AccountId: 011433970860
ContactId: d1fac4ce-40e1-468e-a1b6-e27cab96dcac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293160 ms
Total Talk Time (AGENT): 110318 ms
Total Talk Time (CUSTOMER): 101536 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/d1fac4ce-40e1-468e-a1b6-e27cab96dcac_20250527T19:28_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Aspen Dental Trustful. I was calling to get a breakdown of benefits for a mutual patient of ours.
[AGENT][NEUTRAL] OK, I could 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] Absolutely it's [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It's gonna be 02396574.
[AGENT][NEUTRAL] OK, and then what was
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So I have the policy under [PII] date of birth [PII], but I'm calling in regards to his wife [PII], and that date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. Um, alrighty, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And if you'd like I can send you the fax back that shows all of the coverage procedures and benefit information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can I get it over the phone real quick?
[AGENT][POSITIVE] Oh yeah sure I can still send this to you either way but yeah I'm happy to answer questions over this time as well.
[CUSTOMER][NEUTRAL] OK, um, so the individual deductible.
[AGENT][NEUTRAL] That is $50.
[AGENT][NEUTRAL] Does apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, what about maximum?
[AGENT][NEUTRAL] Yeah, give me just a moment. Of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, calendar year maximum is $1500 per covered insured per calendar year.
[CUSTOMER][NEUTRAL] OK, and then is there any ortho coverage?
[AGENT][NEUTRAL] No, Orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] OK, so diagnostic and preventative. Um, any waiting periods?
[AGENT][NEUTRAL] Um, they did have a 12 month waiting period for major expenses, however, they are out of that. That was for 12 months, so no current waiting periods.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about any missing tooth louses?
[AGENT][NEGATIVE] There is a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then frequencies, so exams, cleanings, are those 2 and 12?
[AGENT][NEUTRAL] Uh, yes, so, uh, let's see. Cleaning's gonna be once every 6 months, exams, uh, 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, bite wings, is that 1 in 12?
[AGENT][NEUTRAL] Yes, that's correct, once per 12 month period.
[CUSTOMER][NEUTRAL] OK, full mouth, um, and pano is that 1 in 36?
[AGENT][NEUTRAL] That is once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then let's see, periodontal maintenance is that 4 and 12?
[AGENT][NEUTRAL] Let's see. So I've got, um,
[AGENT][NEUTRAL] Crowns and bridges once every 7 years per tooth, partials and dentures once every 5 years.
[CUSTOMER][NEUTRAL] OK, you said crowns and bridges once every 7 and then partials and dentures once every 5?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what about periodontal maintenance?
[AGENT][NEUTRAL] Um, do you have a specific code for that?
[CUSTOMER][NEUTRAL] Yes, it's going to be 4910.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] That is 1 per 6 months.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Um, 4341.
[AGENT][NEUTRAL] 4341. Give me just a moment.
[AGENT][NEUTRAL] That is maximum of 1 each quadrant per 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, I think that's all I needed thank you so much.
[AGENT][NEUTRAL] Sure, did you want me to still go ahead and send this fax back to you?
[CUSTOMER][POSITIVE] Uh, no, ma'am, you don't have to, but thank you though.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course is there anything else I can help you with?
[CUSTOMER][POSITIVE] That was it thank you so much.
[AGENT][POSITIVE] All right. You're very welcome. I hope you have a great rest of your day. Thank you.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thanks bye bye.