AccountId: 011433970860
ContactId: 167bde4e-5435-4080-a5fd-1422cabbed58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351809 ms
Total Talk Time (AGENT): 168729 ms
Total Talk Time (CUSTOMER): 129372 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/167bde4e-5435-4080-a5fd-1422cabbed58_20250625T18:22_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to see if this patient has benefits and if we're in network with those benefits.
[AGENT][POSITIVE] Great. Happy to check on benefits. Can I get their policy number?
[CUSTOMER][NEUTRAL] Sure, uh, the policy number is 02640581.
[AGENT][NEUTRAL] Thank you. And then if I could get patient's name and date of birth.
[CUSTOMER][NEUTRAL] Her name is [PII] A. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. So, patient is active. Effect date is [PII].
[AGENT][NEUTRAL] Uh, there is no network required for usage. The member plan type is a limited benefit plan, so it just pays a set amount depending upon what they're being seen or treated for.
[CUSTOMER][NEUTRAL] OK, can you give me just one second?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so it was started on [PII] you said?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], OK, and you said it's a limited?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] So there's no dental?
[AGENT][NEUTRAL] No, this isn't a dental plan. Is that what we're looking for?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see if they have a dental plan. I apologize. I should have asked if it was medical or dental.
[CUSTOMER][NEUTRAL] OK, no, that's OK.
[AGENT][NEUTRAL] I usually do that. OK.
[CUSTOMER][POSITIVE] That is quite OK.
[CUSTOMER][NEUTRAL] I thought I was, I pushed the one for the dental, so I figured.
[AGENT][NEUTRAL] Yeah, I'm sorry. Um, OK, member does have a dental plan. Let me give you that policy number though, it's different than the one you have.
[CUSTOMER][NEUTRAL] OK, what is the ID number for that?
[AGENT][NEUTRAL] Uh, ID for that is 02640586.
[CUSTOMER][NEUTRAL] OK, and can you, um, do you guys do back back or can you tell me what's covered and the percentage and is it a PPO?
[AGENT][NEUTRAL] Mhm so we can.
[AGENT][NEUTRAL] Yeah, so we can do either we can send a fax back, do a verbal, whatever works best for you. It does participate in the Carrington PPO network if you guys are a part of that. Otherwise it would just pay off of UCR.
[CUSTOMER][NEUTRAL] R UCR OK, that's the uh.
[AGENT][NEUTRAL] Usual customary, yeah, reasonable fee mhm.
[CUSTOMER][NEUTRAL] The fee, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um.
[AGENT][POSITIVE] But I can definitely send you a fax pack or give you verbal whatever you need.
[CUSTOMER][NEUTRAL] Can I get both?
[AGENT][POSITIVE] Yeah, absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is your first name again?
[CUSTOMER][NEUTRAL] [PII] Y.
[AGENT][NEUTRAL] Really.
[AGENT][NEUTRAL] All right. And then what did you need me to give you verbally, [PII]?
[CUSTOMER][NEUTRAL] Um, what's the limit and then what's, you know, covered as far as, um, preventative is probably 100, and then what are the basic and major coverage?
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] So patient has it looks like a calendar year maximum of $500 with a $50 deductible. Both are remaining.
[AGENT][NEUTRAL] Um, preventative does not apply towards the deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And patients plan is preventative and basic coverage only. Preventative is at 100%. Basic is gonna be covered at 100%, and that does include FMX is at um 82 as well.
[CUSTOMER][NEUTRAL] OK, so 100 for preventative and basic and no major?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, there is no major.
[CUSTOMER][NEUTRAL] OK. Uh, are there any, OK, are there any waiting periods?
[AGENT][NEUTRAL] Hm, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No waiting and then um I guess as long as we're PPO we're in network with them.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. All right. Um.
[CUSTOMER][NEUTRAL] Do you consider uh deep cleanings major or basic?
[AGENT][NEUTRAL] Um, they consider them major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so SRPs are major.
[AGENT][NEUTRAL] Yeah, and any sort of like pero maintenance, yeah, it's all considered major.
[CUSTOMER][NEUTRAL] And crowns
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about oral surgery?
[AGENT][NEUTRAL] Yeah, it does have, let's see.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Oral surgery is considered major. It just honestly covers like simple extractions.
[CUSTOMER][NEUTRAL] OK, a simple extraction it will cover and fillings I'm guessing.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yeah, mhm, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there an age limit on fluoride?
[AGENT][NEUTRAL] Yeah, there is. Let me see what that is. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it is limited to dependent children under the age of [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. OK, I'll just wait for the fax that's all I need to know thank you very much for your help.
[AGENT][POSITIVE] You're welcome. It's on its way. You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm bye.