AccountId: 011433970860
ContactId: c20d3258-e721-4c1a-8024-14680d6f02f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542479 ms
Total Talk Time (AGENT): 216316 ms
Total Talk Time (CUSTOMER): 169265 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c20d3258-e721-4c1a-8024-14680d6f02f1_20250305T21:30_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, this is [PII]. I need to verify a patient's dental benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the dental benefits. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII] is option 2.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is 02110440.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII] birthday, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And you said you wanted to go over the benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, and did you need a copy of the fax back or you have particular questions?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have some questions. First of all, what is the name of of the insurance company?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The insurance company is American Public Life or APL.
[CUSTOMER][NEUTRAL] OK, and are you able to.
[CUSTOMER][NEUTRAL] Um, look and see if if our office is in network for you.
[AGENT][NEUTRAL] So the insurance product is on the car is Carrington Dental.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But this particular policy um isn't on like the Carrington PPO network or HMO, so there's no network for this particular policy.
[CUSTOMER][NEUTRAL] OK and then is there a claim address?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And are there any deductibles?
[AGENT][NEUTRAL] Yes, um, it's $50 per person up to $150 per family, and the deductible doesn't apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK, and has deduct deductible been met for this year?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] user.
[AGENT][NEGATIVE] Um, so far, the deductible has not been met and the max has not been used either.
[CUSTOMER][NEUTRAL] OK, and you said the max was 1500?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, is there orthodontic coverage?
[AGENT][NEUTRAL] Um, no orthodontic treatment.
[CUSTOMER][NEUTRAL] OK, and then what percentage is diagnostic covered?
[AGENT][NEUTRAL] Diagnostic, um, so it's broken down into preventative, radiograph and FMX, basic, basic restorative and major.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Usually
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] And those are both covered?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Preventative is covered at 100% of the UCR um radiographs 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic expenses and basic restorative are at 80%.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Major expenses, which for us includes endodontic, periodontic, prosodontic, and oral surgery, is all covered at 40%.
[CUSTOMER][NEUTRAL] Oh, like
[AGENT][NEUTRAL] And there's a 12-month waiting period, but this policy has passed that waiting period.
[CUSTOMER][POSITIVE] I'm pretty
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and are implants covered?
[AGENT][NEUTRAL] Um, implant placement, removal, and all related services are not covered on the policy.
[CUSTOMER][NEUTRAL] OK, uh, what about dentures?
[AGENT][NEUTRAL] Um, dentures under major once every 5 years.
[CUSTOMER][NEUTRAL] OK, and crowns and bridges?
[AGENT][NEUTRAL] are under major as well once every 7 years per 2.
[CUSTOMER][NEUTRAL] OK, and frequency for exams?
[AGENT][NEUTRAL] 2 for 12-month period.
[CUSTOMER][NEUTRAL] And cleanings.
[AGENT][NEUTRAL] Um, once every 6 months.
[CUSTOMER][NEUTRAL] OK, and bite wing X-rays?
[AGENT][NEUTRAL] Um, once per 12 month period.
[CUSTOMER][NEUTRAL] And full mouth X-rays?
[AGENT][NEUTRAL] Or once every 5 years.
[CUSTOMER][NEUTRAL] OK, and floor treatments?
[AGENT][NEUTRAL] Fluoride, hold on one moment.
[AGENT][NEUTRAL] Fluoride is limited to dependent children under age [PII].
[AGENT][NEUTRAL] And what was the other limitation? Hold on one moment.
[CUSTOMER][POSITIVE] Mm, no problem.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And maximum 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK, and then pay maintenance?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Do you have a code for the maintenance?
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] It's under major the um maximum of 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] What coverage category are simple extractions?
[AGENT][NEUTRAL] I believe basic let me double check, hold on one moment.
[AGENT][NEUTRAL] Like the 7140, yes, it's under basic.
[CUSTOMER][NEUTRAL] OK, and is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes, this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and then the frequency for SRP and that would be 4341.
[AGENT][NEUTRAL] 4341, hold on one moment.
[AGENT][NEUTRAL] It's under periodontic at 40% and the limitation is maximum 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK, and frequency for crowns?
[AGENT][NEUTRAL] Um, crowns and bridges once every 7 years per tooth.
[CUSTOMER][NEUTRAL] OK, and then dentures?
[AGENT][NEUTRAL] Dentures.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh God.
[AGENT][NEUTRAL] Once every 5 years.
[CUSTOMER][NEUTRAL] OK, and our crown bridge restorations on the molars downgraded to cast primarily base metal?
[AGENT][NEUTRAL] Um, so there's no downgrades on the policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and are posterior composite fillings, um, covered as resin or are they they're downgraded to a game?
[AGENT][NEUTRAL] Um, there's both. There's, um, resin codes and Ammagram.
[CUSTOMER][NEUTRAL] But they're not, are they downgraded at all?
[AGENT][NEUTRAL] No, there's no downgrades for the entire policy.
[CUSTOMER][NEUTRAL] Oh, OK, and is predetermination mandatory on anything?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I'll just need your name and a reference number.
[AGENT][NEUTRAL] Sure, so my name is [PII] The [PII] my [PII], and there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK all right sounds good thank you so much for your help today.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, that'll that'll be everything.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.