AccountId: 011433970860
ContactId: b958ca7f-a76a-4504-83c7-0da21f5fe572
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 730859 ms
Total Talk Time (AGENT): 303433 ms
Total Talk Time (CUSTOMER): 229429 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/b958ca7f-a76a-4504-83c7-0da21f5fe572_20250421T13:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I was just calling to see if this patient um had an active and benefits.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility. May I have your name?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You need her name?
[AGENT][NEUTRAL] Your name.
[CUSTOMER][NEUTRAL] Oh, my name is [PII]
[AGENT][POSITIVE] Thank you, Miss [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from from my notation?
[CUSTOMER][NEUTRAL] Uh, Aspen dental.
[AGENT][POSITIVE] OK, OK, thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] That's good, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02584561
[AGENT][NEUTRAL] Perfect. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], one second, um, date of birth [PII].
[AGENT][NEUTRAL] Thank you. All right. and Ms [PII], you said you need eligibility. Uh, we have an effective date of [PII]. It is active at the moment and this is one of our basic dental policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me if she's in network with Aspen?
[AGENT][NEGATIVE] There is no network on this one.
[CUSTOMER][NEUTRAL] There's there's no in network or out of network?
[AGENT][NEUTRAL] No, if the provider participates with Carrington, they can get that additional discount, but it is not required because we don't have any networks.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one second as I put this information in if you don't mind.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sure, yes, no problem.
[CUSTOMER][NEUTRAL] Um, can you tell me if there's a grouping?
[AGENT][NEUTRAL] A group name
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, OK, yeah, let me go ahead and put that out.
[AGENT][NEUTRAL] And I also have a payer ID if you need it. Um, the group um name is going to be Oxford Global Resources.
[CUSTOMER][NEUTRAL] You said Oxford, O X F O R D?
[AGENT][NEUTRAL] Global
[AGENT][NEUTRAL] Yes, O X F O R D, Global Resources.
[CUSTOMER][NEUTRAL] OK, is there a group number?
[AGENT][NEUTRAL] Yes, the group number is 70052.
[CUSTOMER][NEUTRAL] And you said the, the policy number that I gave you is not her member ID number?
[AGENT][NEUTRAL] It is her member ID, yes. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I'm so sorry because I wasn't sure what she said what is the insurance name?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] APL or American Public Life.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It says Amera.
[AGENT][NEUTRAL] And again, I have a payer ID.
[AGENT][NEUTRAL] If you need it.
[CUSTOMER][NEUTRAL] It says um um the.
[CUSTOMER][NEUTRAL] Use use other networks not found.
[CUSTOMER][NEUTRAL] Is there a plan product name?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] There's not a plan product name.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] How about the network?
[AGENT][NEUTRAL] There's no network um.
[CUSTOMER][NEUTRAL] Did you say it's
[AGENT][NEUTRAL] If the provider participates with Carrington, they can use the fee schedule.
[CUSTOMER][NEUTRAL] OK, so the Carrington PPLA.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Alright and then may I have the claims address?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Alright, one second as I find that [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] There's so many addresses I wish that it it could just come up once I put the name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see, yeah, the last person that called from [PII], she used the payer ID and it was a lot faster for her. I'm not sure if that makes a difference or not.
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah, no, it won't let me it it.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Actually I'm gonna, I'm gonna try what is the payer ID number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, no, I thought that it would have come up and you said that is 248-950 Oklahoma?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, Oklahoma City, Oklahoma.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Alright, I'm gonna just put whatever and I'm sorry, you said 608 for the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 01. Alright, I'll go back to that because it will allow me. I don't wanna hold you up too too much. Um, can you tell me if there's a deductible for individual?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, um, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. Um, let me see how much is this one. Bear with me just a second.
[AGENT][NEUTRAL] All right. So this one has a $50 deductible and a calendar year maximum of $500.
[CUSTOMER][NEUTRAL] Has anything been used for either of them?
[AGENT][NEUTRAL] Not for this year.
[CUSTOMER][NEUTRAL] OK. And can you give me the diagnostic percentage?
[AGENT][NEUTRAL] The radiograph FMX.
[AGENT][NEUTRAL] Or which one?
[CUSTOMER][NEUTRAL] No, the diagnostic percentage?
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] Diagnostic preventive like.
[CUSTOMER][NEUTRAL] There's no code for it's usually like in the basic major and uh endonnatics periodontics, that type of percentage like usually 100 180, 60 usually or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can give you a breakdown of our frequencies. Bear with me just a second, let me get that for them.
[AGENT][NEUTRAL] OK, so this one has a preventative 100%. Radiograph FMX is 80%, basic expense and basic restorative is 80%, and there is no major service. So endodontics, periodontics, prosthodontic repair, oral surgery, those are not covered. There's no major service, so it will only cover preventatives, which is 100%, radiograph FMX which is 80%, basic expense and basic restorative expense which is 80.
[CUSTOMER][NEUTRAL] So dentures, uh, implants, oral surgery, crown bridges is all at 0. Just and theonyx is 80.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Mm, not covered.
[AGENT][NEUTRAL] No, mm mm. Andoonic periodontics, protoonic repair are not covered again. Endoontics, periodontics, prosthoontic repair are not covered. Mm.
[CUSTOMER][NEUTRAL] OK, now may I have the the.
[CUSTOMER][NEGATIVE] Oh, they're not, that's not.
[CUSTOMER][NEUTRAL] Oh, OK, um, may I have the frequencies for exam?
[AGENT][NEUTRAL] OK, if this alerts number with me.
[CUSTOMER][NEUTRAL] Do you need the code for that?
[AGENT][POSITIVE] Yes, if you don't mind.
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] OK, so the evaluation is going to be, let's see, limited to two oral evaluation procedures and any combination of 120, 140, 150, or 160 for 12 month period.
[AGENT][NEUTRAL] And that's gonna be under preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, cleaning 11:10.
[AGENT][NEUTRAL] OK, so that one is going to be also under preventative and we have maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Um, by wings 270.
[AGENT][NEUTRAL] OK, so this one is also gonna be under preventative and is going to be limited to one byw X-ray procedure and any combination of 270 to 72 or 274 per 12 month period.
[CUSTOMER][NEUTRAL] OK, FMX 210 or yeah, 210.
[AGENT][NEUTRAL] OK, so that one is gonna be on the radiograph FMX which is the 80% and it's limited to one X-ray procedure in any combination of 210, 277 or 330 per 5-year period.
[CUSTOMER][NEUTRAL] OK, and that um shares same frequency with panel.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, fluoride 1208.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so for fluoride, let's see.
[AGENT][NEUTRAL] That's also on the preventative.
[AGENT][NEUTRAL] And that's gonna be limited of one procedure for 12 months and dependent children, um, let's see.
[AGENT][NEUTRAL] Limited children aged [PII], I'm sorry.
[CUSTOMER][NEUTRAL] Mhm. Perial maintenance 4910.
[AGENT][NEGATIVE] And Puyo is not covered.
[CUSTOMER][NEUTRAL] Hm, excuse me, sorry, uh, Per SRP 4341.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEGATIVE] PBO is not covered at all.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Uh, dentures, bridges, and crowns.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And is there a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yeah, what did you say your name was?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK, and then today's date sounds good thank you so much for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good week, Miss.
[CUSTOMER][POSITIVE] Thank you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.