AccountId: 011433970860
ContactId: a18f0bf5-cfc9-473b-b2f5-2bb452609e84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325040 ms
Total Talk Time (AGENT): 126061 ms
Total Talk Time (CUSTOMER): 104709 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/a18f0bf5-cfc9-473b-b2f5-2bb452609e84_20250603T12:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and I was calling to see if you could help me do an insurance breakdown for a patient.
[AGENT][NEUTRAL] Yeah, absolutely. What is the patient policy number?
[CUSTOMER][NEUTRAL] It is 02594156.
[AGENT][NEUTRAL] Alright, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] S as in Sam, T as in Tom, A as in apple.
[CUSTOMER][NEUTRAL] L
[CUSTOMER][NEUTRAL] Is it a is it a permanent or
[AGENT][NEUTRAL] All right. And then if I could get first name, last name, and date of birth for the patient.
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][POSITIVE] Perfect. So patient is active. Effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me just pull their plan here, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Is this the lower right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like their calendar year, uh, maximum is gonna be $500. They have a calendar year deductible of $50. Both are remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient plan has uh preventative and basic. Preventative is covered at 100%.
[AGENT][NEUTRAL] FMX and basic are at 80%.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] No waiting periods for those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like cleanings are once every 6 months.
[AGENT][NEUTRAL] Oral evaluations are gonna be 2 for 12 months.
[AGENT][NEUTRAL] bit wings or once per 12 months?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then FMX and pano once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like the policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about coverage for Pago?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then no endo no oral surgery.
[AGENT][POSITIVE] Correct, yeah, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, and then so just pay your maintenance follow under the cleaning regimen or it's just for profies like a healthy mouth cleaning?
[AGENT][NEUTRAL] Just the uh, healthy mouth cleaning, that's it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And then as far as the deductible, the deductible only apply to the basics?
[AGENT][POSITIVE] Mhm, correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright, now for the basics, um, what frequency is it going to be for, um, fillings?
[AGENT][NEUTRAL] What was the, I'm sorry for fillings again, what was the question?
[CUSTOMER][NEUTRAL] Yeah, what is the frequency for fillings? Does that follow under your basic?
[AGENT][NEUTRAL] Yes, it falls under basic. I'm sorry, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] And then what's the frequency for that?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It looks like there is no, I don't show any sort of limitation.
[CUSTOMER][NEUTRAL] OK, alright, any downgrades for those fillings on posterior teeth?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then lastly, do you show that my provider is going to be in network if I give you the tax ID?
[AGENT][NEUTRAL] Um, I can pull up to see if you guys have ever filed any claims. The plan itself doesn't require like a network. It pays by UCR.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, however, I mean it does participate in the Carrington PPO network if you guys are part of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Carrington PPO we do take that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect. And then do you guys have a payer ID by any chance?
[AGENT][NEUTRAL] Yeah, absolutely, it's 60801.
[CUSTOMER][POSITIVE] Perfect. Alright, that answers all of my questions. Can I get a reference number for phone call [PII]?
[AGENT][NEUTRAL] Yeah, absolutely. Call references my name with today's date. My name is [PII], which is [PII], last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] OK perfect all right thank you so much for today you have a great day OK?
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.