AccountId: 011433970860
ContactId: acff88c6-7b69-462d-ab07-065c15420d5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325200 ms
Total Talk Time (AGENT): 170442 ms
Total Talk Time (CUSTOMER): 92789 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/acff88c6-7b69-462d-ab07-065c15420d5b_20250102T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey there, I just needed to get a breakdown of benefits for a patient please.
[AGENT][NEUTRAL] OK, I can help you. Could you speak a little louder? I can barely hear you.
[CUSTOMER][NEUTRAL] Oh sorry, there we go, let me pull this up. Is that better?
[AGENT][NEUTRAL] Uh, a little bit. And your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um, 02572952.
[AGENT][NEUTRAL] 02572952 or 56?
[CUSTOMER][NEUTRAL] 52
[AGENT][NEUTRAL] 52, OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][POSITIVE] Thank you for that information. And we're checking dental benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, would you like the schedule faxed over to you?
[CUSTOMER][NEUTRAL] Um, no, I would, I, if I could just go ahead and get a verbal real quick, that would be fine.
[AGENT][NEUTRAL] OK, and I show the policy effective date is [PII].
[AGENT][NEUTRAL] Policy is active at this time?
[AGENT][NEUTRAL] Uh, under this policy, the calendar year max is $500 per covered person per calendar year. I do show this as an individual policy. There is a $50 calendar year deductible that applies towards basic only. Uh, preventive is reimbursed at a 100%, basic 80%, major is not covered.
[AGENT][NEUTRAL] Uh, let me know when you're ready for the frequencies.
[CUSTOMER][NEUTRAL] You can go ahead.
[AGENT][NEUTRAL] So for cleanings once every 6 months?
[AGENT][NEUTRAL] Oral evaluations 2 for 12 month period.
[AGENT][NEUTRAL] Uh, bite wings are once per 12-month period.
[AGENT][NEUTRAL] And then FMX and Penno is once every 5 years.
[AGENT][NEUTRAL] Uh, there is a missing tooth clause under this plan. Uh, orthodontic treatment is not covered. Uh, TMJ is not covered. Any implant placement removal is related services are not covered by this policy. I don't show a history for this patient, so no claims have been received or paid.
[AGENT][NEUTRAL] Um, did you need the claim's mailing address, fax number, and payer ID number?
[CUSTOMER][NEUTRAL] Um, just the mailing address and payer ID, please.
[AGENT][NEUTRAL] OK. Payer ID is 60801.
[AGENT][NEUTRAL] And the claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm so sorry hold on [PII], and then what was the zip code one more time?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, now are there any waiting periods on the policy?
[AGENT][NEUTRAL] No major, so no waiting periods.
[CUSTOMER][NEUTRAL] OK, now do y'all classify like periodontics as major category or would that be under basic?
[AGENT][NEUTRAL] Perio Indo is major.
[CUSTOMER][NEUTRAL] OK, so none of that. OK dokey. What about like for um extractions?
[AGENT][NEUTRAL] The only code that's covered is the simple extraction, the D 7140.
[CUSTOMER][NEUTRAL] Alright, um,
[CUSTOMER][NEUTRAL] And then um because we're out of network, do y'all still do assignment of benefits or would a member get reimbursed?
[AGENT][NEUTRAL] So the PPO network is Carrington. Are you familiar with Carrington?
[CUSTOMER][NEUTRAL] Um, somewhat, yes.
[AGENT][NEUTRAL] OK, are you contracted with that network of providers?
[CUSTOMER][NEUTRAL] No, we're not contracted with any insurances, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the pro so a benefit could be provided.
[AGENT][NEUTRAL] Just not at a discounted rate.
[CUSTOMER][NEUTRAL] Right now would the would reimbursement go to the member or would y'all accept assignment of benefits?
[AGENT][NEUTRAL] So if there's an assignment of benefits uh on file, it can be submitted and reimbursed to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and then um can you just confirm to me the group name and number?
[AGENT][NEUTRAL] I have that information for you. I believe it's also on the identification card. The group number is 70076 Wagner Service Solutions.
[CUSTOMER][NEUTRAL] Wagner.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] OK. Um, if I could just get a reference number, please?
[AGENT][NEUTRAL] My name in today's date, [PII].
[AGENT][NEUTRAL] Oh NYA.
[AGENT][NEUTRAL] First initial of my last name is [PII], and of course the information provided is verification, not a guarantee of payment. And Chrissy, any other questions I can help out with today?
[CUSTOMER][POSITIVE] Uh, no, that was it. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.