AccountId: 011433970860
ContactId: 00266d88-bb87-44a2-bdc8-115386dbb8d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324279 ms
Total Talk Time (AGENT): 108791 ms
Total Talk Time (CUSTOMER): 93689 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/00266d88-bb87-44a2-bdc8-115386dbb8d0_20250407T12:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] My name is [PII] calling from provider's office specific question for dental.
[AGENT][NEUTRAL] OK, I, I didn't hear what you said. It sounds kind of shuffle. Can you repeat what you said, please?
[CUSTOMER][NEUTRAL] My name is [PII] calling from provider's office and I have a specific question for dental benefits for patients.
[AGENT][NEUTRAL] OK, well, I can help you with the patient's benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02555514
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Thank you for verifying and all the information provided is a verification of benefits, not a guarantee of payment. And what questions did you have?
[CUSTOMER][NEUTRAL] What is the effective date of this policy?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] 1978 is a subscriber of this policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Group number 70055.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Annual max 5000 deductible individual 50.
[AGENT][NEUTRAL] Hold on one moment let me see what type they have.
[CUSTOMER][NEGATIVE] out of network, we are out of network with this one.
[AGENT][NEUTRAL] Hold on one moment. I'm pulling up the um fax back so I can follow with you.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so yes, the calendar year max is 500 deductible is $50 per person up to 150 per family. This policy doesn't have any, uh, well, it's on the Carrington PPO network, but the benefits are the same if they're not a Carrington provider. There's no out of network benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anything used for this year?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, [PII] has not used any or met the deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No waiting period, there is a missing the clause.
[AGENT][NEUTRAL] There is a missing tooth clause, there's no waiting period because this policy doesn't cover major.
[CUSTOMER][NEUTRAL] OK, the vanity at 100 basically at 50%.
[AGENT][NEUTRAL] 100, um, preventative is 100, basic, basic restorative, and radiographs and FMX are all at 80.
[CUSTOMER][NEUTRAL] Any history for this year or the previous year that might affect the frequency for this patient?
[AGENT][NEUTRAL] Do you have specific code? Do you have specific codes you'd like me to look up?
[CUSTOMER][NEUTRAL] And it's 340,120.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, there's no um claims on file with that code?
[CUSTOMER][NEUTRAL] 0150 0140.
[AGENT][NEUTRAL] There's no um claim with either of those codes?
[CUSTOMER][NEUTRAL] FMX pano 02100330.
[AGENT][NEUTRAL] Neither.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fillings, 1110.
[AGENT][NEUTRAL] We haven't actually, well, I'll just do it this way. We haven't processed any claims for the members, so there's no history on file.
[CUSTOMER][POSITIVE] OK, thank you so much. Tell me your name.
[AGENT][NEUTRAL] My name is [PII] The first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Reference number.
[AGENT][NEUTRAL] The first initial to my last name is [PII]. There's no call reference number, you can use my name in today's date. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Nothing, that's it, yeah. Thank you so much. Have a great day. Bye.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You have been removed from the call. Goodbye.