AccountId: 011433970860
ContactId: 1ba3a3a1-472e-476f-ada5-1b28cbe22034
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324959 ms
Total Talk Time (AGENT): 148368 ms
Total Talk Time (CUSTOMER): 113770 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/1ba3a3a1-472e-476f-ada5-1b28cbe22034_20250210T19:58_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with Western Dental. I'm calling to get eligibility and benefits on behalf of a patient.
[CUSTOMER][NEUTRAL] Sorry
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And the patient's policy number is 02584976.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, is it a PPO or an HMO?
[AGENT][NEUTRAL] And did you
[AGENT][NEUTRAL] Hold on one moment, let me pull up the fax bag. And did you need a copy of the fax bag?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, please.
[AGENT][NEUTRAL] So this is on the Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are the same, um, there's no in or out of network benefits.
[CUSTOMER][NEUTRAL] OK, can you give me the annual max?
[AGENT][NEUTRAL] Yes, it's $500 per calendar year per person.
[CUSTOMER][NEUTRAL] And is the 500 still remaining?
[AGENT][NEUTRAL] Um, let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, yes, so far he has not used any of the max or met the deductible.
[CUSTOMER][NEUTRAL] OK, and what is the deductible?
[AGENT][NEUTRAL] Um, the deductible is $50.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sit there.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] That's for single, right? Does he have any for family?
[AGENT][NEUTRAL] Um, let me see, I believe this is, uh, the deductible per family or is the plan on the family plan?
[CUSTOMER][NEUTRAL] No, there's a deductible per family.
[AGENT][NEUTRAL] Yes, it's up to 150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then are you able to give me the percentages?
[AGENT][NEUTRAL] Yes, the policy um covers preventative and basic. So for preventative services, um, it will be covered at 100% of allowable for radiograph and FMX expenses, basic and basic restorative expenses, it's all at 80%.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK and for major?
[AGENT][NEUTRAL] Um, there's no major coverage. Major for us includes endogenic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for those there's no coverage?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and then, um, is sealant covered?
[AGENT][NEUTRAL] Um, yes, ceilings are covered under preventative.
[CUSTOMER][NEUTRAL] OK, and are prior extractions covered?
[CUSTOMER][NEUTRAL] Would be
[AGENT][NEUTRAL] Um, do you have a code for that?
[CUSTOMER][NEUTRAL] Mm no, it doesn't tell me.
[AGENT][NEUTRAL] Um, prior extractions, there's a simple extraction, um, that's covered under basic, but any other like extractions or surgery would be major.
[CUSTOMER][NEUTRAL] It just says our
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and is there a waiting period?
[AGENT][NEUTRAL] Um, there's no waiting period because there's no major coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And are the following downgraded on posterior teeth.
[CUSTOMER][NEUTRAL] A lot of um
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] No? OK. And does the patient have any history?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, no, not yet. There's no history on file. We haven't processed anything yet.
[CUSTOMER][NEUTRAL] OK, and do you have the fee schedule?
[AGENT][NEUTRAL] Yes, this is just a standard um Carrington fee schedule, um, depending on what the charges are, will pay those percentages, the 100% or 80% of the total.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the fee schedule is just Carrington?
[AGENT][NEUTRAL] Yes, it's a Carrington fee schedule.
[CUSTOMER][NEUTRAL] OK, I'll go now.
[CUSTOMER][NEUTRAL] OK, sounds good. Are you able to send me a fax of the benefits, please?
[AGENT][POSITIVE] Yes, that's a good fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And do I need to put attention [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do I need to put attention [PII]?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Alright, so I'll go ahead and send this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No that's it thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you