AccountId: 011433970860
ContactId: d239d192-7d68-4857-8f4c-60237956a204
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438040 ms
Total Talk Time (AGENT): 247791 ms
Total Talk Time (CUSTOMER): 202164 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/d239d192-7d68-4857-8f4c-60237956a204_20250312T15:21_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Dental Center West. I was calling to get a breakdown of benefits on a patient please.
[AGENT][NEUTRAL] I can certainly help with benefits, and [PII], what is that policy number, please?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Um, and the certificate number?
[AGENT][NEUTRAL] Uh yes, please.
[CUSTOMER][NEUTRAL] 0202478398
[AGENT][NEUTRAL] Alright, thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] I appreciate that.
[AGENT][POSITIVE] Thank you. Now, if I could just have a callback number please ma'am, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you so much. Now, uh, the policy went into effect on [PII]. It is active. You mentioned wanting to know about the benefits. The policy has $500 per calendar year as a maximum. That is just a verification of those benefits, not a guarantee of payment.
[AGENT][NEUTRAL] It covers basic, basic.
[AGENT][NEUTRAL] Only. Now, I don't show that that there's a $50 deductible that does not apply to preventative services.
[CUSTOMER][NEUTRAL] Is there deductible?
[CUSTOMER][NEUTRAL] OK, and preventative is covered at 100?
[AGENT][NEUTRAL] Yes, and basic and basic restorative is uh at 80%. I have a fax back I can send to you if you like or?
[CUSTOMER][NEUTRAL] OK, basics.
[CUSTOMER][NEUTRAL] Mhm it's, it's no that's OK um so basic is at 80. What about uh major?
[AGENT][NEGATIVE] There's no major coverage on this. It only covers basic, basic sort of presented.
[CUSTOMER][NEUTRAL] OK, what about
[CUSTOMER][NEUTRAL] OK, so no perio and oral surgery, none of that.
[AGENT][NEUTRAL] No, ma'am. None of that.
[CUSTOMER][NEUTRAL] OK, uh, any waiting periods or missing tooth claws?
[AGENT][NEGATIVE] There is a missing tooth cloth. There are no waiting periods.
[CUSTOMER][NEUTRAL] There is a missing tooth clause all right and then I just have a few um.
[CUSTOMER][NEUTRAL] For specific code 4355.
[AGENT][NEUTRAL] Uh, that is not covered.
[CUSTOMER][NEUTRAL] 9110
[AGENT][NEUTRAL] Uh, let me just check here.
[AGENT][NEGATIVE] I don't think it is. Oh, absolutely, um, no, that is not covered.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[CUSTOMER][NEUTRAL] OK, and then now I'm gonna ask anyway, not.
[AGENT][NEGATIVE] Oh, Sunday, I'm sorry, I'm sorry. I was, uh, forgive me. I, I slipped right by that. Now, the 431 is not covered. 9110, yes, palliative emergency treatment, yes, that is under basic at 80%. There's no limitations. Please forgive me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. 9944.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9944.
[AGENT][NEGATIVE] Uh, that, that is not covered, no.
[CUSTOMER][NEUTRAL] OK, for sure, huh, right, I thought um 60, right, 6010.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] 6010.
[CUSTOMER][NEGATIVE] Not covered mm.
[AGENT][NEUTRAL] No, it's not. I'm just looking, I just wanna be sure, uh, since I made that first mistake.
[CUSTOMER][POSITIVE] Oh, no, no, you're fine and I do appreciate you. And is there a repla replacement clause?
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Uh, it's not covered. This is not covered, uh, yeah.
[CUSTOMER][NEUTRAL] OK, and then what about the posterior composites? Are they downgraded or are they not even a covered benefit? I don't think they would be honestly, but I'm asking.
[AGENT][NEUTRAL] They are
[AGENT][NEUTRAL] Uh, absolutely. Now that, uh, they, um, you're talking about fillings, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct, yes ma'am.
[AGENT][NEUTRAL] Yes, yes, they are. They are under basic at um at 80%, but they do not downgrade to um, yeah, they don't downgrade to amalgam.
[CUSTOMER][POSITIVE] OK, I'm glad I asked. No, OK, perfect. What about 4381? Right, that's why I said I expected it to say no.
[AGENT][NEUTRAL] That's about all that's, that's.
[AGENT][NEUTRAL] Uh, 43
[AGENT][NEGATIVE] Sure. 4381, no, it is not.
[CUSTOMER][NEUTRAL] OK, and then, um, as far as the preventative goes they cover 2 cleanings per year?
[AGENT][NEUTRAL] Yes, now, the cleanings have to be every 6 months and then the, the oral examinations are 2 for 12 month period.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] All right, and what about the bite wings?
[AGENT][NEUTRAL] Once for 12 month period.
[CUSTOMER][NEUTRAL] Alright, and the panel?
[AGENT][NEUTRAL] Once every 5. And by the way, uh, there's no history for um uh Mr. [PII] so.
[CUSTOMER][NEUTRAL] No history. You knew I was gonna ask that next.
[AGENT][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You can always tell uh the next place right so then what about the group number and is there a group name?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] There is a group number. It is uh 70056.
[AGENT][NEUTRAL] And that is management analysis services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I'm sorry, you're breaking out.
[AGENT][NEUTRAL] Uh, a management analysis services. And did you get the number? 70056?
[CUSTOMER][NEGATIVE] Mm, no, I can't, I can't, I don't know what's happened, but I can, I can barely hear you now.
[AGENT][NEUTRAL] OK, can you hear me now? I'm, I'm a little bit louder. 00, good. OK, yeah, I'm, I'm not trying to shout. I apologize. Um, the group number is um 70056.
[CUSTOMER][POSITIVE] Yep I can now.
[CUSTOMER][NEUTRAL] No, no, no, you're fine.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And it's management, uh, management analysis.
[CUSTOMER][NEUTRAL] And the group name? Management.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Analysis.
[AGENT][NEUTRAL] Group
[CUSTOMER][NEUTRAL] OK, got you, and then is there a payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801 and we are sending claims addressing the claims to what um Carrington?
[AGENT][NEUTRAL] No, it's called APL, A as in apple, P as in Papa, L as in Lima.
[CUSTOMER][NEUTRAL] OK, I'm.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] Would you like our mailing address, the fax number, or we also have an online service center?
[CUSTOMER][NEUTRAL] Um, the mailing address please.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm. OK, now let me ask you this, um, these particular fees you guys use, whose fees do you use?
[AGENT][NEUTRAL] We use the Carrington PPO network fee schedule, but you do not need to be in network with Carrington. They can go anywhere, but they just, there's just no major, yeah. Well, we use that, we use that, um, uh, we use their uh um fee schedule, but no, it's not a PPO uh program. What it is, this is is it's a limited benefit, uh uh dental policy that only covers the very, very basics.
[CUSTOMER][NEUTRAL] So it is a PPO?
[CUSTOMER][NEUTRAL] OK and you said it's called Carrington.
[AGENT][NEUTRAL] Well, yes, the, the fee schedule is the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEGATIVE] And unfortunately, I don't have a copy of that, but you don't need to be in, in uh uh membership or network with them for it to work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you, um, due to age, uh, OK, so it looks like it's just the preventative and basic at 80% and then, um, no, that maximum is 500 deductible 50 and then so it's really basically just the cleanings and some basic work you will help cover and that's it.
[AGENT][POSITIVE] That is correct. Yeah, this, this is this is very, that's why they're allowed to go anywhere, yeah. Yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] Yeah, OK, it's pretty limited, real basic, yeah, right, right, right, got you. OK, I sure do appreciate your help and I, I hope that you have a great day. Thank you again.
[AGENT][POSITIVE] OK, well, thank you for contacting if you have a good.