AccountId: 011433970860
ContactId: dc45649b-eff4-4431-8a92-23d64851bbba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414760 ms
Total Talk Time (AGENT): 196978 ms
Total Talk Time (CUSTOMER): 116989 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/dc45649b-eff4-4431-8a92-23d64851bbba_20250204T22:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII], and I'm calling on behalf of dental office to check on the eligibility and benefits for patiently. Can you please help me with that?
[AGENT][NEUTRAL] I certainly can, [PII]. What is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is your policy number, please?
[CUSTOMER][NEUTRAL] It is 2, I'm sorry, let me go again. 02554118.
[AGENT][NEUTRAL] OK. And to repeat and confirm, I have that as 02551, excuse me, 02554118.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][POSITIVE] OK, thank you very much for the information, [PII], and you're calling again for eligibility and benefits. I can help you with both.
[AGENT][NEUTRAL] The policy for the member thank you shows effective as of [PII], and this policy shows active for the member.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] And for benefits, one moment please. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Please note verification of benefits provided does not guarantee payment. The member has a $500 calendar year max for covered benefits. The plan covers only preventative and basic services. There is no coverage for major services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with the use amount from the end of my towards the deductibles, please?
[AGENT][NEUTRAL] OK, one moment, let me check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Currently, $210.60 has been accumulated.
[CUSTOMER][NEUTRAL] OK. And what about the
[CUSTOMER][NEUTRAL] Deductibles, has anything been used from deductibles?
[AGENT][NEUTRAL] I can check to see if that has been met. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The $50 deductible has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about orthodontics? Is it a covered benefit?
[AGENT][NEUTRAL] No, orthodontics is not a covered benefit.
[CUSTOMER][NEUTRAL] All right. What about the missing two clauses in the waiting period? Does it apply?
[AGENT][NEUTRAL] There is a missing tooth clause. There is no waiting period.
[CUSTOMER][NEUTRAL] OK. Can you also help me with the history? Is there any history for FMX spinal bite wings that might affect the frequencies?
[AGENT][NEUTRAL] Let me tell you what the, what the history is. One moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, on [PII], member had an exam, 0150. Member also did have a FMX.
[AGENT][NEUTRAL] And that is 1 for 5 year period.
[AGENT][NEUTRAL] And that's covered under basic and 80%, and the exams are 2 excuse me, the exams are 2 per 12 month period.
[AGENT][NEUTRAL] And also,
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just confirm again for the FMX on the exam, was done on [PII] or [PII]? Sorry.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] And that is all as of current. Thank you.
[CUSTOMER][NEUTRAL] OK. And can you also help me with the
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The frequency for prophy fluoride.
[CUSTOMER][NEUTRAL] And buy drinks, please.
[AGENT][NEUTRAL] Trophies are once every 6 months.
[AGENT][NEUTRAL] Bite wings are 1 per 12 month period under preventative.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And fluoride is 1 per 12 month period under the age of [PII] and preventative.
[CUSTOMER][MIXED] OK. And sealants, is it covered not for sealants?
[AGENT][NEUTRAL] Sills are 1 per 36 months, permanent molar teeth only, only limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK. And for posterior composite, is there any altered benefits or downgrades?
[AGENT][POSITIVE] No, there are no no downgrades.
[CUSTOMER][NEUTRAL] And it is consultation 9310 covered and bone graft?
[AGENT][NEUTRAL] Phone graft is not a covered benefit. I'm sorry, that was [PII]. Is that the code, the other code you want me to check?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry, yes.
[CUSTOMER][NEUTRAL] Yes, yes, yes. [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Thank you. One moment. That is covered under basic at 80%. It shows no frequency or.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Limitation.
[CUSTOMER][NEUTRAL] No frequent. Alright. And lastly, can you help me with the group name and the group number please?
[AGENT][NEUTRAL] No, certainly. One moment, please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the group name is T like Tom, R Robert C like Charlie Staffing.
[AGENT][NEUTRAL] Services
[AGENT][NEUTRAL] INC.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the group number is 70055.
[CUSTOMER][NEUTRAL] 70055. The coordination of benefits, it's standard, right? And the plan launched in a calendar year?
[AGENT][NEUTRAL] We do not coordinate benefits.
[CUSTOMER][NEUTRAL] Oh, so there's no party.
[AGENT][NEUTRAL] And this is
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a calendar year policy.
[CUSTOMER][NEUTRAL] OK, and lastly, can you help me with the payer ID and the billing address, please?
[AGENT][NEUTRAL] OK, our payer ID is 60801 and the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What about the fee schedule of the provider? Can you help me with that as well?
[AGENT][NEUTRAL] This plan participates in the Carrington PPO network.
[CUSTOMER][POSITIVE] OK, alright then, thank you so much. Can you help me with the caller reference number, [PII]?
[AGENT][NEUTRAL] You're welcome, [PII]. We do not use call reference numbers, however, you can use my name. No problem. My last initial is [PII], and today's date?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much once again for help me and I hope you have a great day ahead of you.
[AGENT][POSITIVE] You as well, and thank you for calling APL bye.
[CUSTOMER][NEUTRAL] Bye-bye.