AccountId: 011433970860
ContactId: 1026f626-90a5-4934-9a6c-5dc346a0bcca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272750 ms
Total Talk Time (AGENT): 123120 ms
Total Talk Time (CUSTOMER): 102646 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/1026f626-90a5-4934-9a6c-5dc346a0bcca_20250225T20:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you doing?
[AGENT][POSITIVE] I'm doing well, thank you for asking.
[CUSTOMER][NEUTRAL] I'm calling for an EOB. I have a patient in office, but um, I need an explanation of benefits and effective dates.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can help you with that. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am and yours?
[AGENT][NEUTRAL] [PII]. [PII], what is a good callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. What is the policy number for the patient?
[CUSTOMER][NEUTRAL] The policy number is going to be 02576415.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] member date of birth [PII].
[AGENT][NEUTRAL] Thank you. And do you happen to have a claim number or do we need to look for it by data service?
[CUSTOMER][NEUTRAL] We haven't done any services yet. The patient has come to us as a new patient.
[AGENT][NEUTRAL] You're needing a breakdown.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you. I apologize. I heard an EOB.
[AGENT][POSITIVE] I can help you with that. So [PII]'s policy is active.
[AGENT][NEUTRAL] Effective date on the policy is [PII].
[AGENT][NEGATIVE] He has no history, nothing new, nothing met. This is a limited dental policy. It does not cover major procedures.
[CUSTOMER][NEUTRAL] Does it pay out of network?
[AGENT][NEUTRAL] It does. It does participate in the Carrington PPO network, but network participation is not required.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what the schedule does it go by? The Carrington, is it the Carrington 500 series?
[AGENT][NEUTRAL] Uh carrington PPO.
[CUSTOMER][NEUTRAL] So it should be the Carrington.
[AGENT][NEUTRAL] If you're not a Carrington provider, you can use your fee schedule and then we pay according to the benefits.
[CUSTOMER][NEUTRAL] Well, now I have a Care Platinum series, a Care series PPO, and a Carrington 500 series.
[AGENT][NEUTRAL] Carrington PPO.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So it wouldn't be a platinum.
[AGENT][NEUTRAL] And I just participates in the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] And if you'll go ahead and give me that fax number, I'll go ahead and get this on the way for you.
[CUSTOMER][NEUTRAL] The fax number is gonna be [PII].
[AGENT][NEUTRAL] And just to verify that fax number, I'm sending this break down to [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, that's on the way for you. Now the group name and number will not be listed on the breakdown if you need that I can provide that for you as well.
[CUSTOMER][NEUTRAL] Alrighty, just to confirm, is the group number 70055 and subscriber ID is 02576415?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alrighty, I will wait for the fax over. Is all diagnostics by chance 100% covered at 100%?
[AGENT][NEUTRAL] The preventive services are covered at 100%. The radiographs and FMX and basic expenses and basic restorative expenses are covered at 80%. Your bite wings are considered preventive.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And major restorative?
[AGENT][NEUTRAL] And it'll be
[AGENT][NEUTRAL] Mature's not listed.
[CUSTOMER][NEUTRAL] It'll be on the OK, so it will be on the breakdown. I'll wait for the breakdown, but I do know that we can go ahead and get him back and get started while I wait on that fax back.
[AGENT][POSITIVE] Yeah, and if you have any questions once you receive that breakdown just give us a call back we'll be happy to assist you.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Good bye.
[AGENT][NEUTRAL] Bye-bye.