AccountId: 011433970860
ContactId: 11000f02-0d40-4064-b159-29803425cfac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333459 ms
Total Talk Time (AGENT): 109521 ms
Total Talk Time (CUSTOMER): 151174 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/11000f02-0d40-4064-b159-29803425cfac_20250319T17:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from an oral surgery office hoping you can help me out with dental benefits.
[AGENT][NEUTRAL] OK, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a callback number I can get?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I have a member ID and the group number. Which would you prefer?
[AGENT][NEUTRAL] Member ID number.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 02130.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was the patient's name?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yes, it's actually the first time I call you guys, so I wanted to check the um the network to see if we're in network with it.
[AGENT][NEUTRAL] OK, I can help you with that. It would depend on if you're Carrington provider we um use Carrington's network.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, perfect. So as long as we do uh Carrington um network then we're in network, is that correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect so that means we're in.
[CUSTOMER][NEUTRAL] And patients active, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, is this a calendar year policy?
[AGENT][NEUTRAL] It is a calendar year, yes, ma'am.
[CUSTOMER][NEUTRAL] Calendar, OK, um, is there any annual max or deductible for this plan?
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment. The deductible is $50.
[AGENT][NEUTRAL] It applies to everything but preventative.
[AGENT][NEUTRAL] The calendar, your maximum is 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect and anything used or met so far for the year?
[AGENT][NEUTRAL] Hold on just a moment, I'll check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No ma'am, she has not used anything for this year.
[CUSTOMER][NEUTRAL] OK, and I'm looking for the co-insurance for preventative, basic and major.
[AGENT][NEUTRAL] Major is not covered under this policy, so endo perio oral surgery, crowns, bridges, parcels, dentures are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative is paid at 100% of usual and customary rate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Basic, which is fillings and simple extraction is.
[AGENT][NEUTRAL] At 80%.
[CUSTOMER][NEUTRAL] 80%. OK, and would I be able to check on uh coverage or frequency for a few codes that I have here?
[AGENT][NEUTRAL] Yes, ma'am. How many codes do you have?
[CUSTOMER][NEUTRAL] I have 123456. So I have 6.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you like them at the same time or separately?
[AGENT][NEUTRAL] Separately.
[CUSTOMER][NEUTRAL] OK, first one is 9310.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is under basic, no limitation.
[CUSTOMER][NEUTRAL] OK and next one is 0330.
[AGENT][NEUTRAL] Preventative 1 in 5 years.
[CUSTOMER][NEUTRAL] 5 years, uh, next one is 0367.
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] Covered next one's 7210.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. 7140.
[AGENT][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] OK and the last one is 6010.
[AGENT][NEGATIVE] Not cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Beautiful. And is there any claims mailing address for this plan?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I just forgot to ask um if there's any history for uh the 0330.
[AGENT][NEUTRAL] Hold on just a moment, I'll check for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] No history. Perfect. Alright, and any call reference number if you guys use them?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] Perfect. You were a great help. Thank you so much, [PII]. You have a good day, OK?
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You as well.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.