AccountId: 011433970860
ContactId: 19ef1022-466c-445a-8e7e-deb480cacb44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435239 ms
Total Talk Time (AGENT): 190027 ms
Total Talk Time (CUSTOMER): 194382 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/19ef1022-466c-445a-8e7e-deb480cacb44_20250228T13:28_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental office, and I am just looking to get a breakdown of benefits for one of my patients.
[AGENT][NEUTRAL] I can help with benefits. [PII], what's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Um, the number that I was given, it's gonna be 02593222.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate that. Is there a callback number I can have in the event we're disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Of course it's gonna be [PII].
[AGENT][POSITIVE] OK, thank you very much. I'm just looking that up now.
[CUSTOMER][NEUTRAL] OK, that means, so what I mean by the policyholder is that like if you were married sometimes have like.
[AGENT][NEUTRAL] OK. Excuse me just one moment, please. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] I appreciate that. Thank you. Her policy went into effect.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] And so there's
[CUSTOMER][NEGATIVE] No one wanted to do that he was.
[AGENT][NEUTRAL] On [PII], it is active. Uh, these policies have $750 per calendar year as the maximum. That's just a verification of the benefits, not a guarantee of payment, and they cover basic, basic, restorative and preventative services only.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Like I said,
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Now there's not a uh network. They can go to any provider that they want, and I have a list of uh what is covered as well as where to submit your claims if you would be interested or is there anything in particular I can tell you about this policy?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, uh, what's the claims mailing address?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And then um
[AGENT][NEUTRAL] It is in [PII].
[AGENT][NEUTRAL] And our zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, OK, and the group number is it 70084?
[AGENT][NEUTRAL] Uh, yeah, let me just check here.
[AGENT][NEUTRAL] OK, so the group number for this.
[AGENT][POSITIVE] Is 70084, that is correct.
[CUSTOMER][NEUTRAL] OK, is there a group name?
[AGENT][NEUTRAL] And that is a surge staffing, yeah, surge staffing.
[CUSTOMER][NEUTRAL] Uh, OK, got it. And is this a calendar year policy?
[AGENT][NEUTRAL] It is, yes.
[CUSTOMER][NEUTRAL] OK, um, and is there a fee schedule like what fee schedule is used?
[AGENT][NEUTRAL] Yes, what we do is we use the Carrington PPO fee schedule, but we don't, you don't need to be in in membership with Carrington in order for the policy to pay out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods?
[AGENT][NEGATIVE] No, they are not.
[CUSTOMER][NEUTRAL] Uh, OK, um, can you tell me the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][MIXED] Perfect thank you um I'm gonna have missing tooth claws, but that's not gonna really apply, um.
[CUSTOMER][NEUTRAL] Let's see, um, what's the deductible?
[AGENT][NEUTRAL] There's a $50 deductible that does not apply to the preventative services.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, has any of her Macs been used?
[AGENT][NEGATIVE] No, nothing's been used so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it, um, and can you tell me, um.
[CUSTOMER][NEUTRAL] The frequency for profus and exams.
[AGENT][NEUTRAL] Yes, the, um, cleanings are once every 6 months, the exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][POSITIVE] It's the stuff right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And what are the details on pay and maintenance [PII]?
[AGENT][NEUTRAL] Those are not covered. It just covers basic, basic restorative and preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, can you tell me the frequency for bite wings?
[AGENT][NEUTRAL] Yes, that is once every 12 months.
[CUSTOMER][NEUTRAL] OK, and what about for um FMX and Pan?
[AGENT][NEUTRAL] That's once every 5.
[CUSTOMER][NEUTRAL] 5 years. OK, um, and can you tell me if fluoride and sealants are covered?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, it's for ages [PII] and under.
[AGENT][NEUTRAL] It is covered, but for ages [PII] and under.
[CUSTOMER][NEUTRAL] OK, and um, are there frequencies?
[AGENT][NEUTRAL] Yes, uh, the, um, frequency for the, uh, let me just check here, for the fluoride, um,
[CUSTOMER][NEUTRAL] They don't need to be in that folder
[AGENT][NEUTRAL] That is once for 12 months and then the uh few months or once uh.
[AGENT][NEUTRAL] Once every 24.
[CUSTOMER][NEUTRAL] Yeah, I don't have them.
[CUSTOMER][NEUTRAL] OK, got it, um.
[CUSTOMER][NEUTRAL] And you, I'm sorry, you said it was basic and preventive only um.
[CUSTOMER][NEUTRAL] Are fillings considered basic under this plan?
[AGENT][MIXED] Yes, uh, they don't, they don't downgrade to amalgam, but yes, uh, fillings and simple extractions are covered.
[CUSTOMER][NEUTRAL] OK, OK, and um is there a frequency for fillings?
[AGENT][NEUTRAL] Uh, yes, the, um, check here really quickly. OK.
[CUSTOMER][NEUTRAL] Oh yeah, you
[AGENT][NEUTRAL] Yes, the fillings are um uh replaced existing only been placed for 24 months, and it is a maximum of 1 tooth for 24 months.
[CUSTOMER][NEUTRAL] Auto, yes, that
[CUSTOMER][NEUTRAL] OK, um, and it's to replace existing fillings only?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][MIXED] OK, um, OK, so simple extractions are covered, but surgical extractions are not.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there any endo or PO that's covered at all?
[AGENT][NEGATIVE] No, no, it is not.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I think that's about it.
[CUSTOMER][NEUTRAL] It's all the questions that I have.
[AGENT][NEUTRAL] Would you like a, would you like a fax back? Uh, is there anything else I can help with?
[CUSTOMER][POSITIVE] Sure, yeah, the fax that would be great actually.
[AGENT][NEUTRAL] OK, and what is your, uh, [PII], what is your fax number, please?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] [PII]. OK, great. I'll have that sent to you.
[CUSTOMER][NEUTRAL] You got it and
[CUSTOMER][POSITIVE] Perfect and can I um could I get your name one more time please?
[AGENT][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] We can use that in today's date as a reference.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if there's, there's nothing else that I can help with, then I'll go ahead and send this fax off to you and once you get it, if you, if you have any questions, uh then you can uh contact us again and we'll try to help with anything we can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now we are
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good thank you so much.
[AGENT][POSITIVE] Thanks for contacting if you have