AccountId: 011433970860
ContactId: e1b442fc-f820-412b-b2fa-01ea826c4c6e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301250 ms
Total Talk Time (AGENT): 133282 ms
Total Talk Time (CUSTOMER): 84694 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/e1b442fc-f820-412b-b2fa-01ea826c4c6e_20250407T19:13_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] Hey, this is [PII] at Doctor Krimpa's dental office. We have a new patient here, uh, that presented an insurance card. I've never heard of this, so I was just calling to see if he had dental and if he had out of network benefits and who we file the claims to.
[AGENT][NEUTRAL] OK. Well, I can definitely help you with the coverage, um, and all the questions that you said if it's medical or just dental, who you file the claims to and the coverage?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, and if he has out of network benefits.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. And um may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And his policy number is 02506660.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] here Snell.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So let me take a look at this. Hold on one moment.
[AGENT][NEUTRAL] So yes, this is dental only. Um, let me see the network if there is one.
[AGENT][NEUTRAL] Hold on, it's coming up now. I'm just waiting for the fax back. Um, this policy.
[AGENT][NEUTRAL] Doesn't have a network. Um, we use Carrington in general, but there's no like PPO network or anything.
[CUSTOMER][NEUTRAL] So he can go to any doctor?
[AGENT][NEUTRAL] Mhm. He can go to any dentist that he, he would like to.
[CUSTOMER][NEUTRAL] OK, and then is it a plan year or calendar year? What is this?
[AGENT][NEUTRAL] This is um calendar year. Um, the max is 1500 per insured.
[AGENT][NEUTRAL] The deductible is $50 per person.
[CUSTOMER][NEUTRAL] Does it apply to diagnostic and preventative?
[AGENT][NEGATIVE] The deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods on the policy?
[AGENT][NEUTRAL] Um, there is a 12-month waiting period for all major expenses. Major for us is endodontic, periodontic, prosodontic, and oral surgery. So, um, he'll be able they'll be able to use that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and then what percentage is um basic endoperio oral and major surgery?
[AGENT][NEUTRAL] So all majors at 40%?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic, basic restorative and radiographs are all at 80.
[AGENT][NEUTRAL] And then preventative is at 100.
[CUSTOMER][NEUTRAL] And do y'all pay to us or the patient?
[AGENT][NEUTRAL] Um, it depends. It could be both or either or, uh, just once we get the paperwork of whoever is old.
[CUSTOMER][NEUTRAL] But do you accept assignment of benefits?
[AGENT][POSITIVE] Yes, we will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what are the frequencies for exams and X-rays?
[AGENT][NEUTRAL] Exams are 2 for 12-month period, full m x-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] You try to
[CUSTOMER][NEUTRAL] You could call the number on the back of your
[CUSTOMER][NEUTRAL] And then bye wings.
[AGENT][NEUTRAL] Fight wings are once per 12 month period.
[CUSTOMER][NEUTRAL] Check
[CUSTOMER][NEUTRAL] Is he eligible for a pay?
[AGENT][NEUTRAL] Um, do you have a, let me see if we have any history for him. Hold on one second.
[CUSTOMER][NEUTRAL] 0330 or 0120?
[AGENT][NEUTRAL] We don't have any history on file, so he doesn't, um, so he, he, he hasn't used that code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII] and my first name is [PII]
[CUSTOMER][POSITIVE] OK, thank you [PII].
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No ma'am, that was it.
[AGENT][POSITIVE] All right. Well, thanks so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.