AccountId: 011433970860
ContactId: d5c04a75-7e1e-4737-9a79-4d486e9c4151
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493260 ms
Total Talk Time (AGENT): 205913 ms
Total Talk Time (CUSTOMER): 164268 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/d5c04a75-7e1e-4737-9a79-4d486e9c4151_20250108T19:17_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] [PII], this is [PII] with Aspen Dental in [PII], and I am trying to see if we're in network and coverage for one of my patients, please.
[AGENT][POSITIVE] OK. Well, I can definitely assist you with the coverage and um help you with the network. And [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Well, she gave me her Social Security and said that's what it was supposed to be.
[AGENT][NEUTRAL] OK, um, it's not, but I can use the social to get to the policy and then I'll give you the policy number.
[CUSTOMER][POSITIVE] Perfect, it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for everything to pop up here hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name just so I make sure I'm in the right place?
[CUSTOMER][NEUTRAL] Sure, [PII], birth date is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] And thank you so much for verifying her information and all the information provided is a verification of benefits, not a guarantee of payment. Um, so the policy number is 258.
[CUSTOMER][NEUTRAL] Hang on, 258 mhm I'm ready.
[AGENT][NEUTRAL] OK. Mhm. 446 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the policy has been active since [PII].
[CUSTOMER][NEUTRAL] And what's the policy or the group name?
[AGENT][NEUTRAL] Hold on one moment. Group name is Crown Services.
[CUSTOMER][NEUTRAL] And the group number please.
[AGENT][NEUTRAL] 70036.
[CUSTOMER][NEUTRAL] 70036 and is this family or single?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEUTRAL] Um, this is a single parent.
[CUSTOMER][NEUTRAL] OK, OK, so it is family because you said single parent, so she's got a child, right?
[AGENT][NEUTRAL] Coverage.
[AGENT][NEUTRAL] Uh, well, yes, for you, yes, um, in our system, family coverage is different, but I guess yes.
[CUSTOMER][NEUTRAL] OK, alright, and the name of the insurance is America.
[AGENT][NEUTRAL] The insurance company is American Public Life. This policy um participates in the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, American Public.
[CUSTOMER][NEUTRAL] Hang on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There we go, and you said this is under Carrington?
[AGENT][NEUTRAL] Yes, ma'am. This is on the Carrington PPO network.
[CUSTOMER][NEUTRAL] Alright, and address for claims please.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So is it [PII]?
[AGENT][NEUTRAL] Yes, that's the [PII].
[CUSTOMER][NEUTRAL] OK, do you accept assignment of benefits of nonparticipating provider?
[AGENT][NEUTRAL] Um, there's no assignment of benefits for this policy. However, the claim is received will process it.
[CUSTOMER][NEUTRAL] OK, so I'm not sure what that means.
[AGENT][NEUTRAL] OK. So you said do we accept assignment of benefits?
[CUSTOMER][NEUTRAL] For non-participating providers.
[CUSTOMER][NEUTRAL] So are we in network? I guess is what I need to find out.
[AGENT][NEUTRAL] Right, so that's, I can give you the number to Carrington if you'd like to see if you are in in or out of network provider for them, um, but what I'm saying is the benefits are the same whether you're a Carrington provider or not.
[CUSTOMER][NEUTRAL] Where it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes we are. OK, now I got you, um, if benefits are exhausted to participating provider discounts apply.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] For non-covered services do participating provider discounts apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is there a deductible and if so, how much?
[AGENT][NEUTRAL] Mhm. Um, there is a $50 deductible up to $150 per family.
[CUSTOMER][NEUTRAL] OK, and what is the max?
[AGENT][NEUTRAL] The calendar year max is $500 per covered insured.
[CUSTOMER][POSITIVE] Oh my gosh, that's it.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, it's the orthodontic coverage, uh, uh, it doesn't matter, it's 500.
[CUSTOMER][NEUTRAL] OK, what are her, uh, is it, what is it, uh, percentage for diagnostic and preventative?
[AGENT][NEUTRAL] Um, so preventative, is that 100%?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this policy only covers preventative, radiograph and FMX basic and basic restorative, um, so everything except preventative is at 80%.
[CUSTOMER][NEUTRAL] OK, so basic is at 80?
[AGENT][NEUTRAL] Basic restorative is at 80, Basic is at 80, and radiographs and FMX are at 80.
[CUSTOMER][NEUTRAL] OK, is there major coverage?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Dentures, bridges, and crowns, OK.
[AGENT][NEUTRAL] No, ma'am, this policy doesn't cover major for us, um, that includes endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods for um.
[AGENT][NEUTRAL] For the policy? No, ma'am, um, because it doesn't cover major.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, so that's not covered, not covered. Is there a missing tooth cloth?
[AGENT][NEGATIVE] Um, this policy does have a missing tooth cloth.
[CUSTOMER][POSITIVE] OK, excellent, uh, 2 exams in a year or 1 in 6 months?
[AGENT][NEUTRAL] Um, 2 in a year.
[CUSTOMER][NEUTRAL] OK, is there 2 cleanings in a year?
[AGENT][NEUTRAL] Um, hold on one second, is there 2 cleanings?
[AGENT][NEUTRAL] Once for 6 months. So, yes.
[CUSTOMER][NEUTRAL] OK, um, bite wings?
[AGENT][NEUTRAL] Uh once per 12 month period?
[CUSTOMER][NEUTRAL] And that is covered under Basic, correct?
[AGENT][NEUTRAL] Let me double check, bite wings are covered under preventative.
[CUSTOMER][NEUTRAL] OK, full mouth and panel?
[AGENT][NEUTRAL] Um, basic, oh wait, were you asking for the frequency?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, full mouth x-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fluoride
[AGENT][NEUTRAL] Fluoride.
[AGENT][NEUTRAL] It's under preventative, um, if it's for a child, hold on, let me get the codes for the child and the adult. Hold on one moment.
[CUSTOMER][NEUTRAL] No, it's for the, it's for the patient, yeah, it's for the, it's for the adult.
[AGENT][NEUTRAL] OK. Um, so it's a max of 1 procedure per 12 months?
[CUSTOMER][NEUTRAL] OK, excellent, um, is scaling and route planning covered?
[CUSTOMER][NEUTRAL] 43 41 43 42.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, oral cancer screening it's not covered. Those are not covered. Are there any downgrades? Are there downgrades on fillings?
[AGENT][NEUTRAL] Um, no, ma'am. There's no downgrade.
[CUSTOMER][POSITIVE] Excellent all right that's all I needed thank you so much I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL [PII], I'm sorry, thanks for calling APL, and I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] You're welcome bye