AccountId: 011433970860
ContactId: 1183748d-a608-4c1e-8c82-f4a926196301
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164940 ms
Total Talk Time (AGENT): 73434 ms
Total Talk Time (CUSTOMER): 75523 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/1183748d-a608-4c1e-8c82-f4a926196301_20250225T15:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII] with Highland Creek Family Dentistry, and I'm calling because I need a breakdown of benefits for a patient's policy.
[AGENT][NEUTRAL] Sure, I can look at those benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] Alright, let's give me 02594686.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], and his [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII] and uh did you want me to just send you a fax back that shows all the covered procedures and benefit information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, you can, and then can I go over some of the stuff verbally, yeah, OK.
[AGENT][NEUTRAL] Of course. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright. And of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, what kind of questions did you have for me?
[CUSTOMER][NEUTRAL] Um, first one is is on a calendar year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Is there any waiting period on anything?
[AGENT][NEUTRAL] No, so this policy only uh has uh preventative and basic coverage. There's no major expenses, so nothing is, uh, there's no waiting period for anything.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, and then, um, we're a provider is that a network will you pay us directly or do you pay the subscriber?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, we would pay you if you were the one to file the claim.
[CUSTOMER][NEUTRAL] OK OK, and is it UCR or fee schedule?
[AGENT][NEUTRAL] So this one is uh participates in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Uh, which you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then what's the um maximum and deductible?
[AGENT][NEUTRAL] So the calendar year maximum is $500 that deductible is $50 and does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is preventive cover at 100% and 80% for basic?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, um, and then does 4910 fall underneath, um, basic or preventive?
[AGENT][NEUTRAL] Let's see, 4910 is not going to be a covered procedure.
[CUSTOMER][POSITIVE] OK perfect that's all I need to know thank you.
[AGENT][NEUTRAL] OK, did you still want me to send you this so back, Kennedy?
[CUSTOMER][NEUTRAL] Uh, no, it should be fine, thank you.
[AGENT][POSITIVE] OK, alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Um bye bye.