AccountId: 011433970860
ContactId: d9bbc578-72a8-4d24-8955-3943596bcc91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495290 ms
Total Talk Time (AGENT): 197940 ms
Total Talk Time (CUSTOMER): 144786 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/d9bbc578-72a8-4d24-8955-3943596bcc91_20250307T17:34_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from our dental provider's office in regards to getting uh benefits for a patient.
[CUSTOMER][NEUTRAL] And their family.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The policy number I have is 02544684.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And so I have [PII] in.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for the family?
[CUSTOMER][NEUTRAL] The whole family, yes, ma'am.
[AGENT][NEUTRAL] Let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] And what is that number?
[AGENT][NEUTRAL] 259-638-1
[CUSTOMER][NEUTRAL] 381
[CUSTOMER][NEUTRAL] OK, you have a group ID?
[AGENT][NEUTRAL] Yes, this policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Group number is 70058.
[CUSTOMER][NEUTRAL] I'm sorry, you're breaking up 7.
[AGENT][NEUTRAL] 0058.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Is there, can I ask a few questions?
[AGENT][POSITIVE] Sure, and I can send you a fax back as well of the benefits if you would like.
[CUSTOMER][POSITIVE] Sure, you can uh go ahead and do that if you, if you can, please.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], this policy has a maximum benefit amount of $500 per calendar year with a $50 deductible per insured up to $150 per family, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, is this a calendar year?
[AGENT][NEUTRAL] From January to December.
[CUSTOMER][NEUTRAL] And what's the fee schedule?
[AGENT][NEUTRAL] Based on user and customary, preventative is covered at 100 and basic at a. Unfortunately, major endoeroprosthesis or surgery crowns, bridges, ortho, none of that is covered under the policy.
[CUSTOMER][NEUTRAL] So just basic diagnostic and prevent and preventative.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] You said endopperio and oral surgeries, is that covered?
[AGENT][NEUTRAL] No, it's not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Policy is very limited.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is it a PPO plan?
[AGENT][NEUTRAL] Yes, it's a PPO, but it's the Carrington network, but the member does not have to utilize the Carrington network provider because the policy is a PPO.
[CUSTOMER][NEUTRAL] OK, and what's your name? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] The American Public Life is the insurance name?
[AGENT][NEUTRAL] American Public Life is the insurance, yes.
[AGENT][NEUTRAL] 259-6381.
[CUSTOMER][NEUTRAL] Hold on one, is there any waiting periods?
[AGENT][NEUTRAL] No, there's no waiting period.
[AGENT][NEUTRAL] There is a missing tooth los, however, I'm not sure why.
[CUSTOMER][NEUTRAL] Well, I mean, yeah, if there's no major benefits.
[CUSTOMER][NEUTRAL] There shouldn't be a
[AGENT][NEUTRAL] Unless
[AGENT][NEUTRAL] Unless it's because of the frequency like um your bit wins or once every 12 months or your
[AGENT][NEUTRAL] Or your oral exams are once every 212 months.
[CUSTOMER][NEUTRAL] Sure. Give me 1 2nd.
[AGENT][NEUTRAL] I'm not sure if that's why it's there.
[CUSTOMER][NEUTRAL] Do you guys have um does this plan down code?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the member has no history on file, nor have they utilized any of their benefits for 24 or met their deductible.
[CUSTOMER][NEUTRAL] OK, and can I get the frequencies, um.
[CUSTOMER][NEUTRAL] Uh, for like the uh diagnostic and preventative.
[AGENT][NEUTRAL] So it'll be listed on the very first page that I've just sent over to you by fax. However, preventing trophies and cleanings are once every 6 months or evaluations or 2 for 12 month period, bite wings are once per 12 month period, and full mouth X-rays and panoramics are once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And real quick, hold on one second, let me see.
[CUSTOMER][NEUTRAL] And this is under Morales Enterprises, right? for the employer?
[AGENT][NEUTRAL] That's the group name, correct.
[CUSTOMER][NEUTRAL] And um is there any coverage for saling and fluorides?
[AGENT][NEUTRAL] Falls on the preventative at 100%.
[CUSTOMER][NEUTRAL] OK, and that's on the front?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, real quick, uh, simple extractions, 7, code 7140.
[AGENT][NEUTRAL] Covered on the basic at 80%.
[CUSTOMER][NEUTRAL] Are those covered?
[CUSTOMER][NEUTRAL] That's why there's a missing tooth clause, huh, Liz.
[AGENT][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] Well, yeah, probably so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And along with this.
[CUSTOMER][NEUTRAL] Is there any coverage for a Kuelguard?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. What, um, would there be the frequency for code D0140?
[AGENT][NEUTRAL] 30,140.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] That's a limited exam.
[AGENT][NEGATIVE] They'll fall on the basic.
[AGENT][NEUTRAL] At 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Two or evaluation procedures in any combination of B0120,0140,0150,0160 per 12 month period.
[CUSTOMER][NEUTRAL] And those are all under 80?
[AGENT][NEUTRAL] Yes, that is correct. Well, some of them are under 100% and some of them are under 80%. It's listed, so on the schedule that I sent over to you, it's a breakdown of the the benefits along with the category that they fall under like D0120 that's on the preventative, it's not on the basic or D0150 is on the preventative, not on the basic.
[CUSTOMER][NEUTRAL] Which one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have any other questions of, for any other colds?
[CUSTOMER][NEUTRAL] Hello ma'am, that's it.
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][POSITIVE] You too thank you bye.