AccountId: 011433970860
ContactId: a871ae8f-8eb1-44dc-a6f8-57e34966b0ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441589 ms
Total Talk Time (AGENT): 213145 ms
Total Talk Time (CUSTOMER): 140767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/a871ae8f-8eb1-44dc-a6f8-57e34966b0ae_20250226T17:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of the dental office to check 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, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] That would be 02568310.
[AGENT][NEUTRAL] Thank you [PII] and the patient's name and date of birth, please, sir.
[CUSTOMER][NEUTRAL] It's uh [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 the patient.
[AGENT][NEUTRAL] I'm showing that Ariane's policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And I do have a breakdown I can fax to you with the calendar year max deductibles, frequencies, limitations, and our billing information. Are you interested in that fax back?
[CUSTOMER][NEUTRAL] Uh, no, actually, I do have only a couple of questions regarding the dental benefits. So, uh, we can go over the phone. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That'll be fine.
[CUSTOMER][NEUTRAL] All right. So, um,
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, uh, what will be the group name and the group number?
[AGENT][NEUTRAL] The group name is.
[AGENT][NEUTRAL] Wagner, that's W A G N E R.
[AGENT][NEUTRAL] Service solutions.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And the group number 70076.
[CUSTOMER][NEUTRAL] Got it. And is it a single or a family coverage?
[AGENT][NEUTRAL] This is.
[AGENT][NEUTRAL] Single coverage.
[CUSTOMER][NEUTRAL] OK. And uh what will be the claim's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you accept assignment of benefits to a non-participating provider?
[AGENT][NEUTRAL] We do. The policy does participate in the Carrington PPO uh network, but network participation is not required for benefits.
[CUSTOMER][NEUTRAL] OK. And if benefits are exhausted, do in-network providers discounts apply?
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][NEUTRAL] OK. And is it a benefit year plan or a calendar year plan?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] And what will be the deductible and maximum?
[AGENT][NEUTRAL] All benefits given over the phone is a verification of coverage, not a guarantee of payment. The calendar year max on this policy is $500.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the deductible?
[AGENT][NEUTRAL] Deductible is $50 and it's up to $150 per family, the deductible does not apply to preventive services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And anything been used or met.
[AGENT][NEGATIVE] No history, nothing used and nothing met.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Uh, do we have any coverage for orthodontics?
[AGENT][NEGATIVE] Orthodontics is not covered.
[CUSTOMER][NEUTRAL] And any coverage for implants.
[AGENT][NEUTRAL] Implant is not a covered benefit either.
[CUSTOMER][NEUTRAL] OK. And uh is there a waiting period or a missing tooth loss?
[AGENT][NEUTRAL] There's no waiting period. There is a missing tooth cloths.
[CUSTOMER][NEUTRAL] And what will be the co-insurance for preventative basic measure?
[AGENT][NEUTRAL] For preventive, it's 100%. Radiographs FMX basic and basic restorative is 80% and there is no major coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for endoperio and oral surgery, uh those are the basic or major?
[AGENT][NEUTRAL] Those would be considered major and not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And even 4910 is not covered, right?
[AGENT][NEUTRAL] That's correct. No endodontic or periodontic services are covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And just to confirm, uh, is 7140 covered?
[AGENT][NEUTRAL] 7140.
[AGENT][NEUTRAL] It is covered under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for 70 to 10.
[AGENT][NEUTRAL] 7210 is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um for the replacement clause on major services, is it once every 5 years?
[AGENT][NEUTRAL] For a major for like a crown or bridge?
[CUSTOMER][NEUTRAL] Oh, OK. Yes. Uh, actually, uh, yeah, it doesn't matter. It doesn't, uh, yeah, it's not covered, sir. And, and, um, do we have any downgrade for fillings?
[AGENT][NEUTRAL] That's true.
[AGENT][POSITIVE] That's correct.
[AGENT][NEGATIVE] We do not downgrade.
[CUSTOMER][NEUTRAL] All right. And lastly, I do have around um 4, yeah, 4 codes to check. I only need the frequencies. So do you need all the codes at once or one by one?
[AGENT][POSITIVE] Yeah, let's do all of them at once if that's OK. Let's, and I'm ready.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the first would be 0150.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then 0274.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0 to 10
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And 1208.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm checking this, so bear with me just one moment.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Now the 0 150.
[AGENT][NEUTRAL] That is covered under preventive.
[AGENT][NEUTRAL] And the oral evaluations for 2 for 12 month period.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] By wings are once per 12 month period and covered under preventive of 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0210 FMX that is covered under basic along with the pano, and it's once every 5 years.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And the 1208, the fluoride is covered under preventive for 100% under the age of [PII], every 12 months.
[CUSTOMER][POSITIVE] Got it. And yes, I'm done with all my questions and you can provide me the reference number to a call.
[AGENT][NEUTRAL] The reference number is my name in today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] And [PII], thank you so much for your assistance and have a wonderful day ahead.
[AGENT][POSITIVE] Well, it's been my pleasure to assist you, Prince. Thank you for calling APL and I hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] You too bye bye bye bye.
[AGENT][NEUTRAL] Bye-bye.