AccountId: 011433970860
ContactId: 113a7519-53a4-4e76-ab9f-38e65d35677f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1259089 ms
Total Talk Time (AGENT): 341465 ms
Total Talk Time (CUSTOMER): 255890 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/113a7519-53a4-4e76-ab9f-38e65d35677f_20250514T12:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I just want to, uh, check the eligibility and benefits for our patients.
[AGENT][NEUTRAL] OK, did you say that your name is [PII]? Is that correct?
[CUSTOMER][POSITIVE] Yes, [PII], yes, that's correct.
[AGENT][NEUTRAL] OK, and what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you and you said that you were needing eligibility and benefits or just eligibility?
[CUSTOMER][POSITIVE] Uh, eligibility and benefits, please. Thank you so much.
[AGENT][NEUTRAL] Yes, I can help you with those things. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02623646.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII], will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh the patient's name is [PII] and the last name is [PII], together with her sister, [PII] Thank you so much. And the date of birth?
[AGENT][POSITIVE] Spell the, I'm so sorry. I'm so sorry. Can you spell the first name for me again, please, [PII]
[CUSTOMER][NEUTRAL] Uh the first name is [PII].
[AGENT][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] And the other one is [PII]
[AGENT][NEUTRAL] So you, this is two different people?
[AGENT][NEUTRAL] Or is that one person?
[CUSTOMER][NEUTRAL] Uh, yes, it's the same policy.
[CUSTOMER][NEUTRAL] Oh sorry, it's uh
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] It's a two person, just the same policy. I can give you first, the first name, uh the first one.
[AGENT][NEUTRAL] OK, what is your best date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And your male.
[CUSTOMER][NEUTRAL] Yeah, next is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII] is [PII] and [PII] is [PII].
[CUSTOMER][NEUTRAL] Uh, your rabbit is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] OK. All right, thank you. So now, on this, on this policy, I do not show that either one of these people are covered.
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I only showed the subscriber.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Subscriber will be uh Lionelon, right?
[AGENT][NEUTRAL] Yes, ma'am. And he, and currently, he is the only person that is listed as being covered on this policy.
[CUSTOMER][NEUTRAL] Understand. So, uh, just to confirm that you are a vet and the other is not covered under this policy.
[AGENT][NEUTRAL] No, and if they should be, he would just need to reach out to his employer regarding that.
[CUSTOMER][NEUTRAL] So, he needs to reach out with his employer, understand. Um, can I just get a reference number for this call and also can you spell your name for me? Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am. Give me one second. Let me make one note here.
[AGENT][NEUTRAL] And they both have the same last name as [PII]. Is that correct?
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that again?
[AGENT][NEUTRAL] Are the two children, do they have the same last name as the subscriber?
[AGENT][NEUTRAL] Is their last names [PII]? OK. All right, one moment.
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, give me just one second to make a note on this, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] OK, so you would, as far as the reference number is going to be my name and today's date.
[AGENT][NEUTRAL] And my name is spelled [PII].
[AGENT][NEUTRAL] And if there's a way, Crystal, that you could make a note just for future reference for claims submitted on this policy, once they have been processed by APL, we do have a portal that you all should also be able to check claim status in and the website for our portal is [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, thank you for that. Uh, can I just confirm one more thing about this, uh, policy? Because the, uh, the parents send us, uh, uh, PDF email like it says from the
[CUSTOMER][NEUTRAL] Coverage, uh, I mean, it says APL Carrington insured the name of the subscriber, then under it is coverage, which is, it says family. Does it mean that uh this one covers the family or it is uh indeed that the, those kids are not covered under this policy?
[AGENT][NEUTRAL] Let me look at the ID card because we, there's no children. It's only the insured that I'm showing, but let me look at the ID card.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] Can I please place you on a brief hold?
[CUSTOMER][POSITIVE] Yes, yes. Thank you.
[AGENT][POSITIVE] Thank you. OK, thank you. Yes, ma'am. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is gonna be one of those days, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I am.
[AGENT][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], I do not want you to think I forgot about you. I'm still having someone look on the, at this for me because I also do see family on the ID card. So I have someone checking. Do you mind continuing to hold?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, yes, it's OK.
[AGENT][POSITIVE] Great. Thank you so [PII]uch. OK. You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Hello? Yes.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] Yes, I think that the connection was bad earlier.
[AGENT][NEUTRAL] I'm so sorry. I can barely understand you. Could you say, you can hear me? Yes, ma'am. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Hello, yes, yes, yes, I can hear you now.
[AGENT][NEUTRAL] OK, so both of the children are on this policy and this policy is active.
[AGENT][NEUTRAL] Again, the effective date is [PII].
[AGENT][POSITIVE] OK. And for our dental policies, we have facts backs of the benefits that I'll be happy to send over to you.
[CUSTOMER][NEUTRAL] Understand.
[CUSTOMER][NEUTRAL] Yes, please, for both of the patients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need a separate fax back for each one?
[CUSTOMER][POSITIVE] Yes, please. Thank you.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what is your fax number please?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So give me just a couple of minutes to get each one sent to you, OK?
[CUSTOMER][NEUTRAL] Thank you so much. Uh, I will just need to ask some questions. Probably it's not into the facts. Um, is there any payer ID for this, uh, policy?
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] Yes, ma'am, and that is on the fax back.
[CUSTOMER][POSITIVE] Thank you so much. And uh also the fee schedule, is it also included in the tax back just to verify it so I won't call again.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. This plan participates with the Carrington PPO network, however, they are not required to use a network provider.
[CUSTOMER][NEUTRAL] Thank you. Uh, are we in network for this policy?
[AGENT][POSITIVE] Now, if you are not sure if you're a participating provider with Carrington, I'll be happy to give you their phone number so that you can contact. I can actually transfer you also so that you can verify that.
[CUSTOMER][NEUTRAL] Understand, uh, let me just confirm that because I've called Carrington, uh, previously and we are in network. So does it mean like for this kind of policy also we are in network as long as we are in network with Carrington, or does it only applies with some policy?
[AGENT][NEUTRAL] Yes, again, this plan.
[AGENT][NEUTRAL] No, ma'am, this plan, this particular policy participates in the Carrington Network PPO.
[CUSTOMER][POSITIVE] Understa. Thank you so much for that, um, uh.
[AGENT][NEUTRAL] OK. And the
[CUSTOMER][POSITIVE] Yes, you can go ahead.
[AGENT][NEUTRAL] I just was gonna repeat your facts. 5123531619.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I have just sent you the one for [PII]. And did you say her name is [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so on our
[AGENT][NEGATIVE] Our system, it does not show, it just has [PII]
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So give me just a moment to have them to look at that.
[CUSTOMER][NEUTRAL] Uh, let me go ahead and inform them.
[AGENT][NEUTRAL] OK, let me, let me have someone verify that.
[CUSTOMER][NEUTRAL] Under understand
[AGENT][NEUTRAL] Now, what I sent you on the fax back, I spelled it the way that you have it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And while they're verifying that, I'm going to send you the one for Yamax.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] So, nothing is confirmed also for this kind of policy, this, uh, the fax includes auto coverage, so I should know if I should ask this or.
[AGENT][NEGATIVE] There is no ortho coverage, and it does state that on there.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I have also sent the one for Yamallux now as well. So it'll take a few minutes for them to, for you to receive them, but they both have been sent to you, [PII].
[CUSTOMER][POSITIVE] Thank you so much and thank you for your help.
[AGENT][NEUTRAL] Well, you are certain
[AGENT][POSITIVE] You're very welcome. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, I think that's it. Thank you so much.
[AGENT][POSITIVE] OK, well then thank you for calling APO and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye-bye.