AccountId: 011433970860
ContactId: da0a2ade-3d05-434b-be56-34436f208b9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420000 ms
Total Talk Time (AGENT): 193662 ms
Total Talk Time (CUSTOMER): 115435 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/da0a2ade-3d05-434b-be56-34436f208b9a_20250610T17:41_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] Hello, my name is [PII], and I'm calling from Aspen Dental. I'm just calling to verify eligibility and benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] option 2 and that is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and that is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] Um, I'm looking at the policy, so there's no history on file yet.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And did you need like a copy of the fax back or you have particular questions about the fax back?
[CUSTOMER][NEUTRAL] I have particular questions um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is going to be the fee schedule that I will be using?
[AGENT][NEUTRAL] Um, it's a, it's, it's a standard fee schedule. Um, it's on the Carrington PPO network, but the benefits are the same whether you're a Carrington provider or not.
[CUSTOMER][NEUTRAL] OK perfect and what's the claims address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Um, do you accept assignments of benefits and nonparticipating providers?
[AGENT][NEUTRAL] Do we accept assignment of benefit? Yes.
[CUSTOMER][POSITIVE] Perfect. Um, if the, if benefits are exhausted and for non covered services, do discounts apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And then it does not if the patient's not eligible for services do discounts apply.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] If they're not eligible to do this, no.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, perfect. What is the deductible and max for this plan?
[AGENT][NEUTRAL] Um, it's a $500 per calendar year max, a $50 deductible per person.
[CUSTOMER][NEUTRAL] Is there any ortho coverage?
[AGENT][NEUTRAL] No, there's no orthodontic treatment.
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEUTRAL] What are the group a group coverages?
[AGENT][NEUTRAL] What do you mean by group coverages?
[CUSTOMER][NEUTRAL] The percentages?
[AGENT][NEUTRAL] Um, for preventative, we'll, um, we'll pay at 100% of allowable.
[CUSTOMER][NEUTRAL] Say there are
[AGENT][NEUTRAL] Radiograph and FMX basics and basic restorative are all at 80.
[AGENT][NEUTRAL] This policy does not cover base or I'm sorry, major, major for us includes endodontic, periodontic, prosodontic, and oral surgery codes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Any waiting periods?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEGATIVE] Um, missing two claws.
[AGENT][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] The 6 bag. Hold on one second. Missing tooth clause, the policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then I just need a couple frequencies if you're able to help me out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want to give all the clothes at once?
[CUSTOMER][NEUTRAL] The first one is going to be 01.
[CUSTOMER][NEUTRAL] I can do that uh 0120 1110.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0272.
[CUSTOMER][NEUTRAL] 0210 and then 1208.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 0120 is under preventative at 100%, limited to two oral evaluations, um, it's in combination with 140, 50, and 60 per 12-month period.
[AGENT][NEUTRAL] 1110 is preventative at 100% max of one procedure per 6 months.
[AGENT][NEUTRAL] 0272 bite wings are under preventative at 100%, um, limited to one bite wing X-ray procedure per twelve-month period. It's paired with 270 and 274.
[AGENT][NEUTRAL] Um, 0210.
[AGENT][NEUTRAL] is under radio and FMX, so that's 80%.
[AGENT][NEUTRAL] Limited to one X-ray procedure per five-year period.
[AGENT][NEUTRAL] And it's paired with 277 and 330.
[CUSTOMER][NEUTRAL] You were looking to get a new
[AGENT][NEUTRAL] And 1208 is not a cover code on the, on the fax back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect and then are there any downgrades on fillings?
[AGENT][NEUTRAL] No, there's no downgrades.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And then is my doctor in network with this plan?
[AGENT][NEUTRAL] Um, now for the, the, um, list of doctors that's through [PII], um, I have their phone number if you'd like to check. Um, if he's not, the benefits are still the same though.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need [PII]'s number? OK, hold on one moment.
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK thank you yes I do.
[CUSTOMER][NEUTRAL] this together
[AGENT][NEUTRAL] Alright, so their phone number is
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 400.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright perfect and that is all for me if I may just have a reference number for this call please.
[AGENT][NEUTRAL] Sure, there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right perfect thank you so much for your help have a wonderful day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No ma'am, that is all thank you.
[AGENT][POSITIVE] Alright, have a good day. Bye bye.
[CUSTOMER][NEUTRAL] You too bye.