AccountId: 011433970860
ContactId: 1197d4be-e5d8-469d-ab09-a2d6b4a01ef4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409690 ms
Total Talk Time (AGENT): 204901 ms
Total Talk Time (CUSTOMER): 121930 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/1197d4be-e5d8-469d-ab09-a2d6b4a01ef4_20250130T15:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to check eligibility and benefits for this patient.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with eligibility and benefits. What is the callback number please, ma'am?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient, please?
[CUSTOMER][NEUTRAL] I have 02456758.
[AGENT][NEUTRAL] And the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] Alright, thank you. Is this for dental eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I can help you with those benefits, [PII]. [PII], I am showing that this policy is active.
[AGENT][NEUTRAL] Effective date is.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is there a termination date?
[AGENT][NEUTRAL] Uh, there's no termination date on file.
[AGENT][NEUTRAL] And I apologize. What did
[CUSTOMER][NEUTRAL] Is there a waiting
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I'm sorry, what?
[AGENT][NEUTRAL] You said this for
[CUSTOMER][NEUTRAL] Uh, no, you go ahead first.
[AGENT][NEUTRAL] Is this for [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm not sure how to say that one either.
[CUSTOMER][NEUTRAL] Uh, I went with [PII], hoping maybe.
[AGENT][NEUTRAL] Uh sounds good. And then when I got to looking at it I was like, I think she said [PII]. OK, yeah, I just wanted to verify that, but there is no termination date on file.
[CUSTOMER][NEUTRAL] And then, uh, is there a waiting period?
[AGENT][NEGATIVE] No waiting period. Ma is not covered under this plan.
[AGENT][NEUTRAL] And it's only preventive and basic, and I do have a breakdown I can fax to you with the policy, the calendar year max, deductibles, frequencies, limitations. It has our billing, um, information and the procedures listed that are covered. Are you interested in that fax back?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I just also would like to go over some codes also that I'm pretty sure would be considered major, but I wanna make sure.
[AGENT][NEUTRAL] All right, what are those codes?
[CUSTOMER][NEUTRAL] Um, but first, before I ask that, what is, are we in network with this patient's policy?
[AGENT][NEUTRAL] So the policy participates in the Carrington PPO uh network, however, participation is not required. We pay both in and out of network benefits.
[CUSTOMER][NEUTRAL] And they're the same
[AGENT][NEUTRAL] Mhm, they are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is the payer ID and claims address that I would, um, send claims to?
[AGENT][NEUTRAL] The payer ID is 60801.
[AGENT][NEUTRAL] Or the claims, uh, sorry, mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Um, and then.
[CUSTOMER][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] I don't know if you guys would cover this code, so that's why I'm gonna ask you this one before you send that fax uh 0364.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 3, I just cannot talk today. I'm so sorry.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] 0364 is not a covered benefit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0460.
[AGENT][NEUTRAL] 0460 is not covered.
[AGENT][NEGATIVE] I will tell you on the fax pack if the procedure is not listed, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] If that helps you.
[CUSTOMER][POSITIVE] Well, OK, yeah, that does help. Um, if I could get that faxed back please.
[AGENT][NEUTRAL] Alright, give me just one second. I'm.
[AGENT][NEUTRAL] Finishing that up.
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And just to verify that fax number, I'm sending this to [PII].
[AGENT][NEUTRAL] Shucks, OK. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, that is on the way for you.
[AGENT][NEUTRAL] And you'll see the procedures that are listed. It will also have the frequencies and limitations as well.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, um thank you and it'll have the maximum and like the remaining maximum.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] She's not used any of her benefits for 2025.
[CUSTOMER][NEUTRAL] Or how much has been used?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the deductible and everything.
[AGENT][NEUTRAL] Right, and no deductible met for [PII] as of yet either, but it will have the calendar year max deduct and deductibles. It will not have the group name and number. If that is needed, I'll be happy to provide that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The group number is 70,030.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the group name is Creative.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Circle
[CUSTOMER][NEUTRAL] Alright and um she's the policy holder correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right, um,
[CUSTOMER][POSITIVE] Thank you so much. I hope you have a great day.
[AGENT][POSITIVE] It's been my pleasure to assist you with that breakdown, [PII]. Thank you for calling APL and I hope you have a great day as well. You should be receiving that fax just any minute.
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][POSITIVE] If you have any questions once you receive it, please give us a call back, we'll be happy to assist you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.