AccountId: 011433970860
ContactId: f657a723-99fd-46c4-b32d-7a80914ea9e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 822349 ms
Total Talk Time (AGENT): 374852 ms
Total Talk Time (CUSTOMER): 200768 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f657a723-99fd-46c4-b32d-7a80914ea9e3_20250117T16:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Absolute Dental to Verify Dental Benefits. How are you doing today?
[AGENT][POSITIVE] Hey, I'm doing wonderful. Thank you so much for asking and I can certainly help you with dental benefits today. Do you mind if I grab your callback number, please?
[CUSTOMER][NEUTRAL] Sure, the callback number I have like [PII] is a direct line, no extension.
[AGENT][POSITIVE] Thank you so much. And what is the policy number we're looking at today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, the policy number I have like it's um
[CUSTOMER][NEUTRAL] 02571356
[AGENT][POSITIVE] Perfect. Let me get that policy pulled up for you, one sec.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. Sure, it's uh
[CUSTOMER][NEUTRAL] [PII], date of birth will be [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I do see
[AGENT][NEUTRAL] I do see a booth here. Um, are you wanting a fax back of benefits sent your way?
[CUSTOMER][NEUTRAL] Um, actually, can we go verbally, please?
[AGENT][NEUTRAL] OK, yeah, absolutely, let me pull up their benefit information, one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, um, I do have that pulled up now there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And I do wanna let you know that any information I give you over the phone is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, their current annual maximum is $500 per calendar year.
[AGENT][NEUTRAL] And they have a $50 deductible that does not apply to preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, they are covered 100% of allowable for preventative expenses and then 80% for radiographs basic and basic restorative.
[AGENT][NEUTRAL] Um, their profies are once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Their oral evaluations are 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a second. Uh, what's the percentages for preventative, basic and major?
[AGENT][NEUTRAL] Uh, they don't have major coverage, but they have preventative at 100% of allowable radiographs, basic and basic restorative at 80%.
[CUSTOMER][NEUTRAL] OK. So the preventative and basic only covered, right? No major service?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And uh the group, mhm OK. And the deductible $50 no family, and the annual maxim is $500?
[AGENT][NEUTRAL] And you access 500. They do have a family deductible of $150 but this is just an individual plan.
[CUSTOMER][NEUTRAL] Oh, so this is an individual plan, got it. OK. mm.
[CUSTOMER][NEUTRAL] Mm, policy effective date you said?
[AGENT][NEUTRAL] Uh, the policy effective date was [PII].
[CUSTOMER][NEUTRAL] [PII]. Got it. And uh nothing nothing is, nothing bad, right?
[AGENT][POSITIVE] And I'm so sorry, can you repeat that question for me?
[CUSTOMER][NEGATIVE] And nothing new, nothing made from the deductible and the annual max, right?
[AGENT][NEUTRAL] Uh, for this calendar year, no, we have not used anything.
[CUSTOMER][NEUTRAL] OK, not use anything, got it. Um, just a second.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][POSITIVE] No, take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] What's the coordination of benefit?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So these benefits are.
[AGENT][NEUTRAL] They follow the Carrington PPO fee schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm asking for the coordination of benefit.
[AGENT][NEUTRAL] I'm really sorry. I don't know.
[CUSTOMER][NEUTRAL] OK, do you see any missing tooth loss?
[AGENT][NEGATIVE] We do have a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what about the pre-authorization? Do you see any pre-authorization number?
[AGENT][NEUTRAL] We don't require any pre-authorization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. What is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] No pres missing tooth last, yes, is the ortho is not a covered benefit or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Inontics, periodontics, and oral surgery is a covered benefit.
[AGENT][NEGATIVE] Um, no, they're not covered.
[CUSTOMER][NEUTRAL] Endoperia and oral surgery is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second, I'm almost done.
[AGENT][POSITIVE] Oh, no, you're so fine. I get paid by the hour. Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Actually I have to note all my notes that's why.
[AGENT][NEUTRAL] Oh, you're OK.
[AGENT][NEUTRAL] Just let me know if you need anything else from me.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. OK. What about the like uh fillings, fillings are around rate?
[AGENT][NEUTRAL] Uh, we do not downgrade. I'm sorry.
[CUSTOMER][NEGATIVE] Uh, fillings and uh crows are not done good, got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] 4381 is a covered benefit in the policy?
[AGENT][NEUTRAL] You said 4381?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's not.
[CUSTOMER][NEGATIVE] Not covered. Got it.
[CUSTOMER][NEUTRAL] And uh yeah, I have a few quotes. I just want to know the frequency and percentage.
[AGENT][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Could you please help me with that?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Mhm, can I give you a letter once?
[AGENT][POSITIVE] Um, yes, let me pull them. OK, I'm ready for him.
[CUSTOMER][NEUTRAL] OK, it starts with um.
[CUSTOMER][NEUTRAL] Mm yup. uh 0603.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 43 46 9230 9944.
[CUSTOMER][NEUTRAL] 0150
[CUSTOMER][NEUTRAL] 11 1
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] 03300274
[CUSTOMER][NEUTRAL] 1351.
[CUSTOMER][NEUTRAL] 1206 4341.
[CUSTOMER][NEUTRAL] 4910
[CUSTOMER][NEUTRAL] 23, sorry, 9310.
[CUSTOMER][NEUTRAL] 2740
[CUSTOMER][NEUTRAL] 23 91 51 10.
[AGENT][NEUTRAL] So 2391 and then what was that last one?
[CUSTOMER][NEUTRAL] Uh 5110.
[AGENT][NEUTRAL] 22,110. Thank you. All right, I will check on these for you and I'm just gonna give them to you one at a time as I find them if that's OK.
[CUSTOMER][POSITIVE] Uh, sure, no problem. It's OK.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, I do not have any coverage for 0603.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I do not have any coverage for 4346.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No coverage for 9230?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No coverage for 9944.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, 150 is covered preventative, which is listed under the 100%, and it has one limitation stating that it's limited to two oral evaluation procedures in any combination, including 120, 140, 150, 160, and those are gonna be in a 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, 111
[CUSTOMER][NEUTRAL] Once in the 12 months?
[AGENT][NEUTRAL] I'm so sorry. It's maximum of 2 in a 12 month period out of those combinations.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just help me with the frequencies.
[AGENT][NEUTRAL] Oh, OK, 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then 1110?
[AGENT][NEUTRAL] It is a preventative, so it's covered at the 100% and it's one procedure every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 210 is covered under um the basic and it is 80% and it's limited to one procedure for five-year period. That does include the 210, the 330, and the 277.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 330, we just talked about that is a covered service as well, and it has that same limitation as above.
[AGENT][NEUTRAL] 274 is covered under preventative and it is limited to one bite wing X-ray procedure for twelve-month period. That also includes 270 and 272.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1351 is covered under preventative and it has a lot of limitations. BD and E, let me check them for you. Um, one procedure for 36 months, it's limited to dependent children under [PII] and only on permanent molar teeth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have any coverage listed for 1206.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 4341 does not have any coverage.
[AGENT][NEGATIVE] 4910 does not have any coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the 9310 is covered under basic at 80%. It does not have a limitation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 2740 shows no coverage.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2391 is listed under basic restorative so that same 80% um and it does have two limitations let me read them to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They state maximum 1 each tooth for 24 months and then replace existing only if in place for 24 months.
[CUSTOMER][NEUTRAL] OK. What's uh like uh
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What's the group number group name? What's the group number group name?
[AGENT][NEUTRAL] Uh, group number? Yes, so the group number is 70051 and let me pull up that group name. I can't remember it.
[AGENT][NEUTRAL] And it's called Focus Workforce Management.
[CUSTOMER][NEUTRAL] Could you please spell that one for me, not in politically.
[AGENT][NEUTRAL] Yes, um, it's gonna be Focus. F like Frank, O like Oscar, C like cat, U like umbrella, S like Sam, Workforce, W like Walter, O like Oscar, R [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then management, I'm like mom, I'm sorry, I don't know him. I'm making them up. [PII] like think.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] OK. Yes, I'm done with my patient. Can I get a call reference number for this?
[AGENT][NEUTRAL] You bet you you can. It's gonna be just my name, [PII], first and last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah [PII] got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thanks for supporting the information. That's. Have a nice day. Bye-bye. Take care.
[AGENT][POSITIVE] My pleasure. Bye-bye.