AccountId: 011433970860
ContactId: 1816a07d-c58d-4245-923f-08eb6a11c4e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528349 ms
Total Talk Time (AGENT): 173447 ms
Total Talk Time (CUSTOMER): 106549 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/1816a07d-c58d-4245-923f-08eb6a11c4e5_20250109T14:43_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to verify dental benefits.
[AGENT][POSITIVE] OK, sure. I can.
[CUSTOMER][NEUTRAL] Is this the right phone number?
[AGENT][POSITIVE] Yes, I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected with [PII].
[CUSTOMER][NEUTRAL] Sure [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Do you have a policy number for me?
[CUSTOMER][NEUTRAL] I do 02464490.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], um, do you need a full breakdown sent to you by fax or given to you verbally or you have a specific questions?
[CUSTOMER][NEUTRAL] Um, well, no, can you send me via fax, and, um, I'm gonna, if it's OK, can I ask just a few things, uh, just about history and things like that also?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Yes, yes, mhm, right, um, go ahead with your questions so I can put this together for you.
[CUSTOMER][NEUTRAL] Uh, well, if can you go ahead and send me the verification, the summary of the benefits via fax, and then what I'm gonna ask is just like what history do you have on file and how much is remaining of the max and if the deductible's been met, stuff like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Alright, let me go ahead and put this together and send it to you right now. Um, do you mind holding for me?
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Get my lips so dry
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Miss [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Um, I checked the history and there's no history on file for this member, and he has not used his benefits for [PII] as of today. Um, he has a benefit amount. This is not a guarantee of payment, just a verification of coverage of $500 for the $50 deductible. He has not met the deductible either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it a calendar year plan?
[AGENT][NEUTRAL] Yes, it's the account under your plan. Mhm.
[CUSTOMER][NEUTRAL] And then what's the effective date?
[AGENT][NEUTRAL] Active date on the policy is [PII] and it is showing active at the moment.
[CUSTOMER][NEUTRAL] OK, and um the payer ID.
[AGENT][NEUTRAL] The payer ID is 60801. Again, that's 608.
[CUSTOMER][NEUTRAL] Oh, say that one more time. You're you you you broke up 6.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 60801 and that's also gonna be in the fax.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK great and then um do you know, can you tell me real quick if perio into an oral surgery fall under basic or major?
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] None of that's covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, OK, so this is just like for exams or?
[AGENT][NEUTRAL] Uh, yeah, this one is just a basic dental, so it will cover preventative, radiograph, FMX, basic expense, and basic restorative expense. So it doesn't cover any major expense on which major includes endodontics, periodontists, pro repair and oral surgery. So those are not covered and endodontics are not covered.
[AGENT][NEUTRAL] Or I'm sorry.
[CUSTOMER][NEUTRAL] OK and then um what's the mailing address for claims?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, the mailing address for claims is [PII], and that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII] and that's also on the fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, I guess and there's no waiting periods and uh what is the, is there a missing tooth cloth?
[AGENT][POSITIVE] No, there's no waiting periods, no missing two claws because um this is just basic.
[CUSTOMER][POSITIVE] OK great um alright I guess that's it thanks so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well, thank you for calling APL. Have a good, uh-huh. OK. Yes, yes, uh-huh.
[CUSTOMER][NEUTRAL] Oh, are we showing, wait, wait, wait, real quick, are we showing in or out of network and what network is?
[AGENT][NEUTRAL] There's there's no network. If the provider participates to Carrington, they can use the re schedule. If not, uh, we pay on the usual and customers rates UCR.
[CUSTOMER][NEUTRAL] OK, yeah, I think we are contracted with Carrington, so maybe that they'll that that'll fall under that correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect. Yes, mhm, right.
[CUSTOMER][POSITIVE] Awesome OK well thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] the