AccountId: 011433970860
ContactId: 033d82f5-41b5-43ad-b423-a0f506bfb3a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670520 ms
Total Talk Time (AGENT): 182643 ms
Total Talk Time (CUSTOMER): 185481 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/033d82f5-41b5-43ad-b423-a0f506bfb3a1_20250122T19:51_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII] from provider's office. How are you doing today?
[AGENT][NEUTRAL] I'm good. You said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, that is [PII]. That is [PII], that is [PII].
[AGENT][NEUTRAL] Oh, [PII]. OK. And how can I help you, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, I didn't get your name. Like, can you please spell your name once again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, it's [PII] So [PII], there's a patient, uh, need to get a full general breakdown. That's all for today.
[AGENT][NEUTRAL] OK, what's your fax number?
[CUSTOMER][NEUTRAL] Uh, OK. Uh, is it possible to get it over the phone or is it only for the fax?
[AGENT][NEUTRAL] Yeah, I'll have to send it via fax and then if you have further questions we can discuss it. It's a detailed um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Schedule of benefits, so let me get it faxed over to you and then we can discuss once you receive if you have any questions.
[CUSTOMER][NEUTRAL] OK, OK. In case if I miss anything, then I will have to call back again. OK, got it, got it. And the fax number is going to be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. What's your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. It's going to be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number?
[CUSTOMER][POSITIVE] OK, thank you
[CUSTOMER][NEUTRAL] Sure, uh, it's going to be uh 616-8778.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure, business name is going to be [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm preparing the document. Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yup, yup, sure, sure.
[AGENT][NEUTRAL] OK, so I just faxed that over to [PII].
[AGENT][NEUTRAL] I'll give you a moment to to to receive that. It shouldn't take very long.
[AGENT][NEUTRAL] Um, I will start, uh, with the, let me check their history. Did you want any history information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, please, if there's any history that will have any frequency in this case.
[AGENT][NEUTRAL] Yeah, so the last claim that we received was for year [PII], so they would be eligible. I've not had it received a claim since that time.
[CUSTOMER][NEUTRAL] Uh, since [PII], right?
[AGENT][NEUTRAL] Since the year [PII].
[CUSTOMER][NEUTRAL] Oh well, OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And providers in or out of network with the plan?
[AGENT][NEUTRAL] There's no, um,
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] I do see a uh uh an extraction in [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] But I'm not showing any, any preventive services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Since actually [PII] beyond [PII].
[AGENT][NEUTRAL] Uh, [PII] is the last time to have preventive services.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I think it will not affect any frequency, right, cause that is too beyond that.
[AGENT][POSITIVE] They're eligible. Yeah.
[CUSTOMER][POSITIVE] OK. Got it, got it.
[CUSTOMER][NEUTRAL] And as of the in and out of status providers network, uh, is it?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, let me verify if there is a network affiliated with this policy.
[CUSTOMER][NEUTRAL] Necessary?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so,
[AGENT][NEUTRAL] I don't show a PPO network affiliated.
[AGENT][NEUTRAL] With this
[AGENT][NEUTRAL] With this policy, so it's provider, so it's provider of choice. I'm sorry, coughed in your face. Let me mute you real quick.
[CUSTOMER][NEUTRAL] OK. So I think
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's provider of choice?
[CUSTOMER][NEUTRAL] OK. So this is provider of choice.
[AGENT][NEUTRAL] Have you received the schedule yet?
[CUSTOMER][NEUTRAL] Well, let me check in this case. Please allow a moment. Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I think I haven't received the fax yet.
[AGENT][NEUTRAL] OK, and I stand to be corrected, uh, Carrington would be the, uh, PPO network of contracted providers.
[CUSTOMER][NEUTRAL] OK, it's for Carrington. OK, let me check this one more pack.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I got it. Uh, I received just now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's probably about um 67 pages with the cover, cover sheet.
[CUSTOMER][NEUTRAL] OK. And I have, I'm seeing the codes right here and I think this is a benefit amount, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you say benefit, you mean the calendar your maximum?
[CUSTOMER][NEUTRAL] Mm. For every code, there is a specific amount that is specific, right?
[AGENT][NEUTRAL] Or, are you talking about the payment?
[AGENT][NEUTRAL] Yes, for each procedure code to the right would be the benefit amount for that procedure code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And for this code, uh, for every code, there is no specific percentage. I think it's based on uh uh payment, right? That is the specific amount that is, uh, given to a specific code, right?
[AGENT][NEUTRAL] I didn't understand what you just said. Can you repeat?
[CUSTOMER][NEUTRAL] Uh, uh, I, I'm just, uh, asking like for any code, there's no specific frequency at what percentage the code is covered at. But for this one, I think, uh, there's a specific uh specific amount is given to every code, right?
[AGENT][MIXED] Correct, but there are a list of frequencies at the top.
[CUSTOMER][NEUTRAL] Uh, OK. Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they're fixing on the top, but there's no percentage cost to a given dollar amount.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it, got it.
[AGENT][NEUTRAL] See how detailed that is?
[CUSTOMER][NEUTRAL] And uh yeah, go ahead. I'm, I'm seeing the $1000 is the annual max.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the effective date is 795. OK.
[CUSTOMER][NEUTRAL] And as of the network status with the provider, uh, is it in or out? I'm just confirming this one more time.
[AGENT][NEUTRAL] We do not have a list of Carrington's contracted providers um.
[AGENT][NEUTRAL] And so I can provide you with their phone number.
[AGENT][NEUTRAL] Uh, if you would like to verify whether this your office is a part of that network.
[CUSTOMER][NEUTRAL] OK. If provider is in network with Caddington, then you guys also be uh consider in network, right?
[AGENT][NEUTRAL] And, and, and, and technically, this is the benefit for this policy, that it, the benefit amount that's shown, so.
[CUSTOMER][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, I didn't believe that that would change if you were to call Carrington since it specifically states what the dollar amount is.
[CUSTOMER][NEUTRAL] Mm, OK. Got it. Got it, understood.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got it. I think I have all the information. In case if I miss anything, then I will call once again. Uh, there's no issue. Yeah, by the way.
[AGENT][NEUTRAL] All right, [PII], and anything else?
[CUSTOMER][NEUTRAL] Uh, yeah, please, your call reference number.
[AGENT][NEUTRAL] My name and today's date, [PII], first initial last name is [PII].
[CUSTOMER][POSITIVE] Mhm. OK. Got it. Thank you so much for the help. Bye, have a great, uh, have a great day.
[AGENT][POSITIVE] Welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Yeah, thank you.