AccountId: 011433970860
ContactId: 0d584d80-3b49-4757-b5d3-de4b373f19e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604700 ms
Total Talk Time (AGENT): 240657 ms
Total Talk Time (CUSTOMER): 197976 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/0d584d80-3b49-4757-b5d3-de4b373f19e8_20250423T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] here. And I'm calling on behalf of the dental office to check benefits and eligibility for one patient today. Can you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check eligibility benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Thank you. It is [PII] and it's a direct line?
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Sure. Policy number is 02592893.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Sure. Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, that one, is it possible if we can verify over the phone?
[AGENT][POSITIVE] Yeah, I can uh definitely answer questions for you over the phone, but I can also send this to you if you'd like.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, what was that fax number for you?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, just give me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh yes, [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I can go ahead and get this sent to you now. I should get it within about 10 minutes or so, um, and what kinds of questions did you have for me, [PII]?
[CUSTOMER][NEUTRAL] Uh, for this number actually. Can you help me if the dentist is in or out of network?
[AGENT][NEUTRAL] Sure, so this policy participates in the Carrington PPO network. Uh, however, utilization of a provider within that network is not required, so it could be used anywhere.
[CUSTOMER][NEUTRAL] Uh, uh, is it possible if you can check for me or we can follow Carrington?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, is it possible if you can check for me whether it's in or out of network?
[AGENT][NEUTRAL] Um, I am not able to check that. However, I can give you, uh, Carrington's information. They'll be able to check that for you, uh, if you'd like their phone number, and then I can also transfer you when when we're done if you like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, sure thing. That would be perfect. And the group name, group name.
[AGENT][NEUTRAL] OK, give me just a moment, let me get that phone number for you.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, um, are you ready for Carrington's phone number?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Of course, alrighty and then you needed that uh group name and number?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, so that group number is 70,070.
[CUSTOMER][NEUTRAL] [PII]. And the group name?
[AGENT][NEUTRAL] Yes, that is [PII] Staffing and that's spelled [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. And the coordination of benefit?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] Oh, this doesn't have coordination of benefits.
[CUSTOMER][NEGATIVE] No coordination.
[CUSTOMER][NEUTRAL] Thank you. And is this a family or a single coverage plan?
[AGENT][NEUTRAL] Um, this is the, this is a single coverage. He is the only, uh, member under this policy.
[CUSTOMER][NEUTRAL] Thank you. Calendar or fiscal year?
[AGENT][NEUTRAL] It is calendar year.
[CUSTOMER][NEUTRAL] And thank you. And can you help me with the annual maximum deductible?
[AGENT][NEUTRAL] Sure, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so the calendar year maximum is $500.
[AGENT][NEUTRAL] The calendar year deductible is $50 and that does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK. 500 is the annual max and 50 is the deductible. It does not apply to preventive.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you, thank you. And uh there's no family deductible as this is a single coverage plan?
[AGENT][NEUTRAL] Correct, yeah, so it would just be that 50.
[CUSTOMER][NEUTRAL] OK. Anything you on that?
[AGENT][NEUTRAL] Uh, let me check that for you. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, none has been used or met so far this year.
[CUSTOMER][POSITIVE] Thank you. Any missing tooth cloths or waiting period?
[AGENT][NEUTRAL] Yes, so there is a missing teeth clause. Uh, this policy does not have any waiting periods. Um, the only coverages they have are going to be preventative and basic, uh, so there is no major coverage under this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm so sorry for that. You told me major is not covered, but preventive and basic only.
[AGENT][NEUTRAL] Oh, you're OK.
[AGENT][POSITIVE] Correct and uh radiographs as well.
[CUSTOMER][NEUTRAL] Right, OK. So which means, uh, what is the uh percentage for preventive and basic?
[AGENT][NEUTRAL] Yeah, preventative is going to be at 100%. radiographs and all basic expenses are going to be at 80%.
[CUSTOMER][NEUTRAL] No need.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And any missing tooth loss or waiting period?
[AGENT][NEUTRAL] There is a missing tooth clause and no waiting periods.
[CUSTOMER][NEUTRAL] And is all talk of it on the plan?
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][NEGATIVE] Not covered. Crown and bridges space at purple seating.
[AGENT][NEUTRAL] Um, either one.
[CUSTOMER][NEUTRAL] Um, thank you. Any downgrade on fillings and forms?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I think Crown's bridge denture implants will not be covered, right, as uh the majors are not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And uh yeah, um that is um actually I have not received the fax yet.
[AGENT][POSITIVE] Oh, it's sending right now. I'm sorry it is taking just a little bit. You should be getting it here pretty soon though.
[CUSTOMER][NEUTRAL] Oh, it's OK. So,
[CUSTOMER][NEUTRAL] Thank you. And uh how many number of what can be done for the SRP?
[AGENT][NEUTRAL] Uh, all 4 can be done at the same time.
[CUSTOMER][NEUTRAL] Thank you. And pay maintenance and SA do they share frequency?
[AGENT][NEUTRAL] Uh, could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Sure. Uh, pay your maintenance, 49, 10 and 1110, do they share frequency.
[AGENT][NEUTRAL] 10 on 10 and 1110. Give me just a moment. Let me check that.
[AGENT][NEUTRAL] You did say 4910 correct?
[CUSTOMER][NEUTRAL] Mhm. 49, 10 and 1110.
[AGENT][NEUTRAL] OK, so 4910 is not a covered um procedure code. Uh, however, 11:10 is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. So, uh, SRP 4341 is covered, right?
[AGENT][NEUTRAL] That was 4341?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that is not a covered procedure.
[CUSTOMER][NEUTRAL] Thank you. And the 4381 is not covered as well.
[AGENT][NEUTRAL] Correct, that is not covered.
[CUSTOMER][POSITIVE] Thank you so much. And actually, just one last question. Is there any history for this patient?
[AGENT][NEUTRAL] No, we don't have any history on file for this number.
[CUSTOMER][NEUTRAL] Thank you. I just want to confirm also if any procedure code which is not listed on the fax will not be covered, right?
[AGENT][NEUTRAL] That is correct, yes ma'am. If you're looking for something specific and you don't see it listed, that is not going to be a covered procedure.
[CUSTOMER][POSITIVE] Thank you. Can you please spell your name for me?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] OK. Reference number?
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date and so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so very much, [PII]. I just want uh to confirm the fax I will be receiving, right?
[AGENT][POSITIVE] Absolutely it did send um again it can take about 10 minutes or so.
[CUSTOMER][POSITIVE] Thank you so very much. It was such a pleasure working with you and I hope you have a wonderful day ahead. Bye-bye.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Thanks for giving us a call, [PII] you too bye bye.