AccountId: 011433970860
ContactId: a1fb0795-8854-4271-aa2c-177f0ed76286
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 815849 ms
Total Talk Time (AGENT): 254596 ms
Total Talk Time (CUSTOMER): 261099 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/a1fb0795-8854-4271-aa2c-177f0ed76286_20250306T18:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning, my name is [PII] from Amber Hills Dental, and I'm sorry I didn't get your first name.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] OK, hi [PII] thank you how are you?
[AGENT][POSITIVE] Uh-huh, you're welcome. I'm good. How are you?
[CUSTOMER][POSITIVE] Doing well thank you. I was just calling to verify dental benefits.
[AGENT][NEUTRAL] OK. And would you like the schedule faxed over to you, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, I don't know what, um, I, this is the first time I've heard of this insurance. I was wondering if, um, do you do benefits over eligibility over the phone?
[AGENT][NEUTRAL] Uh huh, we can provide it over the phone as well. Um, what's the policy number?
[CUSTOMER][POSITIVE] Oh, OK, OK, thank you.
[CUSTOMER][NEUTRAL] So he provided 02571796.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] This is [PII] [PII].
[AGENT][POSITIVE] OK, thank you for that.
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] So I show a policy effective date of [PII].
[AGENT][NEUTRAL] Uh, the policy, excuse me, is active at this time?
[AGENT][NEUTRAL] Uh, this policy covers preventive and basic only major isn't, is not covered.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I show that the calendar maximum is 500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the calendar year deductible is.
[AGENT][NEUTRAL] 50 and could you hold for just one moment?
[CUSTOMER][NEUTRAL] Sure, of course.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][POSITIVE] Yeah thank you.
[CUSTOMER][POSITIVE] try to get excited.
[CUSTOMER][NEUTRAL] that
[AGENT][POSITIVE] Thank you so much for holding [PII].
[CUSTOMER][POSITIVE] Mhm yes of course.
[AGENT][NEUTRAL] Let's see, so.
[AGENT][NEUTRAL] The, um,
[AGENT][NEUTRAL] Preventive services of course are reimbursed at 100% and basic is at 80%, um, do you need the frequencies?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, I do have some specific code. Are we in network with this plan?
[AGENT][NEUTRAL] So the PPO network.
[AGENT][NEUTRAL] Let me back up and get you to verify the patient's name and date of birth for me.
[CUSTOMER][NEUTRAL] OK, um, first name is, uh, patient's name is [PII].
[AGENT][NEUTRAL] OK, thank you. The network of network of contracted providers is um Carrington.
[CUSTOMER][NEUTRAL] OK, I think we are, yeah.
[CUSTOMER][POSITIVE] Caring, that's what that would be the free schedule Carrington.
[CUSTOMER][NEUTRAL] OK, and then I'm sorry, what's the name of this insurance?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] American Public Life, OK, and then what's the payer ID number?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 801 and the claims address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and then does this plan have um waiting period and everything to clause?
[AGENT][NEGATIVE] So there's no major service, so there's no waiting period, um, I do show that it's a there's a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then you said 180, no major. Is there any downgrades for crowns and filling?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] No downgrades OK and then what's the group number?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 70073.
[CUSTOMER][NEUTRAL] OK, 70073.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then the group name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then [PII] and then [PII] This information should be on the ID card as well.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Whenever they present that to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, she hasn't yet, um, OK, so I do have some codes here, yes, if I could get the frequency please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Is it just preventive and basic?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, uh huh.
[AGENT][NEUTRAL] OK, and how many codes are there?
[CUSTOMER][NEUTRAL] Um 123456.
[CUSTOMER][NEUTRAL] 789.
[AGENT][NEUTRAL] OK, I'm gonna go ahead and fax you over the schedule. What's your fax number?
[CUSTOMER][NEUTRAL] Maybe 10.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And then we can discuss once you receive this because I think it'll answer your questions.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] As far as the frequencies.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was just sent.
[CUSTOMER][NEUTRAL] OK, let me see here.
[AGENT][NEUTRAL] And then the payer ID and the claims mailing address information is on there as well.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And that's gonna uh include all codes that are covered and then it will also provide you with the frequencies.
[AGENT][NEUTRAL] And the limitations as well?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] So whatever is not on there is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] The codes? OK.
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] And then what's the history on him?
[AGENT][NEUTRAL] There's no claims on file for this patient at all.
[CUSTOMER][NEUTRAL] Oh none, OK.
[CUSTOMER][NEUTRAL] OK, yeah, I still haven't gotten that. Let's see.
[CUSTOMER][NEUTRAL] Is 4921 coverage?
[AGENT][NEUTRAL] What is that for?
[CUSTOMER][NEUTRAL] Uh, gingal irrigation.
[AGENT][NEUTRAL] You know, that's going to be considered major. It's not covered.
[CUSTOMER][NEUTRAL] Oh, that's major, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Huh, I don't have it. Let's see.
[CUSTOMER][NEUTRAL] Sorry [PII] it's not coming through um.
[AGENT][NEUTRAL] Yeah, give it a few seconds, yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] I'll get a confirmation once you receive it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can just give me a few of them.
[CUSTOMER][NEUTRAL] Oh, OK, um, we can do the 11:10.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Just go ahead and give me 3 of them.
[CUSTOMER][NEUTRAL] OK, so 11:10.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 0364.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so the frequency for a cleaning is once every 6 months?
[CUSTOMER][POSITIVE] We'll take care of you right whenever you guys.
[AGENT][NEUTRAL] The D 0330.
[AGENT][NEUTRAL] a pano.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited to one X-ray procedure?
[AGENT][NEUTRAL] Her 5 year period.
[CUSTOMER][NEUTRAL] I'm sorry, limited, uh, every 5 years, thank you.
[AGENT][NEUTRAL] And shares frequencies with D0210 and D0277.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you gave me the 0364. What is that for?
[CUSTOMER][NEUTRAL] Mhm, that's a clone beam CAT scan.
[AGENT][NEGATIVE] That's not covered.
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is Nightguard covered 9944?
[AGENT][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, maybe, mm, maybe just a few more than that just, oh wait, the 49, the 4910.
[AGENT][NEUTRAL] Go ahead. Uh-huh.
[AGENT][NEUTRAL] Is that Pero?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, Perio endedo is major.
[CUSTOMER][NEUTRAL] Oh, OK, uh, even the 4341 SRP that's under major.
[AGENT][NEUTRAL] It's 43.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] 41? Yeah, I don't believe that's covered, but I'll double check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's just basic cleaning and the X-rays looks like.
[AGENT][NEGATIVE] Yeah, that's not covered under that code is not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, ah.
[CUSTOMER][NEUTRAL] OK, so the the only basic would be the um filling then the 2391 that's new.
[AGENT][POSITIVE] Pretty much restorative the restorative services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, that's it, OK, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess what's the frequency for bite wings?
[AGENT][NEUTRAL] Right wing X-rays.
[AGENT][NEUTRAL] And what code are you billing for?
[CUSTOMER][NEUTRAL] Um, the 0274.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so it's limited to one bite wing X-ray procedure per 12 months and it shares frequencies with D070 and then D072.
[CUSTOMER][NEUTRAL] OK, I think I'm done, uh, fluoride, please, that's 12:08.
[AGENT][NEUTRAL] 1208
[CUSTOMER][NEUTRAL] OK, so that's OK.
[AGENT][NEUTRAL] So a max of 1 procedure per 12 month period, uh, limited to two dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK, and I, I guess I'll just wait for the um fax back. If not, I can call back and then um ask for another fax back, yeah.
[AGENT][NEUTRAL] Yeah, I sent it. Yeah, I sent it to, yeah, you should receive it. Sometimes it takes a minute. [PII].
[CUSTOMER][NEUTRAL] I'll take
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][POSITIVE] Yeah, that's correct, yeah.
[AGENT][POSITIVE] Yeah, you're gonna be getting it here shortly.
[CUSTOMER][NEUTRAL] OK, um, and just a reference number then please.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference [PII] and then first initial and last name is [PII] and anything else, [PII]?
[CUSTOMER][NEUTRAL] Tell him how
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][POSITIVE] OK, no, that's it, [PII], thank you, have a good one, OK.
[AGENT][POSITIVE] Alrighty, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks OK bye bye.