AccountId: 011433970860
ContactId: edf7223b-33a1-4037-a4ba-cc32013ba2eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431500 ms
Total Talk Time (AGENT): 190670 ms
Total Talk Time (CUSTOMER): 212070 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/edf7223b-33a1-4037-a4ba-cc32013ba2eb_20250617T14:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Right here
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental office. I was just trying to call to get some benefits for a patient we're seeing today.
[AGENT][NEUTRAL] All right. Happy to check on benefits, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Sure it's gonna be let me grab that.
[CUSTOMER][NEUTRAL] Uh, let's see here, 02639211.
[AGENT][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then if I can get the patient name and date of birth.
[CUSTOMER][NEUTRAL] Sure, it's [PII] and date of birth is gonna be [PII].
[AGENT][POSITIVE] Thank you. So, patient is active. It looks like the effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you want we can send you a fax back with a breakdown. I can give you a verbal breakdown, whatever works best.
[CUSTOMER][POSITIVE] If you don't mind doing a verbal with me, I'll, I promise I'll be quick on it.
[AGENT][POSITIVE] Yeah, no worries. Yeah, no, no worries. Let me just pull this up here. Give me a sec.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Thank you so much. He listed himself as a policyholder, but he put another date of birth. I think that's for his wife because they had the policyholder date of birth is [PII]. I don't know if that's.
[AGENT][NEGATIVE] Yeah, no.
[AGENT][POSITIVE] Yeah, and yeah, that's correct, yeah.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, so I think it's [PII] because he has his email is [PII], I guess she's a policyholder.
[AGENT][NEUTRAL] No, [PII]'s the policy holder. Coins actually, yeah, mhm.
[CUSTOMER][NEUTRAL] Oh, he is OK.
[CUSTOMER][NEUTRAL] OK, I wonder what he puts OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect. OK, so he's the patient we're seeing. OK, perfect, and that that is the correct ID that he gave.
[AGENT][NEUTRAL] Mhm, yep, sure is.
[CUSTOMER][POSITIVE] OK perfect OK perfect.
[AGENT][NEUTRAL] It looks like um the calendar maximum on here is gonna be $750.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does have a $50 deductible. Uh, patient has both left remaining for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, looks like preventative is covered at 100%.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then patient has also basic and FMX covered at 80%.
[AGENT][NEGATIVE] There is no major coverage on this, so.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] No major OK and um.
[CUSTOMER][NEUTRAL] Let me see here, so night guards would fall under major as well I guess, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. I'm just looking at my little category sheet here I have for that. um, what about you said what is basic covered at 80?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, 80%, uh huh.
[CUSTOMER][NEUTRAL] That'd be filling, so that cover endo perio or oral surgery or do those fall under major?
[AGENT][NEUTRAL] Those all fall under major.
[CUSTOMER][NEUTRAL] OK, so nothing on perio or perio maintenance or any of that fun stuff.
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] OK, so just fillings, OK, uh, do the fillings downgrade?
[AGENT][NEGATIVE] They do not.
[CUSTOMER][NEGATIVE] Do not ground no filling downgrade and that's gonna take care of that coverage but not covered, not covered, and is there a frequency on fillings?
[AGENT][NEUTRAL] Uh, no, there is not.
[CUSTOMER][NEUTRAL] No frequency. OK. And you said preventive diagnostic 100%, so that'd be exams and profy, would that include bite wings at 100%? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No deductible on the X-rays though, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, and then, but you said what was it Hano be under basic you said PAO or FMX.
[AGENT][NEUTRAL] Um, yes, that's gonna be under basic at 80%, uh huh.
[CUSTOMER][NEUTRAL] OK, and what's the frequencies on exams and profies?
[AGENT][NEUTRAL] So Profy is gonna be once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it looks like we have oral evaluation 2 for 12.
[AGENT][NEUTRAL] By wings are 1 per 12 and then FMX and piano are once every 5 years.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, does he have anything that, um, any history that would affect those or?
[AGENT][NEUTRAL] Uh, let's double check here one moment.
[CUSTOMER][POSITIVE] Sure, thanks.
[AGENT][NEGATIVE] No, no history on file.
[CUSTOMER][NEUTRAL] Oh, no history of file. OK, perfect. And then how about PAs or PAs with PAO at 80%?
[AGENT][POSITIVE] Mhm, correct, yep.
[CUSTOMER][NEUTRAL] OK, 80%. Any frequency on the PAs?
[AGENT][NEUTRAL] Uh, looks like once every 5 years.
[CUSTOMER][NEUTRAL] Oh, once every 5 years on the PAs, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And those both are gonna you said neither one, even though they're 80% of basic they're not subject to deductible on those X-rays, right, the panel or the PA.
[AGENT][NEUTRAL] That that is correct, yeah, it's not part.
[CUSTOMER][NEUTRAL] OK, perfect. I know I know sometimes they include those and it's under basic. Does he have uh flu or sealant coverage?
[AGENT][NEUTRAL] Um, let's see. I do know that they both are listed. They're just age restricted. Give me one second. Fluoride.
[CUSTOMER][NEUTRAL] Sure. No.
[AGENT][NEUTRAL] So fluoride looks like limited to uh dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for sealant, let's see.
[AGENT][NEUTRAL] And that's also limited to dependent children um under the age of [PII] as well looks like.
[CUSTOMER][NEUTRAL] Oh, OK, is there any orthodontic coverage?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] None. OK, perfect. And then is there a missing tooth claws or waiting period? I guess that wouldn't affect anything because there's no implants or no major coverage, I guess, but.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] So it does have a missing tooth claws, but there is no waiting period since it's just preventative and basic.
[CUSTOMER][NEUTRAL] OK, and I have the group number is 70101. Is there a group name?
[AGENT][NEUTRAL] Let me double check on that. Let's see.
[CUSTOMER][POSITIVE] Sure thanks.
[AGENT][NEUTRAL] Uh, group number is correct. Group name is showing as superior skilled trades.
[CUSTOMER][POSITIVE] And hopefully sooner than later
[CUSTOMER][NEUTRAL] Perfect and then last question, what are they using for the fee schedule?
[AGENT][NEUTRAL] Uh, looks like it goes by UCR. It does participate in the Carrington PPO network. however, uh, just does not require a live utilization within the network.
[CUSTOMER][NEUTRAL] So we can use the Carrington fees?
[AGENT][NEUTRAL] You can, uh-huh.
[CUSTOMER][NEUTRAL] Oh, he can, OK, because we're a network with Carrington, so.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] So she used to carry is that like the Carrington 500 or the Carrington because I guess it's Carrington [PII], right?
[AGENT][NEUTRAL] It just states [PII], yeah.
[CUSTOMER][NEUTRAL] Oh yeah, Carrington [PII], so we'd be in network with that since we take that then, so they would be able to just use the caring put the Carrington fee schedule and for the fees in on that.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK perfect well that's everything I needed I appreciate your help today and can I get a reference number for the call?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Yeah, call references my name with today's date. My name again is [PII], that's [PII], last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect thank you again for your help hope you have a wonderful rest of the day.
[AGENT][POSITIVE] You as well. Take care. Bye bye.