AccountId: 011433970860
ContactId: f9192a8a-7321-4029-8722-e21af5203e5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452160 ms
Total Talk Time (AGENT): 129732 ms
Total Talk Time (CUSTOMER): 222884 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/f9192a8a-7321-4029-8722-e21af5203e5e_20250409T18:58_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII], and I'm calling from Adams Cheek and Hold Dentistry. I was hoping to verify and get a breakdown of benefits for a patient, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, I have 02586427 [PII].
[AGENT][NEUTRAL] And do you have a good call back number [PII]?
[AGENT][NEUTRAL] OK, thank you. And patient name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, this is not a guarantee of payment, basic outline of the policy.
[AGENT][POSITIVE] I show the policy is effective.
[AGENT][NEUTRAL] And I can send a fax back as well that has all the benefits if that's helpful, um, but policies effective [PII] and active.
[CUSTOMER][NEUTRAL] OK, because we are considered non-contractor providers is an out of network benefits?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, um, they still have benefits. We don't require them to use Carrington. Obviously, if you do, there will be a discount, but um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] But for the benefits, we'll still pay on the policy, so.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, OK, perfect, OK.
[CUSTOMER][POSITIVE] Alrighty, but yes, the fax back would be great as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the um fax number?
[CUSTOMER][NEUTRAL] Let me know whenever.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And is there anything that you want me to go over right now while we're on the phone?
[CUSTOMER][NEUTRAL] Uh yes, ma'am, um.
[CUSTOMER][NEUTRAL] Let's see, is the insurance reimbursement to the provider or subscriber?
[AGENT][NEUTRAL] Um, we do assignment of benefits, so if there's assignment of benefits on the claim, we'll pay you.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, perfect. Are there any waiting periods on the plan?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, let's see, and this is not a guarantee of benefit or guarantee of payment, it's a basic outline of the policy. Um, let's see, I don't show any waiting period.
[CUSTOMER][NEUTRAL] OK, is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and do you pay on pre or seat date for crowns?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] We pay on pull up that.
[AGENT][NEUTRAL] Uh we'll pay on prep date.
[CUSTOMER][NEUTRAL] Prep, OK.
[AGENT][NEUTRAL] And actually for this plan, they don't have coverage for crowns. They only have pre yeah, they only have preventive expenses and then basic expenses in which the facts back gives a detailed list of the codes that are covered under the policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, um, would it show code 0367 typically tax backs don't.
[AGENT][NEUTRAL] 063 7. And what was that for?
[CUSTOMER][NEUTRAL] Mhm, uh, con beam CT scan.
[AGENT][NEUTRAL] Yeah, I do not have that on the list of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Like for 239-3 posterior composite fillings, are there downgrades?
[AGENT][NEUTRAL] No, there's no downgrades.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No worries, I can just see that I'm.
[CUSTOMER][NEUTRAL] And then if by wings and panorex are taken on the same day, will they bundle the FMX or do you pay them as is?
[AGENT][NEUTRAL] And we pay them as is.
[CUSTOMER][NEUTRAL] OK, OK, I'm trying to see, and there's no ortho coverage as well?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then does it have anything about sealants or fluoride or anything?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I don't know if I had an age limit.
[AGENT][NEUTRAL] Um, it does. It's for children, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me look at that.
[CUSTOMER][NEUTRAL] Free.
[AGENT][NEUTRAL] Uh, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and then 2 more codes actually 3.
[CUSTOMER][NEUTRAL] Let's see 9910.
[CUSTOMER][NEUTRAL] 9110.
[CUSTOMER][NEUTRAL] And 9944.
[CUSTOMER][POSITIVE] I'll get your receipt ready for you.
[AGENT][NEUTRAL] Um, 9910 is basic.
[AGENT][NEUTRAL] What was the other two?
[CUSTOMER][NEUTRAL] Uh 9110.
[AGENT][NEUTRAL] Uh, that was the one that
[CUSTOMER][NEUTRAL] And 9944.
[AGENT][NEUTRAL] OK, I just have 9110 listed on here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, so 9910 is not covered?
[AGENT][NEUTRAL] The codes.
[AGENT][NEUTRAL] I don't show that listed.
[CUSTOMER][MIXED] OK, but you said 9110 is basic.
[CUSTOMER][NEUTRAL] And was there a frequency?
[AGENT][NEUTRAL] Uh, I don't show frequency.
[CUSTOMER][NEUTRAL] OK, no fruit, OK.
[CUSTOMER][NEUTRAL] And then 9944 you said was not covered?
[AGENT][NEUTRAL] Uh, correct. I don't show it listed on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for the facts back what it if um perio like SR scaling and route planning 4341, does it have like the guidelines like if all four quads can be done on the same day?
[CUSTOMER][NEGATIVE] torturing.
[AGENT][NEUTRAL] You have the code for, for that?
[CUSTOMER][NEUTRAL] Uh, 4341. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I don't show that under this policy. It's a very limited plan, so.
[CUSTOMER][NEUTRAL] Oh, I see. OK.
[CUSTOMER][NEUTRAL] So if I don't see a code on here, what I, I guess assume that it's not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, well I will see what I can find out on the fax back but um if I have any other questions I'll definitely give a ring back. Is there a reference number for this call?
[AGENT][NEUTRAL] Um, it's just today, my name and today's date.
[CUSTOMER][NEUTRAL] So [PII]
[CUSTOMER][POSITIVE] 4925. All right, well I thank you so very much for your help today, [PII].
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.