AccountId: 011433970860
ContactId: f5ce360e-14f8-4b0f-ba95-9424ec98d2d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 654229 ms
Total Talk Time (AGENT): 279382 ms
Total Talk Time (CUSTOMER): 258158 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/f5ce360e-14f8-4b0f-ba95-9424ec98d2d2_20250530T21:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling to verify patients eligibility.
[AGENT][NEUTRAL] OK, I can check eligibility for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Hey [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[AGENT][NEUTRAL] And then do you have that policy number?
[CUSTOMER][NEUTRAL] Oh sorry my phone's cutting out uh let's see if there's a way to fix that real quick.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Did any of that help at all?
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEGATIVE] Uh, barely, it's still cutting out.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I don't know, it might be me. No, it's OK. Um, uh, do you have that pussy number?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Policy number?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh hello? Oh, hi, so policy number I have is 0265134 02625134.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that uh and this was for dental correct?
[CUSTOMER][NEUTRAL] Dental, yes.
[AGENT][NEUTRAL] OK, yeah, uh, it is active, uh, effective date was [PII], and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][POSITIVE] That would be great, uh, ready for fax number?
[AGENT][NEUTRAL] Sure, what was that fax number? Yes sir.
[CUSTOMER][NEUTRAL] Sure, fax number is area code [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, I will go ahead and get that sent now. I should get it within about 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] I just wondering what the payer ID is.
[AGENT][NEUTRAL] Yeah, that is uh 60801.
[CUSTOMER][NEUTRAL] Thank you, um, payments return 60801.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] And I guess at this point just wanted to know if the patient will be covered for a comprehensive exam, prophylaxis, fluoride, and an FMX.
[AGENT][NEUTRAL] Um, OK, so this.
[AGENT][NEUTRAL] Yes, um, what was that procedure code uh for fluoride, please?
[CUSTOMER][NEUTRAL] 1206.
[AGENT][NEUTRAL] OK, so that's what I thought. Uh, 1206 that's not going to be a covered procedure under this policy. Everything else, uh, they will be good for, um, pro fees, exam, and a panel.
[CUSTOMER][NEUTRAL] Oh cool, so they are eligible. Do they have any history on file?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] No, I have no history for this number so far.
[CUSTOMER][NEUTRAL] Thank you. No history. Uh, also, is there a way, uh, are you able to check if we're in or out of network with our plan?
[AGENT][NEUTRAL] So this policy participates in the Carrington PPO network, uh, but utilization of a provider within the Carrington network is not required. We will still honor those claims.
[CUSTOMER][NEUTRAL] OK, Carrington Carrington platinum count?
[AGENT][NEUTRAL] Uh, PPO, the Carrington PPO, yeah.
[CUSTOMER][NEUTRAL] Carrington.
[CUSTOMER][POSITIVE] Awesome, so at that point we should be a network Carrington PPO.
[CUSTOMER][NEUTRAL] Network.
[CUSTOMER][NEUTRAL] Should be in in network. No history, okey doke and uh I guess simple question what's the.
[CUSTOMER][NEUTRAL] Uh da da da.
[CUSTOMER][NEUTRAL] Frequency for exams and cleanings.
[AGENT][NEUTRAL] Sure, so, uh, cleanings, uh, prof, that's once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[CUSTOMER][NEUTRAL] There you go.
[AGENT][NEUTRAL] Right wings are once per 12 month period.
[CUSTOMER][POSITIVE] Thank you and FMX is maybe once every 16 months or 5 years.
[AGENT][NEUTRAL] Um, no, uh, full mouth X-rays and panel is once every 5 years and they do share frequencies.
[CUSTOMER][NEUTRAL] 5 years.
[CUSTOMER][NEUTRAL] Thank you. Share frequencies do they have ortho coverage?
[AGENT][NEUTRAL] No, Orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] Got it, thank you. I'm guessing this all this information is on the um fax back. I'm just uh I'm just asking questions for things that aren't usually on the fax back. Our posterior com oh sorry.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][POSITIVE] The uh it is on the fax back but no worries, no, no, no, you're fine it it is all on the fax back but I don't mind answering questions over the phone either.
[CUSTOMER][POSITIVE] Oh thank you so much and uh in that case I'll just go through it real quick. What's the group name?
[AGENT][NEUTRAL] 01 moment, let me get that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it's Vella Aerra Services LLC, and I can spell that for you whenever you're ready.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] So, V as in Victor, E as in Echo.
[AGENT][NEUTRAL] R as in Romeo.
[AGENT][NEUTRAL] S as in Sierra.
[AGENT][NEUTRAL] T as in Tango.
[AGENT][NEUTRAL] E as in echo, L as in Lima, A as in Alpha.
[AGENT][NEUTRAL] And then space A as in Alpha.
[AGENT][NEUTRAL] Space T as in Tango, E as in Echo, R as in Romeo, R as in Romeo, A as in Alpha, and then services LLC.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oops, and what is the da da da da da.
[AGENT][NEUTRAL] So, did you need that group number?
[CUSTOMER][NEUTRAL] Is it 70073?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Thank you. uh, can I get a claims mailing address please?
[AGENT][NEUTRAL] Yes, uh, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, calendar year plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you. And percentage coverage for actually I'll get that off the thingy. um, do do preventative and diagnostic procedures count towards your yearly max?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Is there a waiting period or a missing tooth cloth?
[AGENT][NEUTRAL] There is a missing tooth clause uh there is no waiting period as the policy does not provide any major coverage it's only going to be preventative uh radiographs, FMX and basic.
[CUSTOMER][NEUTRAL] No, oh.
[CUSTOMER][NEUTRAL] Oh OK, no major.
[AGENT][NEUTRAL] Correct, so no, uh, endodontic, periodontic, um, oral surgery, not anything like that.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh endo pero or OS.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And percentage coverage for um preventative and basic would be like is it 180 or 180.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, so preventative is at 100%. Radiographs, FMX and basic are all at 80%.
[CUSTOMER][NEUTRAL] No major.
[CUSTOMER][NEUTRAL] Oh OK, includes radio Us.
[CUSTOMER][NEUTRAL] X-rays.
[CUSTOMER][NEUTRAL] Um, and coordination of benefits, is that standard?
[AGENT][NEUTRAL] Uh, there is no coordination of benefits.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, I don't need that, don't need that.
[CUSTOMER][NEUTRAL] Do periodic exams share frequencies with limited?
[AGENT][NEUTRAL] Um, let me, do you have those codes by chance?
[CUSTOMER][NEUTRAL] 0140 and 0120.
[AGENT][NEUTRAL] I believe so, but let me confirm that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, uh, 012001400150 and 0160 all share the same trick when see so that is limited to, uh, 2 for 12 month period.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, so 4 1206 not covered. Do they have coverage for 9944?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 9944 is not covered under this policy.
[CUSTOMER][NEUTRAL] OK, uh, are posterior composites or crowns downgraded?
[AGENT][NEGATIVE] No, they are not.
[CUSTOMER][NEUTRAL] OK, well, no crown's not even covered at that point because major I guess.
[AGENT][NEUTRAL] Right, but still.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] No major thank you. Uh, can all four pers not even covered? I just realized, so SRP is not covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Um, car maintenance also not covered, no history.
[CUSTOMER][NEUTRAL] Do anything else at this point, uh, what's the, uh, deductible on the yearly max?
[AGENT][NEUTRAL] Sure, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, that calendar, your maximum is $500 deductible is $50 per insured, and that does not apply to preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Does not apply to preventative.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEGATIVE] No ortho coverage.
[CUSTOMER][NEUTRAL] Do you have cover for a 9110?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] That was 9910.
[CUSTOMER][NEUTRAL] Uh sorry, 9110.
[AGENT][NEUTRAL] Oh sorry, um 110, yes, that is covered under basic uh no limitations.
[CUSTOMER][NEUTRAL] Basic, no limits, OK.
[CUSTOMER][NEUTRAL] No limitations.
[CUSTOMER][NEUTRAL] Alright, and what's the reference number for the conversation?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date and so my name is spelled [PII] And was there anything else I could help you with R?
[CUSTOMER][POSITIVE] No, that's it for now. Thank you so much [PII].
[AGENT][NEUTRAL] Of course, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much for your help OK I really appreciate it and have a great weekend.
[AGENT][POSITIVE] Of course, yeah, thanks. I hope you have a great weekend. You too thank you bye bye.
[CUSTOMER][POSITIVE] Thank you. Take care. Bye.
[AGENT][NEUTRAL] Bye bye.