AccountId: 011433970860
ContactId: aa4c1cba-cb68-4348-9dc5-0481dc1dca6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784250 ms
Total Talk Time (AGENT): 281689 ms
Total Talk Time (CUSTOMER): 271281 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/aa4c1cba-cb68-4348-9dc5-0481dc1dca6a_20250103T19:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check dental benefit for the patient.
[AGENT][NEUTRAL] OK, [PII], what is your callback number please if disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][POSITIVE] Thank you so much, [PII]. What is the policy number?
[CUSTOMER][NEUTRAL] 025 02408.
[AGENT][NEUTRAL] OK, that was 02502408. Thank you. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] with the date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much for that verification [PII] I have that number pulled up and you're calling for benefits for dental. I can help you with that. Give me one moment please.
[AGENT][POSITIVE] OK, thank you so much for your patience. Um, this policy shows effective as of [PII] and it shows active.
[CUSTOMER][NEUTRAL] And is there any future termination date of this month?
[AGENT][NEUTRAL] It currently shows active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh, uh, providers in-network or out of network with this plan?
[AGENT][NEUTRAL] I can provide you a number for [PII] to call to check to see if that provider is in network. Um, if not, it will follow UCR usual customer and reasonable rates, but let me know when you're ready for that number for Carrington. I can provide that to you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, the provider is, uh, participating with Carrington, so that's fine.
[CUSTOMER][NEUTRAL] Provider is in network.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh yeah, and this is a dental PPO type plan, right?
[AGENT][POSITIVE] Correct, PPO.
[CUSTOMER][NEUTRAL] And how much and how much is the yearly max?
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. The member has a $500 calendar year max with a $50 deductible.
[CUSTOMER][NEUTRAL] And any amount has been used or met as of today?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And benefit period is calendar year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there a waiting period of missing tooth loss?
[AGENT][NEUTRAL] There is no waiting period. There is a missing tooth clause.
[CUSTOMER][NEUTRAL] And uh do you pay on prep date or she date?
[AGENT][NEUTRAL] This plan does not cover any major services that includes any crowns, bridges, dentures, partials.
[CUSTOMER][NEUTRAL] OK, and coordination of benefit is standard or non-loop?
[AGENT][NEUTRAL] We do not coordinate benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh preventive and diagnostic services are covered at 100%.
[AGENT][NEUTRAL] I'm so sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] Uh, I mean, uh, uh, preventive, basic, and major. So what is the coinsurance for preventive and basic? Major is not covered, right?
[AGENT][NEUTRAL] Major is not covered for preventative, we covered at 100% of allowable and basic services are covered at 80%.
[CUSTOMER][NEUTRAL] 80%. OK. Now, uh, restorative uh services like fillings, uh, are covered under the basic or major?
[AGENT][POSITIVE] Under basic at 80%, and those are 1 per 24 months and there are no downgrades at all.
[CUSTOMER][NEUTRAL] OK, 1 for 24 months.
[CUSTOMER][NEUTRAL] No downgrade. Then what about the crown it's not covered, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] 2740 is not go, right?
[AGENT][POSITIVE] That is correct. No major services are covered.
[CUSTOMER][NEUTRAL] Uh, endo 3330.
[AGENT][NEGATIVE] Also not covered.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] There's no endo, no perio, no oral surgery.
[AGENT][NEGATIVE] No prosthodontics, none of those are covered under this plan.
[CUSTOMER][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh 2391 is covered and then.
[CUSTOMER][NEUTRAL] 2950 will not be covered, right?
[AGENT][NEUTRAL] I'm sorry, AJ, what was that question the procedure code?
[CUSTOMER][NEUTRAL] 2950 is not covered, right? is it under the basic or major?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] All right, major.
[CUSTOMER][NEUTRAL] Got it. Then 4346 will be covered or not?
[AGENT][NEGATIVE] No, it is not covered.
[CUSTOMER][NEGATIVE] And 4355 also not cool?
[AGENT][POSITIVE] Correct. No period is covered at all. No perio surges are covered at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 4910 also not covered, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Occlusion card is covered under this plan or not?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 9944, not covered. OK, got it. And uh what is the frequency for uh exam 0120?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That falls under the preventative that is 2 for 12 month period.
[CUSTOMER][NEUTRAL] 2 for 12 months. OK.
[CUSTOMER][NEUTRAL] 0114.
[AGENT][NEUTRAL] That also falls under the same frequency 2 per 12 month period. However, 0140 is covered under basic at 80%.
[CUSTOMER][NEUTRAL] It is on the basic. OK.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] And they do not, so uh it does not share frequency with uh 0120 or 0150, right?
[AGENT][NEUTRAL] I'm sorry, 120, 150, and 140 they share that's 2 for 12 month period.
[CUSTOMER][NEUTRAL] 120, 140, and 150 share, right?
[AGENT][NEUTRAL] Correct, and that's 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK. And 180?
[AGENT][NEUTRAL] OK, 180, excuse me.
[AGENT][NEUTRAL] OK, 0180 is not covered.
[CUSTOMER][NEGATIVE] It is not go. OK, one second.
[CUSTOMER][NEUTRAL] And eno FMX 02100330.
[AGENT][NEUTRAL] Those both are covered under basic at 80%. They are 1 per 5 year period. They share frequency.
[CUSTOMER][NEUTRAL] 1 for 5 year, 80%.
[CUSTOMER][NEUTRAL] OK. Uh, PS 0220.
[AGENT][MIXED] OK, PAs fall under basic at 80%. There is no frequency for PAs.
[CUSTOMER][NEUTRAL] 80%. OK. By wings.
[AGENT][NEUTRAL] Bite wings are covered under preventative. That's 1 per 12 month period.
[CUSTOMER][NEUTRAL] Uh, prophy
[AGENT][NEUTRAL] Once every 6 months under preventative.
[CUSTOMER][NEUTRAL] Does it share, uh, it does not share with pay maintenance or
[CUSTOMER][NEUTRAL] And uh fluoride 1206.
[AGENT][NEUTRAL] 1206 is not covered.
[CUSTOMER][NEUTRAL] 1351
[AGENT][NEUTRAL] 1351 falls under preventative, 1 per 36 months, permanent molar teeth only limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK. And is it for uh permanent tooth only or uh pre-molars and molars?
[AGENT][NEUTRAL] Prominent molar teeth only.
[CUSTOMER][NEUTRAL] Permanent.
[CUSTOMER][NEUTRAL] Molar teeth only got it?
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Uh, what is the history for the patient?
[AGENT][NEUTRAL] OK, on December, excuse me, on [PII] member had a.
[AGENT][NEUTRAL] Pan
[AGENT][NEUTRAL] So that's once they 1 per 5 year period not eligible for that.
[AGENT][NEUTRAL] Remember I had profy.
[AGENT][NEUTRAL] Limited all exam and.
[AGENT][NEUTRAL] PAs so again on [PII] member had a panoramic a pan which he is not eligible for that.
[AGENT][NEUTRAL] Our members not eligible, also had a pro fee that's once every 6 months.
[AGENT][NEUTRAL] And then also an exam.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0150.
[CUSTOMER][NEUTRAL] 0143.
[CUSTOMER][NEUTRAL] It is not 0140?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] 014 excuse me 0150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 0150. OK.
[CUSTOMER][NEUTRAL] So no issue for 0120 and 0140, right?
[AGENT][NEUTRAL] Those are 2 for 12 month period.
[CUSTOMER][POSITIVE] Yeah. Got it.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I doing has no frequent uh uh no, no history, right?
[AGENT][NEUTRAL] No history for bite wings or bite wings.
[CUSTOMER][NEUTRAL] OK, no buttons.
[CUSTOMER][NEUTRAL] And she has also no history, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Got it. And uh what is the group number of this plan?
[AGENT][NEUTRAL] OK, one moment, AJ, let me get that for you.
[AGENT][NEUTRAL] OK, the group number shows 70,050.
[CUSTOMER][NEUTRAL] And group name
[AGENT][NEUTRAL] Group name is Adept, H R I N C, and that is spelled A like Alpha, D David, E Edward, P Papa, T Tango.
[AGENT][NEUTRAL] Second word is H R H R Robert.
[AGENT][NEUTRAL] And third word is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh what is the claim mailing address?
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And your name is [PII]?
[AGENT][NEUTRAL] My name is [PII], last initials [PII]. Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, just give me a second. Let me make sure that everything is fine.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, everything is fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is the reference number for this call?
[AGENT][NEUTRAL] Again, it'll be my name and today's date.
[CUSTOMER][POSITIVE] That's all right, uh, [PII]. Thank you very much. I appreciate you, ma'am.
[AGENT][POSITIVE] You're welcome, [PII] Thank you for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] Bye.