AccountId: 011433970860
ContactId: d8897aaf-babf-4fc5-8401-bfdcbfb6c7bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421399 ms
Total Talk Time (AGENT): 169558 ms
Total Talk Time (CUSTOMER): 169938 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/d8897aaf-babf-4fc5-8401-bfdcbfb6c7bf_20250207T14:50_UTC.wav
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[AGENT][NEUTRAL] Yeah, how may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning. This is [PII]. I'm with Aspen Dental, and I was calling to verify eligibility for dental benefits for patients.
[AGENT][NEUTRAL] OK, you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] 02593186
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] option 2.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for that information, [PII], and we're checking eligibility and then dental benefits.
[CUSTOMER][NEUTRAL] Yes, for dental, this is for dental.
[AGENT][NEUTRAL] OK, OK, so the policy effective date is [PII]. Uh, the policy is active at this time. [PII], do you want the schedule of benefits faxed over to you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If I can get the, am I, can I get the benefits over the phone?
[AGENT][NEUTRAL] You can, you can, so under this policy.
[CUSTOMER][NEUTRAL] OK, and is this under Harrington?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What's the fee schedule?
[AGENT][NEUTRAL] So I think the the the PPO network is Carrington PTO.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what's the address for billings and um claims?
[AGENT][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We can wait.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you ready for the benefits?
[CUSTOMER][NEUTRAL] Hold on, I'm still trying to find the address on my selection. One moment.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um what's the individual deductible?
[AGENT][NEUTRAL] So the calendar, your maximum is 500 per covered person.
[AGENT][NEUTRAL] The calendar your deductible is $50 per covered person.
[CUSTOMER][NEUTRAL] 0 50 and that's the 500 is the maximum.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And deductible is up to 150 per family.
[CUSTOMER][NEUTRAL] And does the member have ortho coverage?
[AGENT][NEUTRAL] Coverage preventive at 100%, basic at 80%, um, major or orthodontic services are not covered.
[CUSTOMER][NEUTRAL] Do they have ortho coverage?
[AGENT][NEGATIVE] Yeah, major orthodontic coverage is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And has any of the deductible or maximum been used?
[AGENT][NEUTRAL] You know she doesn't have any claims on file, so the 500 is available at this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, and you said diagnostic preventative 100, basic 80, and no major ser.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, endodontics, periodontics, and oral surgery, is that under basic?
[AGENT][NEUTRAL] That's major.
[CUSTOMER][NEUTRAL] Oh it's major OK no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, no implants, no dentures coverage.
[CUSTOMER][NEUTRAL] Um, period maintenance is it applies towards preventative, basic, major or period.
[AGENT][NEUTRAL] That's that's major service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the frequency?
[AGENT][NEUTRAL] So I'm showing that for cleaning, it's once every 6 months.
[CUSTOMER][NEUTRAL] Oh, you said not
[AGENT][NEUTRAL] For oral evaluation it's 2 for 12 month period.
[CUSTOMER][NEUTRAL] Is that for 0120?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Code exam.
[AGENT][NEUTRAL] So 01, 2040, 50 and 60 share frequencies.
[CUSTOMER][NEUTRAL] OK, 2 and 12 months you said?
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] OK, and cleaning with the frequency?
[AGENT][NEUTRAL] 1 every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And bite wings.
[AGENT][NEUTRAL] On per 12 month period.
[CUSTOMER][NEUTRAL] And FMX.
[AGENT][NEUTRAL] Give me the code for that?
[CUSTOMER][NEUTRAL] OK, 0210.
[AGENT][NEUTRAL] 0210.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so that's a limitation of one X-ray.
[AGENT][NEUTRAL] Per 5 year period and that shares frequency D210 shares frequency with D277 and D0330.
[CUSTOMER][NEUTRAL] OK, and fluoride 1208.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, that's preventive. If you want the frequency?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is covered.
[AGENT][NEGATIVE] I don't think there is no frequency on the fluoride.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Did you need the age limitation?
[CUSTOMER][NEUTRAL] OK, there's.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just trying to see if she covered for the, for the fluoride.
[AGENT][NEUTRAL] Let's see, maximum of 1 procedure, well, there is a frequency, maximum of 1 procedure for 12 months and limited to.
[AGENT][NEUTRAL] See, I think it's 19, limited to dependent children age [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and the see forer SRP.
[CUSTOMER][NEUTRAL] Code 4341 4341 4342.
[AGENT][NEUTRAL] What's the code?
[AGENT][NEUTRAL] 43, 41.
[AGENT][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and or cancer screening, um, that's 0431.
[AGENT][NEGATIVE] Yeah, that would be major, not covered.
[CUSTOMER][NEUTRAL] OK, and you again you said dentures, bridges, and crowns not covered, correct?
[AGENT][NEUTRAL] Because that's major, so it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, what coverage category are simple extractions considered?
[AGENT][NEUTRAL] Basic, the 7140 is basic. Any other extraction is major.
[CUSTOMER][NEUTRAL] And um is there a missing tooth cloth?
[AGENT][NEUTRAL] There, well, there's no major, but the policy does state that there is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and are composite fillings downgraded?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] To Ama again, OK, and it's predetermination mandatory.
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much for your time that's all that I need.
[AGENT][NEUTRAL] You're welcome, [PII]. Anything else?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.