AccountId: 011433970860
ContactId: b2b542bb-cdeb-4b8e-8d1b-7c961e7aa53b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1096900 ms
Total Talk Time (AGENT): 278607 ms
Total Talk Time (CUSTOMER): 273649 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/b2b542bb-cdeb-4b8e-8d1b-7c961e7aa53b_20250424T15:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], and I'm calling you on behalf of the provider's office to check eligibility and dental benefit. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good, thank you.
[AGENT][POSITIVE] That's good, and I'll be more than happy to help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Of course. It's [PII]. And this call is gonna be recorded for the quality and training purposes.
[AGENT][POSITIVE] Thank you for that and may I
[CUSTOMER][NEUTRAL] And I'm sorry, can you help me with your name on PBM?
[AGENT][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] And uh thank you.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01750414
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax back or you have particular questions about it?
[CUSTOMER][NEUTRAL] Uh, you can provide me the, uh, on the verbal.
[CUSTOMER][NEUTRAL] your phone now.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] you know.
[AGENT][NEUTRAL] OK. So the calendar year max for this policy is $500 per insured.
[CUSTOMER][NEUTRAL] Uh, just a second.
[CUSTOMER][NEUTRAL] Can you first help me with the fee schedule?
[AGENT][NEUTRAL] This is on the on the Carrington PPO. Yes, can you hear me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, yes, now I can hear you. Carrington BPO.
[AGENT][NEUTRAL] This is on the
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Just a second.
[CUSTOMER][POSITIVE] Thank you so much. Yes, and then can you help me with the group and group number as well?
[CUSTOMER][NEUTRAL] For, uh, maybe 2 more minutes let her uh.
[AGENT][NEUTRAL] The group number is 70,030.
[CUSTOMER][NEUTRAL] And uh maybe.
[AGENT][NEUTRAL] The group name is Creative Circle LLC.
[CUSTOMER][NEUTRAL] Creative circle LLC, OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][POSITIVE] OK, so that you got it. Thank you.
[CUSTOMER][NEUTRAL] And is this a guarantee your plan of this school year plan?
[AGENT][NEUTRAL] Calendar year?
[CUSTOMER][NEUTRAL] What would be the coordination of benefit, standard non duplication?
[AGENT][NEUTRAL] There's no coordination of benefits. This policy will pay as uh the claims come in.
[CUSTOMER][POSITIVE] Got it. Thank you. What about the annual match?
[AGENT][NEUTRAL] The max for this policy is up to $500 per covered insured.
[CUSTOMER][NEUTRAL] Anything use anything you know?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, the use amount?
[AGENT][NEUTRAL] Um, let me see if it is being used for this year. Hold on one second.
[CUSTOMER][NEUTRAL] There's no use amount?
[AGENT][NEUTRAL] I'm sorry. Give me just a moment. I, I understand the question. Hold on one moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] They have not used any of the calendar year max or met the deductible for [PII]?
[CUSTOMER][NEUTRAL] And the deductible amount is?
[AGENT][NEUTRAL] $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] And it doesn't apply to the deduct um to the preventative.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] What about any waiting period missing too first?
[AGENT][NEGATIVE] There is a missing tooth cloth. There's no waiting period because this policy does not cover any major services. Major for us is endodontic, periodontic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Prosodontic and oral surgery.
[CUSTOMER][NEUTRAL] Oral surgery, endodontics.
[CUSTOMER][NEUTRAL] Periodontics.
[CUSTOMER][NEUTRAL] Proto. OK.
[CUSTOMER][NEUTRAL] They all are in the major services, right? And crowns also, right?
[AGENT][NEUTRAL] Uh, I'm sorry, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Crown also covered under major only, right? They are also not covered?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you help me with the exam frequency and diagnostic preventive their percentage?
[AGENT][NEUTRAL] So did you want to go over the fact back or you have particular questions because for that I'm gonna need codes, but we didn't get there yet. So did you want me to go over the facts back with you verbally?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, no, verbally, yes. Should I provide you the codes?
[AGENT][NEUTRAL] So preventative
[AGENT][NEUTRAL] You can if you like. We're we're not there yet, but if you'd like to, you can.
[CUSTOMER][NEUTRAL] OK. Go ahead if you want to.
[CUSTOMER][NEUTRAL] Uh, because I'm just asking you the specific questions only. So I have code 0120.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You want me to provide you all of them together?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] 12081351.
[CUSTOMER][NEUTRAL] 23934341 43554381 [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Just a
[CUSTOMER][NEUTRAL] In this plan, uh [PII].
[CUSTOMER][NEUTRAL] [PII] 23 93 10 and [PII]. That's all.
[AGENT][NEUTRAL] OK, so would you like me to go over the codes with you first, or did you want to go through the verbal facts back that you asked for?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] You can directly go with the codes, and I don't need the verbal fas back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment. Um, is it alright if I place you on a brief hold while I go through the codes?
[CUSTOMER][POSITIVE] Sure, no problem. Take your time, [PII]. Thank you so much.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. So for code 0120, it's under preventative at 100%.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's limited to 2 or evaluation procedures per 12-month period.
[AGENT][NEUTRAL] And it can be paired with 140, 50, or 60.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] 020120, I'm sorry, 0210 is full mouth X-rays at 80%, 1 per 5 years?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 0274 is preventative at 100%, 1 per 12-month period.
[AGENT][NEUTRAL] 0330 80%, 1 per 5 year period.
[CUSTOMER][NEUTRAL] To share with [PII].
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, sorry, SMS.
[CUSTOMER][NEUTRAL] It's shared with SMS.
[AGENT][NEUTRAL] I shared with 0.
[AGENT][NEUTRAL] It's shared with 0210 and 0277.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 303-67 and 0431 are not covered.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] 1110 is preventative at 100%, 1 per 6 months?
[AGENT][NEUTRAL] 1206 and 1208 are not covered?
[AGENT][NEUTRAL] 1351 is preventative at 100%, maximum to 1 procedure per 36 months.
[AGENT][NEUTRAL] Limited to dependent children aged [PII].
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2393 is basic.
[AGENT][NEUTRAL] At 80%.
[AGENT][NEUTRAL] Uh, replace existing.
[CUSTOMER][NEUTRAL] It's covered or downgraded?
[AGENT][NEUTRAL] Would you like the limitations for this code?
[CUSTOMER][NEUTRAL] Uh, no, I just need to know that they are covered or downgraded.
[AGENT][NEUTRAL] There's no downgrade, so you don't need to know about the replacing and all of that.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 4341 9,223,372,036,854,775,807 and 9934 are all not covered?
[CUSTOMER][NEUTRAL] 922 3.
[AGENT][NEUTRAL] 9310 is a basic consult at 80%.
[CUSTOMER][NEUTRAL] Uh, for 93, then I need the frequency?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] For 9310, I need the frequency.
[AGENT][NEUTRAL] Again, it's 80%.
[AGENT][NEGATIVE] There's no frequency.
[CUSTOMER][NEUTRAL] Oh, no, frequency, sorry, I didn't hear that. I'm sorry.
[CUSTOMER][NEUTRAL] And missing toothbrush is forever or is there any limitation?
[AGENT][NEGATIVE] Um, there's no limitation. Uh, the policy has a missing tooth cloth.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And code 2630 and [PII] also not covered, right?
[CUSTOMER][NEUTRAL] Can you just check that?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 2630 is not covered and what was the other code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Both of those are not covered.
[CUSTOMER][NEUTRAL] And uh orthodontics also not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. Any history that may affect?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, there's no history on file. We haven't filed, we haven't processed a claim for the insured.
[CUSTOMER][POSITIVE] Sure. Thank you so much. So I got all of the information. That's all I need today. Thank you so much for your time and your help, and you have a great day.
[AGENT][POSITIVE] You're welcome. You also, um, [PII], was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all I need. Thank you so much for your time and your help, and then you have a great day. Bye.
[AGENT][POSITIVE] Thank you, you also. Bye-bye.