEUTRAL] Uh, 150, nothing much, right.
[AGENT][NEUTRAL] I think that
[CUSTOMER][NEUTRAL] Thank you. And what about or, or cover for this patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Orthodontics covered?
[AGENT][NEGATIVE] No ortho coverage.
[CUSTOMER][POSITIVE] Thank you so much. Now, can I have the co-insurance for preventative basic measure, please?
[AGENT][NEUTRAL] Preventative services, which would be cleanings and exams, pay 100%.
[AGENT][NEUTRAL] And then basic services, which includes X-rays, bite wing, full mouth pano.
[AGENT][NEUTRAL] And fillings pay 80% after a $50 deductible.
[CUSTOMER][POSITIVE] OK. Thank you so much. Sorry for asking. Uh, endodontics, periodontics, oral surgery, these are all not covered or covered, sorry.
[AGENT][NEUTRAL] Endodontics and perdontics are not covered. The only oral surgery covered is 7140.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7140. OK. 72 1072 40. These are all covered.
[AGENT][NEUTRAL] Uh, I don't, please. Hold on one moment.
[CUSTOMER][POSITIVE] Sorry, sorry. Thank you so much.
[AGENT][NEUTRAL] Uh, no, those are not covered.
[CUSTOMER][NEUTRAL] OK, thank you. So 7140 covers the basic at 80%, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. And uh so oral surgery not covered. OK, thank you. And OK, and now have some quotes. Can I tell all at 111 please?
[AGENT][NEUTRAL] Uh, yeah, can you do it one at a time?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh, thank you so much. 1st 1, 1110 trophy.
[AGENT][NEUTRAL] It pays 100% and that's once every 6 months.
[CUSTOMER][POSITIVE] Thank you so much. Uh 0120 exam.
[AGENT][NEUTRAL] It's 100%. It's 2 in a 12 month period.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, sorry, once again, uh, profiy are 1 in 6 months, uh, exams are 2 for 12 months, 100%. Sorry, sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, what about wi[PII] [PII]?
[AGENT][NEUTRAL] And that pays 80% and subject to deductible, once for 12 months.
[CUSTOMER][POSITIVE] And for 12 months, 80%. Thank you. Next one, pan on SMS.
[AGENT][NEUTRAL] Uh, that pays 80% once per 5-year period.
[CUSTOMER][NEUTRAL] 1 for 5 years, 80%, thank you uh uh a few questions for this than bye wings and FMX can be done on the same day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Vikings.
[CUSTOMER][POSITIVE] OK, thank you. Next one, bike wings and pano can be done on CMD.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, sorry, one more question. Um, bikings and panel can be done. It will be downgraded to FMX or build it separately.
[AGENT][POSITIVE] There's no downgrades.
[CUSTOMER][NEUTRAL] Um, so by wings and pano can be done, uh, it, it, it's not paid for FMX. It paid for pano and vis, so build it separately, not for FM.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. So pay separately, not far from. Can one can be done on Sunday. OK, thank you. Sorry, sorry. So basic 1 in 5 years, OK. Uh, code 0367.
[AGENT][NEUTRAL] I don't show that covered.
[CUSTOMER][POSITIVE] Oh thank you. Next one, fluoride 1208.
[AGENT][NEUTRAL] Um, I only have for fluoride 1201, 1203, 1204, and 1205 covered.
[AGENT][NEUTRAL] And that's for dependent children to age [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, sorry, 12061208 not covered.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So 21205 120608. OK. Um, next one, C 1351.
[AGENT][NEUTRAL] A max of 1 procedure for 36 months, limited to children under [PII].
[AGENT][NEUTRAL] Permanent molars only.
[CUSTOMER][POSITIVE] Thank you. And it covers 100%?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] For only and that person once every 36 months under the age of [PII]. Thank you. Sorry, sorry. Next 1, 4341 scaling and planning.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] Uh, scaling and group planning not covered. OK. Next 1, uh 229504 buildup.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Thank you. Next 1, 4381 arresting.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Thank you. Next 1, 4346.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 0 4346 also not correct. Thank you. Uh, sorry, 6010.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Thank you. 6059.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Thank you. 6080.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 6091
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 616199.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Thank you. Almost done. 19944 Olosal costs.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Oh, a closer costs also not covered. OK. 7880.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Thank you. Fielding's 2391.
[AGENT][NEUTRAL] Uh, pays the 80%.
[CUSTOMER][NEUTRAL] Frequency please, sorry.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] 1 for 24 months. Thank you. Uh fillings downgraded.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No on this. Thank you. Last three codes are 2962.
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] 2960. Thank you. Last two codes, 4910 period maintenance.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] Oh, maintenance also not covered for the periodontal maintenance.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, not covered. OK, OK. Sorry. Last 1, 4355 full mouth the red one.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, thank you so much. Sorry, once again, uh, bitings are basic 12 months. Pan and theMX are basic 1 in 5 years. Uh, fluoride not covered silences, preventative 1 in 36 months. OK. Exam coffee. OK, thank you. Excellence, not on great. OK. So, uh, crowns are not covered. OK, thank you. So no replacement period for crowns resistance just because they are not covered.
[CUSTOMER][POSITIVE] Thank you. And uh
[CUSTOMER][NEUTRAL] Uh, one more concern, sorry. Do you accept assignment of benefits as well as signature and?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. And finally, can I have the preventative history, please, uh, [PII]?
[AGENT][NEUTRAL] Um, sorry?
[CUSTOMER][NEUTRAL] Uh, history, history for the patient.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] Uh, there's no history at all on file.
[CUSTOMER][POSITIVE] OK, thank you so much. Bytews and FMX can be done on the yes. By twins and pano also can be done on things but they separately and acceptable. Thank you. And uh claim mailing address, please, sorry, PO box.
[AGENT][NEUTRAL] My mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The pay ID please.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, can I have the call reference number please?
[AGENT][NEUTRAL] It's my name which is [PII] and today's date, 5-125.
[CUSTOMER][POSITIVE] 722. 0, thank you, thank you so much, [PII]. Have a great day. Take care. Bye-bye, thank you.
[AGENT][POSITIVE] Thanks for calling APL you too bye bye.
[CUSTOMER][NEGATIVE] No thanks. Bye.