AccountId: 011433970860
ContactId: f9898518-f999-4876-869e-ce151a412830
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410410 ms
Total Talk Time (AGENT): 160106 ms
Total Talk Time (CUSTOMER): 116597 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/f9898518-f999-4876-869e-ce151a412830_20250103T21:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, I am calling from a provider's office. I need to get some eligibility for a patient of mine.
[AGENT][NEUTRAL] OK. And your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] It is going to be 02569697.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] Hello sir, are you still there?
[AGENT][NEUTRAL] Yes, I'm pulling up the information.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Verify the patient's name and date of birth for me, please.
[CUSTOMER][NEUTRAL] Yes, it is uh [PII], 226 of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said that you're checking the claim status?
[CUSTOMER][NEUTRAL] Um, no, I'm calling.
[CUSTOMER][NEUTRAL] Um, because I need to get a breakdown of benefits, uh, for, uh, sorry, dental benefits, yeah.
[AGENT][NEUTRAL] Dental.
[AGENT][NEUTRAL] OK, all right, do you want the schedule of benefits faxed to you, [PII]?
[CUSTOMER][NEUTRAL] Can I please get it over the phone?
[AGENT][NEUTRAL] Oh, that's fine.
[AGENT][NEUTRAL] Sure. And so I have the information for you. I'm showing an effective date of [PII]. Uh, the policy is currently active at this time. Uh, this is a limited dental policy. I'm sorry?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Sorry, uh, before anything else, can you please check if we are in network with this plan?
[AGENT][NEUTRAL] I can tell you who the network of contracted providers are, uh, that network is Carrington. We do not have a list of their contracted providers you would need to reach out to that, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Carrington.
[AGENT][NEUTRAL] Carrington directly, yes.
[CUSTOMER][NEUTRAL] Yeah, I, I think, yeah, we're network with Carrington, OK, um, you said this was a limited dental, um, OK, so what's covered under this plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, I'll proceed. So the calendar, your maximum is $500 per covered insured. Uh, the calendar your deductible is $50 per person. I'm showing that uh [PII] is the only one on the policy. Uh, the preventive services are reimbursed at 100%. Basic is $80. Major is not covered under this plan.
[AGENT][NEUTRAL] Um, let me know when you're ready for the frequencies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, OK, under the basic, what is covered under that, I'm sorry?
[AGENT][NEUTRAL] The basic is restorative services and it covers one extraction code, the D 7140, that's a simple extraction. Any other extractions are considered major. Endoerio is also considered major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so restorative and the extraction 7140.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, yeah, please go ahead with the frequencies.
[AGENT][NEUTRAL] All right. So the, um, cleaning or prophy, uh, it's once every 6 months?
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] White wing X-rays, it's once per twelve-month period.
[AGENT][NEUTRAL] And the FMX and Peno is once every 5 years. Uh, of course, don't show any history for, uh, this patient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you know, TMJ services, orthodontic treatment, implant placement removal related services are not covered.
[CUSTOMER][POSITIVE] Perfect, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there like any waiting period, any waiting period?
[AGENT][NEUTRAL] Since there's no major, there's no waiting period.
[CUSTOMER][NEUTRAL] OK, um, but let me, let me see if I have any more questions, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the group number?
[AGENT][NEUTRAL] The group number for this employee.
[AGENT][NEUTRAL] Is 70051. I think that's also on their medical identification card.
[AGENT][NEUTRAL] For their dental ID card.
[CUSTOMER][NEUTRAL] OK and then your guy.
[CUSTOMER][NEUTRAL] And then you guys' address is the [PII] uh.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] No, so the, the current mail, the current, the current mailing address to submit a claim is [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] is it the the [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That's it. Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, perfect. I, I, I have it here on the card. I'll just take it from there. OK, yeah, that that's really all the information that I needed. um, can I just get a reference number for this call, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh. You'll use my name in today's date as your reference, [PII] and information provided today is verification only, not a guarantee of payment. Any other questions, [PII]?
[CUSTOMER][POSITIVE] No, that's gonna be everything um you have a great day.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.