AccountId: 011433970860
ContactId: d7c4a6e0-7aa4-4a2a-b294-cf14a235fb57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617239 ms
Total Talk Time (AGENT): 158396 ms
Total Talk Time (CUSTOMER): 152556 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/d7c4a6e0-7aa4-4a2a-b294-cf14a235fb57_20250528T14:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, good morning, this is [PII]. I'm calling on behalf of the provider's office looking 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. It's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Is that you don't have the policy number for the member?
[CUSTOMER][NEUTRAL] Uh, OK, sorry about that. It's 02596488.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], and the date of birth I have it's [PII].
[AGENT][NEUTRAL] OK, I don't have that as [PII]. I've got a different month for that date of birth.
[CUSTOMER][NEUTRAL] Just a moment, let me double check it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I have [PII].
[AGENT][POSITIVE] Yes, that's what we've got. OK, thank you so much for that. All right, and this was for dental?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, uh, this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] OK, what was that fax number for you?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All righty. I'll.
[CUSTOMER][NEUTRAL] And also, can I have the claim mailing address?
[AGENT][NEUTRAL] Yes, uh, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK. And also can I have the payer ID number?
[AGENT][NEUTRAL] Her ID is 60801.
[CUSTOMER][NEUTRAL] OK, and also can you please check if the provider will be in or out of network?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Can you please check if the provider is in or out of network with the patient's plan?
[AGENT][NEUTRAL] I'm unable to check that, so I will say that this policy participates in the Carrington PPO network. However, utilization of a provider within the Carrington network is not required, so regardless of whether they are in network or not, we will still pay that benefit.
[CUSTOMER][NEUTRAL] OK. So you said that you schedule, it will be Carrington, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this is a calendar year plan or fiscal year plan?
[AGENT][NEUTRAL] It is a calendar year plan.
[CUSTOMER][NEUTRAL] And also can I have the annual maximum and deductible?
[AGENT][NEUTRAL] Sure, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Calendar year maximum is $500.
[AGENT][NEUTRAL] And then the deductible is $50 per calendar year that does not apply to preventative services.
[CUSTOMER][NEUTRAL] And for the deductible, it applies to services.
[AGENT][NEUTRAL] It deductible does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK. And nothing has been used, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And is this a single coverage of family?
[AGENT][NEUTRAL] Yeah, uh, he is the only one listed, so single coverage.
[CUSTOMER][NEUTRAL] OK. And also, can I have the coverage for preventative, basic, and major?
[AGENT][NEUTRAL] So, uh, there is no major coverage under this policy. Uh, preventative is at 100%. SMX and Basic are going to be at 80%.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So for endoperio and oral surgery, it is going to be on the basic?
[AGENT][NEUTRAL] No, that, that's simply not going to be covered under this policy. There is no endodontic, periodontic, or oral surgery.
[CUSTOMER][NEUTRAL] So it is covered only for uh preventative, diagnostic and basic, right?
[AGENT][POSITIVE] Correct, preventative and basic.
[CUSTOMER][NEUTRAL] OK. And so for this plan is also covered or not?
[AGENT][NEUTRAL] Uh, or
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you, did you ask for ortho? I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, no, orthodontic treatment is not covered under this policy.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] And also I do have some few quotes for the coverage and frequency.
[AGENT][NEUTRAL] I'm sorry, it's, it's a little bit difficult to hear you. Could you repeat that?
[CUSTOMER][NEUTRAL] I do have some few quotes for the coverage and frequency. Could you please help me with that?
[AGENT][NEUTRAL] For specific codes yeah.
[CUSTOMER][POSITIVE] Mhm, we'll provide you all at once or one at a time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, whatever is easier for you.
[CUSTOMER][NEUTRAL] OK. 0120.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh 0180.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 11:10.
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 2991.
[CUSTOMER][NEUTRAL] 0274
[CUSTOMER][NEUTRAL] 0220
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] 0330
[CUSTOMER][NEUTRAL] 1351
[CUSTOMER][NEUTRAL] 1208.
[CUSTOMER][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] 7953
[CUSTOMER][NEUTRAL] 2740. And the last code I have it's [PII].
[AGENT][POSITIVE] OK, OK, I got it. Give me just a moment. I'll get all of that information for you.
[CUSTOMER][POSITIVE] OK, sure. Thank you.
[AGENT][NEUTRAL] That first one.
[CUSTOMER][NEUTRAL] What's