AccountId: 011433970860
ContactId: bbe83589-b879-4887-b526-5e89a34ec395
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 768340 ms
Total Talk Time (AGENT): 332390 ms
Total Talk Time (CUSTOMER): 221795 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/bbe83589-b879-4887-b526-5e89a34ec395_20250527T17:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi. My name is [PII] calling from provider office to check for dental benefits.
[AGENT][NEUTRAL] OK, I can check those benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] ID number for this member starting with 02607620.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like, [PII], I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] All right. So, uh, you don't provide the benefit over the phone?
[AGENT][NEUTRAL] I can give you information over the phone. I can also send you this fax back though that shows all of the uh benefits and procedures.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, sir, can you please, uh, give me the benefit over the phone?
[AGENT][NEUTRAL] Sure, so you didn't want me to send you this fax back?
[CUSTOMER][NEUTRAL] I need to fix that as well. But uh first, can we uh go over with over the phone?
[AGENT][NEUTRAL] Sure, what information can I provide you?
[CUSTOMER][NEUTRAL] Yeah. Can you please check the dentist participation and the the schedule?
[AGENT][NEUTRAL] Uh, so this policy participates in the Carrington PPO network. Uh, utilization of a Carrington or a provider within [PII] is not required.
[CUSTOMER][NEUTRAL] All right. So, uh, if provided, uh, participate with Carrington, we'll go with the Carrington schedule.
[AGENT][NEUTRAL] It would go through that fee schedule regardless um if the provider is within [PII] then the insured just gets a discount we would honor those claims regardless.
[CUSTOMER][NEUTRAL] All right. So what is the group name and group number?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Group number is 70055.
[CUSTOMER][NEUTRAL] And what about the good name?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] Staffing Services Inc.
[CUSTOMER][NEUTRAL] Can you please repeat the uh good name once more?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Staffing Services Inc.
[CUSTOMER][NEUTRAL] Yes, and the second one was passing, right?
[AGENT][NEUTRAL] Staffing S T A F F I N G.
[CUSTOMER][POSITIVE] Thank you so much for it. So for this plan, uh, is this run on a calendar year?
[AGENT][NEUTRAL] Yes, it is a calendar year plan.
[CUSTOMER][POSITIVE] Perfect. So what is the maximum and deductible for this calendar year?
[AGENT][NEUTRAL] Of course I will let you know verification of coverage is not a guarantee of payment for claims. Calendar year maximum is $500 per covered insured. It is $50 deductible per covered insured, and that does not apply to preventative services.
[CUSTOMER][NEUTRAL] So this uh $500 will apply to prevent this uh for all these services.
[AGENT][NEUTRAL] Yes, $500 is the uh maximum benefit. $50 is the deductible, which does not apply to preventative services.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. So, for this calendar year, is there any use a month?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, give me just a moment, let me check that.
[CUSTOMER][POSITIVE] All right. Take your time.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] All right. And orthodontic is covered or not?
[AGENT][NEUTRAL] No, orthodontic treatment is not covered under this policy.
[CUSTOMER][NEUTRAL] All right. So, is there any missing too close on waiting period with this plan?
[AGENT][NEUTRAL] There is a missing tooth clause. This policy does not offer any major expenses, so there is no waiting period.
[CUSTOMER][NEUTRAL] All right. And can you please give me the coinsurance of this plan?
[AGENT][NEUTRAL] There is no coinsurance.
[CUSTOMER][NEUTRAL] All the cover costs are no co-insurance for this plan?
[AGENT][NEUTRAL] Right, so preventative is at 100% of allowable, uh, FMX and basics are all at 80%.
[CUSTOMER][NEUTRAL] And you mentioned the major services are not covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right. So, uh, under the major category like crown bridge, denture implants are all not covered?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And so, can you please give me the frequency for this preventive services, preventive and diagnosis?
[AGENT][NEUTRAL] Yes, so, uh, for prophylaxis cleanings, uh, that is once every 6 months.
[AGENT][NEUTRAL] An oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings are once per 12 month period.
[AGENT][NEUTRAL] And full mouth X-rays and panoramics are once every 5 years, and they do share a frequency.
[CUSTOMER][NEUTRAL] That makes no 100 over at 80%, right?
[AGENT][NEUTRAL] Um, what was that? I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, SMX and Pao will be covered 80% or 100%.
[AGENT][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] All right. And the rest are covered 100, right? For example, cleaning and 3?
[AGENT][NEUTRAL] Prevented it
[AGENT][NEUTRAL] Preventative is at 100. FMX and basic expenses are at 80.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So, uh, fluoride insulins are covered or not?
[AGENT][NEUTRAL] What was that procedure code?
[CUSTOMER][NEUTRAL] 1208 and 1251?
[AGENT][NEUTRAL] OK, so 1351 is covered under preventative, um, 1208 is not going to be covered. Uh, give me just a moment, let me look at the limitations for 1351.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is limited to dependent children under [PII].
[CUSTOMER][NEUTRAL] So, for, and then what will be the frequency?
[AGENT][NEUTRAL] 41351.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's a maximum of 1 procedure per 36 months.
[CUSTOMER][NEUTRAL] Alright, so can you also check the 1206?
[AGENT][NEGATIVE] 1206 is not going to be covered under this policy.
[CUSTOMER][NEUTRAL] All right. And the 1208 also is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 9110 will be covered or not?
[AGENT][NEUTRAL] 9110 is covered under basic, so at 80%, and there is no limitation.
[CUSTOMER][NEUTRAL] All right. And 4 0220?
[AGENT][NEUTRAL] 0220 is covered under preventative or I'm sorry that is covered under basic uh so 80% and excuse me no limitations.
[CUSTOMER][NEUTRAL] Alright. 7953.
[AGENT][NEUTRAL] 7953 is not covered under this policy.
[CUSTOMER][NEUTRAL] 2393.
[AGENT][NEUTRAL] I'm sorry, you said 8393?
[CUSTOMER][NEUTRAL] 0, 2393.
[AGENT][NEUTRAL] 2393 is going to be covered under basic so at 80%, give me just a moment, let me look at those limitations.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so that's going to be maximum of 1 each tooth per 24 months.
[AGENT][NEUTRAL] And replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] So it is limited to 2, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. So it's downgraded or not?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. 7140.
[AGENT][NEUTRAL] I'm sorry, that was 2140?
[CUSTOMER][NEUTRAL] 7140.
[AGENT][NEUTRAL] 7140 is covered under basic, so at 80%.
[AGENT][NEUTRAL] And that is a maximum of one time purchase.
[CUSTOMER][NEUTRAL] For about 70 to 10.
[AGENT][NEUTRAL] 7210 is not covered under this policy.
[CUSTOMER][NEUTRAL] 120.
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] 3120.
[AGENT][NEUTRAL] That was 2120?
[CUSTOMER][NEUTRAL] 3120.
[AGENT][NEGATIVE] 3120 is not covered under this policy.
[CUSTOMER][NEUTRAL] All right. 2940.
[AGENT][NEUTRAL] 2940 is covered under basic, so 80%.
[AGENT][NEUTRAL] And that is
[AGENT][NEUTRAL] Maximum of 1 each tooth for 24 months and again replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] All right. And uh 3330?
[AGENT][NEUTRAL] That was 3330.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is not going to be a covered procedure.
[CUSTOMER][NEUTRAL] OK. And 43, 41?
[AGENT][NEUTRAL] 4341 is not covered.
[CUSTOMER][NEUTRAL] All right. 4910.
[AGENT][NEUTRAL] 4910 is also not covered under this policy.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] 4346 is not a covered procedure.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEGATIVE] That one's not covered either.
[CUSTOMER][NEUTRAL] And lastly, 4355.
[AGENT][NEUTRAL] 4355 is not covered under this policy either.
[CUSTOMER][NEUTRAL] All right. So for this member plan, is there any history on file?
[AGENT][NEUTRAL] No, there is no history.
[CUSTOMER][POSITIVE] M is good to go for all services that are covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And uh before we uh end the call, just want to confirm it, uh, this maximum of $500 applied to this preventive and basic services, right?
[AGENT][NEUTRAL] That's correct. The $50 deductible does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] All right. Can you also give
[CUSTOMER][NEUTRAL] All right. Can you also give me the claim mailing address?
[AGENT][NEUTRAL] That is uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Just want to confirm its [PII]. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what will be the payer ID?
[AGENT][NEUTRAL] That is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And so, uh, can you please uh send me the faxed copy of the benefit as well?
[AGENT][NEUTRAL] Yes, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] Perfect. And before we end the call, can you please give me the call reference number as well?
[AGENT][NEUTRAL] All right. I will go ahead and
[AGENT][NEUTRAL] The reference number would be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, that's all for today. Thank you so much. I really appreciate that.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] You to do the same. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.