AccountId: 011433970860
ContactId: ff3fc05a-1b3b-4af2-b86d-8acf22167165
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364450 ms
Total Talk Time (AGENT): 165077 ms
Total Talk Time (CUSTOMER): 71661 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/ff3fc05a-1b3b-4af2-b86d-8acf22167165_20250129T21:00_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am just needing to see if I can get a verbal breakdown of dental benefits today.
[AGENT][NEUTRAL] I can I help you. What's your name?
[CUSTOMER][NEUTRAL] The patient's name or my name?
[AGENT][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And how do you spell your name, [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] It is 02300258.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you for verifying that information for me. And we're checking eligibility and benefit information, correct?
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Alright, we have that information for you. Uh, the policy effective date is [PII] currently active at this time.
[AGENT][NEUTRAL] Um, I'm showing that the maximum, uh, per calendar your benefit is $1500.50 dollars calendar year deductible.
[AGENT][NEUTRAL] Uh, so for preventive services, the reimbursement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 100% of UCR. Basic is 80% of UCR. Major is 40% of UCR.
[AGENT][NEUTRAL] Uh, this policy does have a 12-month waiting period for major, but it looks like they've exceeded the waiting period. Um, the frequencies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for cleanings, uh, it's once every 6 months.
[AGENT][NEUTRAL] Exams, 2 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bike wings is once per 12 month period.
[AGENT][NEUTRAL] FMX and Peno is once every 5 years.
[AGENT][NEUTRAL] Crowns and bridges is once every 7 years per tooth.
[AGENT][NEUTRAL] And partials and dentures is once every 5 years?
[AGENT][NEUTRAL] This policy does, does have a missing tooth claws. Um, TMJ services are excluded, orthodontic treatment is excluded, and implant placement removal, and any related services to implants are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and then are endo, pero, and oral considered basic or major services?
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] Major and then what are the age limits on fluoride and sealants?
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] And go ahead and give me all your questions that way I can move through it smoother.
[AGENT][NEUTRAL] So you need the the the the frequencies for fluoride?
[CUSTOMER][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] Yes, he's in the age limits.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then I just need to know if build up is covered that code is 29,150.
[AGENT][NEUTRAL] 29.
[CUSTOMER][NEUTRAL] 50.
[AGENT][NEUTRAL] 50. OK.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for fluoride, it's limited to dependent children under the age of [PII], maximum of 1 procedure for 12 months.
[AGENT][NEUTRAL] And for sealants.
[AGENT][NEUTRAL] A maximum of 1 procedure per 36 months.
[AGENT][NEUTRAL] Applications made to the permanent molar teeth only.
[AGENT][NEUTRAL] And the limitation is for dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 2950.
[AGENT][NEUTRAL] 2950 is a coral buildup that is covered under a major.
[AGENT][NEUTRAL] Uh, frequency limitations. Let me see if there'll be any for that.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Maximum of 1 per seven year period.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] Limited to patients age [PII] and over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] Um, I just wanted to triple check yesterday, so I called yesterday to get faxed back and never received it, which is why I called again today. Um, they told me yesterday that we are not in network but that we need to use the Carrington fee schedule. Can you confirm or deny that?
[AGENT][NEUTRAL] Oh, uh-huh.
[AGENT][NEUTRAL] Well, there's not a network affiliated with this policy, so, um, it's provider of choice.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because you're are are you are not, are you not contracted with Carrington?
[CUSTOMER][NEUTRAL] We are.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect well I just wanted to make sure because um I I just wanna make sure but that's all I need thank you very much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day, [PII].
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] It's [PII]. I'm sorry.