AccountId: 011433970860
ContactId: fd942b1e-71af-4a71-9e7f-5cf8cba85e59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 934830 ms
Total Talk Time (AGENT): 390285 ms
Total Talk Time (CUSTOMER): 186534 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/fd942b1e-71af-4a71-9e7f-5cf8cba85e59_20250502T15:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. My name is [PII], calling on behalf of the dental office.
[CUSTOMER][NEUTRAL] To check on eligibility benefit for patient recorded line. Can you please help me with that?
[AGENT][POSITIVE] Sure, I can assist you with the eligibility and benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII] the direct line.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, can you repeat that? [PII]?
[CUSTOMER][NEUTRAL] [PII], a direct line?
[AGENT][NEUTRAL] OK. What's the name of the facility you're calling from from my notation, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure. The facility name that's gonna be Ballard Modern Dentistry.
[AGENT][NEUTRAL] How do you spell the first, the first word?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's B A L L A R D.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and may I have the patient's policy number, Mr. [PII]
[CUSTOMER][NEUTRAL] You mean the uh member ID right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02571797
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm. Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right. And you need um do you have a specific questions or you need a full breakdown or you need a fax bag?
[CUSTOMER][NEUTRAL] Full breakdown
[AGENT][NEUTRAL] Verbal facts.
[CUSTOMER][NEUTRAL] Rubber.
[AGENT][NEUTRAL] Specific questions or just a breakdown?
[CUSTOMER][NEUTRAL] I do have a specific question too if you're not mentioning it on the breakdown.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, I'm waiting on the benefits to pull up.
[AGENT][NEUTRAL] And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, here they are.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this one we have a calendar year maximum of $500.
[AGENT][NEUTRAL] With the $50 deductible, or $150 if it's a family plan.
[AGENT][NEUTRAL] Um, the effective date on the policy is [PII], and it is active at the moment.
[AGENT][NEUTRAL] OK, so this one has um preventative which is cover 100%. Radiograph FMX is covered at 80%, basic expense and basic restorative expenses cover 80%. There's no major service, so endodontics, periodontics, prosthodontic repair, and neurosurgeries are not covered.
[AGENT][NEUTRAL] Um, for the frequencies, we have screenings once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings it once per 12 month period.
[AGENT][NEUTRAL] Informal X-rays and panels are once every 5 years.
[AGENT][NEUTRAL] Orthodontics and implants are not covered.
[CUSTOMER][NEUTRAL] sealants and Flore.
[AGENT][NEUTRAL] OK. For the um fluoride, there is an age limit um dependent, limited to dependent children age [PII]. That's gonna be maximum of 1 procedure for 12 months. Um, for sealants, it's gonna be maximum of 1 procedure for 36 months, and this is gonna be limited to dependent children under the age of [PII], and application made to the permanent molar teeth only.
[CUSTOMER][POSITIVE] Thank you for filling any downgrades.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] We don't done right.
[CUSTOMER][NEUTRAL] All right, thank you. And uh what is the fee schedule here? Is it the Carrington?
[AGENT][NEUTRAL] If you, if the provider, I'm sorry if the provider participates with carrying some PPO they can use their fee schedule.
[CUSTOMER][POSITIVE] All right. Thank you so much. So, and what is the claim mailing address?
[AGENT][NEUTRAL] Mailing address to submit claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. May I have group name and group number?
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Marry me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like the group name and number, uh, the number is 70073. Again, that's 70073. The name is Versella Aterra Services.
[CUSTOMER][NEUTRAL] Vella Ipea Services, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, thank you so much and coordination benefit standard, right?
[AGENT][NEUTRAL] Coordination of benefits? We don't coordinate benefits.
[CUSTOMER][NEUTRAL] All right. Any history of this patient that might affect frequency?
[AGENT][NEUTRAL] OK, let me check on that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, the only, uh, well it's $13.
[AGENT][NEUTRAL] OK, I don't see anything being processed or paid.
[CUSTOMER][NEUTRAL] All right. And uh one last question for this policy. And is there any missing clause?
[AGENT][NEGATIVE] The policy does have a missing tooth cloth.
[CUSTOMER][POSITIVE] All right, great. Thank you so much. I do have one more patient. Can you also help me with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me go ahead and make a note on this one before we move forward to the next one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the next policy?
[CUSTOMER][NEUTRAL] Sure. The number is 02396579.
[AGENT][NEUTRAL] And what's the name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][NEUTRAL] OK, so it's gonna be one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we have an effective date of [PII]. It is active at the moment.
[AGENT][NEUTRAL] And with this one, let's see.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And again, this is not a guarantee of payment, just a verification of coverage. And with this one, we have a calendar year maximum of $1500 with the $50 deductible, $150 if they say family plan.
[AGENT][NEUTRAL] OK, and this one is a little bit different, so let me go ahead and pull the benefits on this one.
[AGENT][NEUTRAL] All right, so the expense is um preventative is covered 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered 80%.
[AGENT][NEUTRAL] Basic expense and basic restorative expenses cover 80%.
[AGENT][NEUTRAL] Major expenses including endogenics, periodontics, prosthodontic repair, and or surgery, they're all 40% after the 12 month waiting period, but he's already out of the waiting period. So it's gonna be 40%.
[AGENT][NEUTRAL] Um, for the frequencies.
[AGENT][NEUTRAL] We have cleanings once every 6 months, exams, 2 for 12 month period.
[AGENT][NEUTRAL] Buy wings once per 12 month period.
[AGENT][NEUTRAL] For my X-rays and panels once every 5 years.
[AGENT][NEUTRAL] Crowns and bridges is once every 7 years per tooth, impartial and dentures is once every 5 years.
[AGENT][NEUTRAL] The policy does have missing tooth cloths, orthodontics and implants are not covered.
[CUSTOMER][NEUTRAL] All right. And uh what about fluoride cements, are they covered here?
[AGENT][NEUTRAL] Mhm. It's gonna be the same limitation as the one prior. So, um, it's gonna be um limited to dependent children aged under the age of [PII] for the fluoride, and that's gonna be one procedure for 12 months. And for the sealants, it's gonna be same maximum 1 procedure for 36 months, limited to dependent children under the age of [PII] and application made to the permanent molar teeth only.
[CUSTOMER][POSITIVE] Great, uh, fillings, they do, do they have any downgrades?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right. And, uh, account speed on seat of update.
[AGENT][NEUTRAL] Uh, feet.
[CUSTOMER][POSITIVE] Thank you so much for that. And for this, I do have another like some quotes also. Can you help me send the fax for this patient?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it's gonna be for this one for [PII], correct?
[CUSTOMER][NEUTRAL] Yes. And also, any history for this patient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check the history.
[AGENT][NEUTRAL] OK, the last prophy is on, let's see.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The last oral evaluate X-ray. I'm sorry. The last x-ray was on the same day, [PII].
[AGENT][NEUTRAL] The last panel, uh.
[CUSTOMER][NEUTRAL] Oh, is that FMX?
[CUSTOMER][NEUTRAL] For, for the date of October is, uh, which was it?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] For the, for the October, for the month of October, which X-ray was it?
[AGENT][NEUTRAL] OK, what's the [PII]?
[CUSTOMER][NEUTRAL] 0210. All right.
[AGENT][NEUTRAL] OK, and there was also a panel.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the evaluation was also the same day.
[CUSTOMER][NEUTRAL] Any other history apart from that?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's all the history for [PII].
[CUSTOMER][NEUTRAL] Alright, then nothing has been used submit from the annual maximum deductible, right for this year?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And uh is there any missing tooth cloth?
[AGENT][NEGATIVE] Yes, there is a missing class.
[CUSTOMER][NEUTRAL] All right. As I check here, the group name is University Trucking Health. What about group number?
[AGENT][NEUTRAL] OK, let me get that.
[AGENT][NEUTRAL] OK, the group number is 22,210.
[AGENT][NEUTRAL] And the group name and Universal Trucking B line delivery.
[CUSTOMER][NEUTRAL] All right. And free schedule, is it also the you Carrington here?
[AGENT][NEGATIVE] No, this one pay on the usuring customer rates, UCR.
[CUSTOMER][NEUTRAL] We're still talking.
[CUSTOMER][NEGATIVE] And uh no coordination benefit for here also, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Great. So thank you so much. You have a nice day ahead. Bye-bye.
[AGENT][NEUTRAL] Uh, miss, um, [PII], do you need me to send the fax?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Do you mind holding while I send this out to you?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, give me just a minute. I'm gonna go ahead and send it before I let you go, OK? One moment.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEGATIVE] You are on hold.