AccountId: 011433970860
ContactId: 0ae23ed9-a1d9-4a4f-95ae-16f8911fb6e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457200 ms
Total Talk Time (AGENT): 236598 ms
Total Talk Time (CUSTOMER): 142164 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/0ae23ed9-a1d9-4a4f-95ae-16f8911fb6e6_20250331T15:00_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I'm calling from a provider's office. I'm trying to get some information on a patient's plan.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Can I get a callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, it is [PII].
[AGENT][NEUTRAL] Thank you. The policy number you're calling on?
[CUSTOMER][NEUTRAL] Um, so he gave me 02564856.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy. And you said you have questions regarding uh his benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, correct, yeah.
[AGENT][NEUTRAL] OK. And.
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Um, first I wanna verify that the plan is active and then see if our office is in or out of network with it.
[AGENT][NEUTRAL] OK, uh, I do show that this policy is active. It's been effective since [PII]. Um, this policy is a non-contracted policy. Um, well, the policy parti participates in the Carrington Carrington PPO network, but um,
[AGENT][NEUTRAL] You don't have to be a Carrington provider.
[CUSTOMER][NEUTRAL] OK, but we are, so then it would fall with Carrington?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can is there a way to because I know there's diff I think there's different Carringtons. I think there's like the Carrington like different ones you can be a network. Is there a way to see if we're a network with this specific one?
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No, no, that's fine.
[AGENT][NEUTRAL] Um, I think there is a name, I mean a number for Carrington.
[CUSTOMER][NEUTRAL] I just know that I think there's like a Carrington 1400 and 1800.
[AGENT][NEUTRAL] Uh, I don't.
[AGENT][NEUTRAL] I'm not sure. I do have a number for Carrington, but this Carrington.
[CUSTOMER][NEUTRAL] I have their number. Would I just give them this plan information?
[AGENT][NEUTRAL] You can see, I don't, you may be able to do so. Uh, normally we give this um number to the insured to find a list of providers in the Carrington network if they want to find a doctor or a dentist, um, but as far as which policy, I can, what I can do is fax you over a copy of their benefits, what is covered and at what percentage.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, that may be able to kinda help you with, you know,
[AGENT][NEUTRAL] That's the only thing that
[CUSTOMER][NEUTRAL] It's fine. I can reach out to Carrington at some point. Um, I just have a few specific questions if that's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK, um, first, can you tell me what the max and deductible is on the plan if any of it's been met and or used?
[AGENT][NEUTRAL] Uh, so there, uh, there are no benefits have been used. Uh, please be advised verifying benefits is not guaranteed payment. The calendar year maximum for this policy is $500. Uh, they do have a calendar year deductible of $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can I give you a few, can I do y'all guys have a payer ID?
[AGENT][NEUTRAL] Yes, the payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can I have a claims address?
[AGENT][NEUTRAL] Claims address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and does it run on a calendar year and is there any waiting periods?
[AGENT][NEUTRAL] It is calendar year, uh, and there is no waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh, and then I have a few specific codes. Are you able to look up codes?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, um, shoot, where was that? OK, do you want them all at once or individually, whatever works best for you?
[AGENT][NEUTRAL] Individually.
[CUSTOMER][NEUTRAL] OK, um, I have 9310.
[AGENT][NEUTRAL] 9310 is covered under their basic benefit.
[CUSTOMER][NEUTRAL] Is that 80%?
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEUTRAL] Basic is paid at 80% preventative at 100.
[AGENT][NEGATIVE] And it does fall under basic.
[CUSTOMER][NEUTRAL] OK, uh, what about.
[CUSTOMER][NEUTRAL] OK, what about 0 140?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I do not show 0140 as a covered procedure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 0220.
[AGENT][NEUTRAL] 0220 is covered under the basic benefit of 8%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0380.
[AGENT][NEUTRAL] 0380 is not a covered benefit.
[CUSTOMER][NEUTRAL] 0460.
[AGENT][NEUTRAL] 0460 is covered under the basic um percentage of 80%.
[CUSTOMER][NEUTRAL] OK, 3330.
[AGENT][NEUTRAL] 3330 is covered.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] And it's limited to one X-ray.
[AGENT][NEUTRAL] Uh, in a, uh, five-year period.
[CUSTOMER][NEUTRAL] And that's 33,303,330?
[AGENT][NEUTRAL] Oh, wait, wait, wait. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, that sounded like a piano maybe.
[AGENT][NEUTRAL] Yeah, uh, 3330 is let me go back up 33.
[AGENT][NEUTRAL] Uh, I do not show 3330 being covered.
[CUSTOMER][NEUTRAL] OK, uh, 3348.
[AGENT][NEGATIVE] 3348 is not covered.
[CUSTOMER][NEUTRAL] OK, 3332.
[AGENT][NEUTRAL] 33, 32 is not covered.
[CUSTOMER][NEUTRAL] OK, 3331.
[AGENT][NEUTRAL] I do not show that as a covered procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about 2940?
[AGENT][NEUTRAL] 2940 is covered under basic.
[AGENT][NEUTRAL] Um, let's see, and it, uh, says replacing replace existing only if in place for 24 months and a maximum of 1 tooth per 24 months.
[CUSTOMER][NEUTRAL] OK, and then lastly 2391?
[AGENT][NEUTRAL] 2391 is covered under basic.
[CUSTOMER][NEUTRAL] OK, and I'm sorry I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Is there a reference number for our call?
[AGENT][NEUTRAL] To reference our call, you will use my name and today's date.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.