AccountId: 011433970860
ContactId: 1945c485-05e2-48fb-b26c-8fe33db29ca8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604000 ms
Total Talk Time (AGENT): 206291 ms
Total Talk Time (CUSTOMER): 131674 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/1945c485-05e2-48fb-b26c-8fe33db29ca8_20250604T17:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, my name is [PII]. I'm calling from a provider's office. I need to get some dental benefits for a patient.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with dental benefits. May I please get your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, phone number is [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] You're welcome. [PII].
[AGENT][NEUTRAL] And what is the name of the dental office?
[CUSTOMER][NEUTRAL] Um, bass drop kids' teeth.
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number, please?
[CUSTOMER][NEUTRAL] Um, patient is going to be.
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII] um policy number please ma'am?
[CUSTOMER][NEUTRAL] Policy number is 02623563.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][POSITIVE] Sure thing thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, on this policy.
[AGENT][NEUTRAL] 02623563. I do not see that [PII] is a member.
[AGENT][NEUTRAL] Um, wait a minute.
[CUSTOMER][NEUTRAL] Is this a discount plan or HMO? How does this plan work?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, it's not either one. Actually, he should be on the policy. I don't see him listed at this time, but the uh um policy holder, [PII] does have family coverage.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] His effective date is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So just to confirm um.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Would, um, since there's family coverage.
[CUSTOMER][NEUTRAL] On the policy is effectively is 55-2025.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, he does like coverage and.
[CUSTOMER][NEUTRAL] And what's the name of the insurance?
[AGENT][NEUTRAL] It's American
[AGENT][NEUTRAL] Public life.
[AGENT][NEUTRAL] And if you want to give me your a fax number I can send you a fax back with the benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] Um, yes, that would be great because I have never heard of this plan before. Um, is it like a PPO? Do they have added network benefits?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, they, they can go to a Carrington provider if they choose, they may get a little discount, but they do not have to use, um, Carrington Network to be able to use their, their benefits. They can use any provider they choose. We pay off of the UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, pay fee schedule?
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, and then on that fax back we'll have your UCR.
[AGENT][NEUTRAL] It'll have um the fee schedule the benefit breakdown procedure codes if if you see a procedure code that is not on the fax back then it's a non-covered procedure. It'll also have the limitations it'll have the waiting periods, um the frequencies, any limitations will all be on the fax.
[CUSTOMER][NEUTRAL] And then um what is the claims address?
[AGENT][NEUTRAL] Yes ma'am, that would be [PII].
[AGENT][NEUTRAL] 248,950.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] And that's also on your fax along with the payer ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK great and then um do they have any waiting periods on any services?
[AGENT][NEUTRAL] Uh, that will also be on your fax back, but let me pull up the fax because I need to send it to you anyway and give you the benefit, give you that waiting period.
[CUSTOMER][POSITIVE] OK, OK, great, thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] 262.
[CUSTOMER][NEUTRAL] 65
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just to verify benefits it's not a guarantee of payment, there is no waiting period for preventative radiographs, basic or basic restorative.
[CUSTOMER][NEUTRAL] OK, and do they have any coverage for Ortho.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the effective date you said it's [PII] or [PII] correct?
[AGENT][POSITIVE] Yes, ma'am, that's right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your fax number?
[CUSTOMER][NEUTRAL] No, or
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you, Miss [PII] and I'll be right back.
[CUSTOMER][POSITIVE] Sure thing thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Thank you for holding for me, Miss [PII]. I have that fax on its way to you now, ma'am.
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, I wanted to confirm you said um that they can go any.
[CUSTOMER][NEUTRAL] Provider, is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] But if they go to a Carrington provider they get a slight discount.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and how would, um, is there.
[CUSTOMER][NEUTRAL] A phone number that I can call to confirm if we are one of those providers.
[AGENT][NEUTRAL] Uh, we don't have a phone number that you can call to confirm. Um, if you're set up with, you would have to call Carrington to see if you're a Carrington provider.
[CUSTOMER][NEUTRAL] question
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][POSITIVE] You're very welcome is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's it thanks.
[AGENT][POSITIVE] OK well you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye bye, [PII]a'am.