AccountId: 011433970860
ContactId: dda85cae-233d-43d5-8f2c-a510a98a2161
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602119 ms
Total Talk Time (AGENT): 211291 ms
Total Talk Time (CUSTOMER): 197491 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/dda85cae-233d-43d5-8f2c-a510a98a2161_20250616T13:13_UTC.wav
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[CUSTOMER][NEUTRAL] For the fillings and cleaning.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hold on one second, [PII], OK?
[CUSTOMER][NEUTRAL] Hi, do you mind holding for one second?
[AGENT][NEUTRAL] No, I can hold for a second.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] We appreciate your patience during this brief delay. One of our team members will be happy to assist you in just a moment.
[CUSTOMER][NEUTRAL] Did you know that for faster service, you can book your appointment online. Just go to Castle Dental and click on book an appointment. Then enter your zip code to select the nearest office and choose the most convenient appointment time.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, this is [PII] with APL. How can I help today?
[CUSTOMER][NEUTRAL] Hi [PII], um, so I'm calling from Rosenberg Castle D and Orthodontics. I have a patient that's coming in at [PII] today. I just needed a breakdown of eligibility and benefits for, for the patient.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Um, so the policy number they have provided is 01714287. wanted to see if you can do as well.
[AGENT][NEUTRAL] Alright, let me pull that up here.
[AGENT][NEUTRAL] And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] On that way.
[CUSTOMER][POSITIVE] No worries I can definitely change it. So it might be a little bit of wait time, but we can definitely see that.
[AGENT][NEUTRAL] OK, so the number that you gave me is actually their medical, their dental policy ends with a 6 instead of a 7. I don't know if that um will matter or not, but
[CUSTOMER][NEUTRAL] So it's it's the same number but just a 6 at the end right then a 7?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you for letting me know.
[AGENT][NEUTRAL] Yeah, and the effective date on here is [PII]. If you need us to, we can send you a fax back with a breakdown, whatever works best, or give it to you over the phone.
[CUSTOMER][NEUTRAL] Can I, can I have both verbally and um facts because sometimes with the fax they won't provide every detail that I need.
[AGENT][POSITIVE] Yeah, absolutely. So,
[AGENT][NEUTRAL] You pull this up here.
[CUSTOMER][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] At [PII] let's put it at [PII] since you are coming in at [PII], just leave her with her and then you just put her also back with you.
[CUSTOMER][NEUTRAL] And that way doctor can look at both.
[AGENT][NEUTRAL] All right, so I've got that pulled up here. What did you need me to verbally give you?
[CUSTOMER][NEUTRAL] Can you check if we're in network with this insurance? I can give you the doctor's information.
[AGENT][NEUTRAL] Um, so we generally don't do that just because with all of our plans no networks required. Some of them participate like in a PPO network with Carrington. This one does not. It just pays by UCR, so there's no network required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so they can be seen here, right?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so the fee schedule is UCR?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's the group number?
[AGENT][NEUTRAL] Uh, yeah, one moment.
[AGENT][NEUTRAL] Group number is 15844.
[CUSTOMER][NEUTRAL] OK, and um what's the group name?
[AGENT][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] OK. Payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, can I have the claims mailing address?
[AGENT][NEUTRAL] Absolutely that's going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, um, what is the max and the deductible?
[AGENT][NEUTRAL] Their calendar year max is gonna be $1500 and then their deductible is going to be $50.
[CUSTOMER][NEUTRAL] Family deductible on it or no?
[AGENT][NEUTRAL] Uh, looks like there is up to 154 families.
[CUSTOMER][NEUTRAL] OK, and then has anything been met for either?
[AGENT][NEUTRAL] Let me check that for you. One moment.
[AGENT][NEUTRAL] Alright, looks like they have the deductible in full amount remaining for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is the coverage for the preventative, basic and major?
[AGENT][NEUTRAL] So, preventative is covered at 100% of UCR.
[AGENT][NEUTRAL] Basic is at 80%.
[AGENT][NEUTRAL] And then majors at 40. That does include any oral surgery, endo or perio.
[CUSTOMER][NEUTRAL] What about uh crowns that's also major?
[AGENT][NEUTRAL] Yes, ma'am, at 40%.
[CUSTOMER][NEUTRAL] And crown is on seat or prep date?
[AGENT][NEUTRAL] Either it does not matter.
[CUSTOMER][NEUTRAL] OK, are all 4 quads allowed on the same day?
[AGENT][NEUTRAL] They are.
[CUSTOMER][NEUTRAL] Um, what about missing tooth claws or waiting period?
[AGENT][NEUTRAL] Uh, policy does have a missing tooth clause. There is a 12-month waiting period for any major that does also include the endopperio and oral surgery.
[CUSTOMER][NEUTRAL] For endopperio and oral, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then can I just have frequency for pro fee?
[CUSTOMER][NEUTRAL] Fluoride exam and all those I'll I'll tell you as we go.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, what's the first code you'd like me to check?
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] All right, so that's covered at 100% and it's a maximum of 1 for 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then fluoride, that is, let me find it for you, 12:06.
[AGENT][NEUTRAL] OK, so fluoride looks like.
[AGENT][NEUTRAL] As a maximum of 1 procedure per 12 months, it is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK, what about 01500140 and 0120?
[AGENT][NEUTRAL] Alright, so it looks like those are covered at 100% and they're gonna carry limited to two oral evaluations in any 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about 0274?
[AGENT][NEUTRAL] Bite wings, it looks like are going to be limited to one bite X-ray procedure for 12 months.
[CUSTOMER][NEUTRAL] What about panel and full mouth?
[AGENT][NEUTRAL] Uh, those are gonna be once every 5 years.
[CUSTOMER][NEUTRAL] Uh, Pario 4910.
[AGENT][NEUTRAL] That
[CUSTOMER][POSITIVE] I'll be right with you, OK?
[AGENT][NEUTRAL] All right, so that's gonna be covered at 40%. It's a maximum of 1 per 6 months.
[CUSTOMER][NEUTRAL] OK, and then SRP which is 4246 or 4341?
[AGENT][NEUTRAL] It looks like that one is going to be a maximum of 1 per 24 months it's showing.
[CUSTOMER][NEUTRAL] 1 for 24 months?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One, I'm sorry, 1 for 24 months?
[AGENT][POSITIVE] Yes, ma'am. Correct.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][NEUTRAL] And then I think that's all I need. I just need your name once more and reference number please.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. My name is [PII], that's [PII] My last initial is [PII], and then today's date would be the reference.
[CUSTOMER][POSITIVE] Perfect thank you [PII] for your help.
[AGENT][POSITIVE] Yeah, you're welcome. Have a good day.
[CUSTOMER][POSITIVE] You as well thanks bye.