AccountId: 011433970860
ContactId: f68393bd-b29e-400b-84a3-cec5ba5afdb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682640 ms
Total Talk Time (AGENT): 276207 ms
Total Talk Time (CUSTOMER): 185982 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/f68393bd-b29e-400b-84a3-cec5ba5afdb2_20250203T18:57_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] Hi, [PII]. This is [PII] calling on behalf of the dental office. I'm checking benefit information on this recorded line. And how are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] I'm also good. Thank you so much for asking about it.
[AGENT][NEUTRAL] You're welcome. And um just for my notes, can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that info and may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, that is [PII]. That is a direct line.
[AGENT][POSITIVE] Thank you for that and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Sure, it's still on. I'm just pulling it up.
[CUSTOMER][NEUTRAL] So the policy number it is 02571797.
[AGENT][NEUTRAL] 02571797
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's first and last name, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I get the um benefit information for you. But I am showing that the policy is active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And could you also spell out your name?
[AGENT][NEUTRAL] Sure, my name is [PII], first initial.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Got you.
[CUSTOMER][NEUTRAL] All right, sir. And now, uh, can you give me the first name?
[AGENT][NEUTRAL] This is on the Carrington PPO network.
[AGENT][NEUTRAL] However, the benefits are the same if the provider is in-network or not.
[CUSTOMER][NEUTRAL] Carrington
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So now, uh,
[CUSTOMER][NEUTRAL] The relationship, it's, uh, the patient is a spouse, right?
[AGENT][NEUTRAL] Yes, patience is a spouse.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you also uh give me the
[CUSTOMER][NEUTRAL] Group and number, please.
[AGENT][NEUTRAL] Sure, the group number is 70073.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the name
[AGENT][NEUTRAL] The name is [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the letter A and then Terra, T E R R A.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Services LLC. Mhm.
[CUSTOMER][NEUTRAL] Services. OK.
[CUSTOMER][NEUTRAL] I will see as well. OK.
[CUSTOMER][NEUTRAL] So now all the provider is in network.
[CUSTOMER][NEUTRAL] Um, this is, this is a calendar, right? The co is standard.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] This is a counter plan, the coordination benefit is standard.
[AGENT][NEUTRAL] This is the calendar year plan and the coordination of benefit, yes, it's standard.
[CUSTOMER][POSITIVE] OK. Now, uh, in this plan, there is a net benefits as well.
[AGENT][NEUTRAL] There is no, so that that's what I was saying. So the benefits are the same whether the provider is on the Carrington PPO network or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you also provide me the account of my deductible and the accumulation as well?
[AGENT][NEUTRAL] Sure, so the calendar year max is $500 per insured.
[AGENT][NEUTRAL] Calendar year deductible is $50 per person, up to $150 per family.
[CUSTOMER][NEGATIVE] Nothing thank you so much so far.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, hold on one moment, I'm getting that for you.
[AGENT][NEGATIVE] So far no one has met the um max or used the deductible.
[CUSTOMER][NEUTRAL] Oh, do you have any waiting period on the class?
[AGENT][NEUTRAL] Um, there's no waiting period. The policy only covers preventative radiograph and FMX and basic.
[CUSTOMER][NEUTRAL] Mhm. So there is no major services covered?
[AGENT][NEUTRAL] Correct. And major for us includes endodontic, periodontic, proteodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And how about the orthodontic?
[AGENT][NEUTRAL] I'm sorry, Orthodontic, um, orthodontic treatment is not covered on the policy.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So now, uh, you said the preventive services are covered. So like and cleaning buttons. Could you please provide me the frequency of those service?
[AGENT][NEUTRAL] Preventative expenses are covered at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiograph, FMX expenses, basic expenses and basic restorative expenses are all at 80%.
[AGENT][NEUTRAL] Cleanings are once every 6 months.
[AGENT][NEUTRAL] Oral evaluations are 2 per 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bite wings are once per 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And full mouth X-rays and panels are once every 5 years.
[CUSTOMER][NEUTRAL] How about car insurance?
[AGENT][NEUTRAL] Fluoride and sealant.
[AGENT][NEUTRAL] You're asking for the limitations?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yes, I do see that I need the frequency of the age limit.
[AGENT][NEUTRAL] I'm sorry, you sound really low. You need the frequency?
[CUSTOMER][NEUTRAL] Yes, frequency and it's limit as well.
[AGENT][NEUTRAL] Well, they're under preventative, so it's that 100%. Do you mean limitations in terms of like age?
[AGENT][NEUTRAL] And if it's paired with any other codes? OK. Um, let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] CG.
[AGENT][NEUTRAL] So for the fluoride.
[AGENT][NEUTRAL] The only limitations are maximum of 1 procedure per 12-month period.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Adult is limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sealants are maximum 1 procedure for 36 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited to dependent children under age [PII].
[AGENT][NEUTRAL] And applications made to permanent molar teeth only.
[CUSTOMER][NEUTRAL] OK, now, uh, could you also check the history for these services? If there's any history with this?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So there's no history on file yet. We haven't processed any claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Oh yes, uh, you said the basic services are covered. How about the composite? Are they downgrade to?
[CUSTOMER][NEUTRAL] Are they downgraded to American filling?
[AGENT][POSITIVE] There is no downgrade.
[CUSTOMER][NEUTRAL] It's not. OK. And the major services are not covered, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Major services are not covered.
[AGENT][NEUTRAL] Correct, Major services are not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, how about the androontic, that is covered at 80%.
[AGENT][NEUTRAL] No, endodontic, periodontic, proteodontic, and oral surgery is all under major, which is not covered on the policy.
[CUSTOMER][NEUTRAL] Pay you as well like SRP?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] SRP how about the SRP?
[AGENT][NEUTRAL] What is it, can you give me a code?
[CUSTOMER][NEUTRAL] 4341
[AGENT][NEUTRAL] Right, 4341 is not covered on the policy.
[AGENT][NEUTRAL] It only covers um preventative.
[AGENT][NEUTRAL] Radiograph and FMX, basic expenses and basic restorative, no major.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. No extraction, no surgery. Nothing like this.
[AGENT][POSITIVE] Correct, no oral surgery, um.
[AGENT][NEUTRAL] Endoonic, periodontic and prosodontic. There may be like a simple extraction like code 7140.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's under basic.
[CUSTOMER][NEUTRAL] 140.
[CUSTOMER][NEUTRAL] All righty. All right. So I'm pretty much done with all my questions regarding this patient's dental plan. And I don't have any further questions if there's no history of this patient.
[AGENT][POSITIVE] All righty. Well, thank
[CUSTOMER][NEUTRAL] And then uh what is the reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] Alright then, thanks so much for your wonderful assistance and uh you have a great day. Thank you.
[AGENT][POSITIVE] Thank you also and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.