AccountId: 011433970860
ContactId: 1c1bbafc-3be3-48b3-9949-d58f6928bacf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414320 ms
Total Talk Time (AGENT): 178172 ms
Total Talk Time (CUSTOMER): 124231 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/1c1bbafc-3be3-48b3-9949-d58f6928bacf_20250324T14:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from T2th HQ in regards to a mutual patient by the name of [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm needing to verify eligibility and benefits.
[AGENT][POSITIVE] Alright, so I'm happy to verify eligibility and benefits today. Do you have the member's policy number by chance?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, yes, 02567992.
[AGENT][NEUTRAL] OK, thank you. Let me pull that up here one moment.
[AGENT][NEUTRAL] And do you have a good call back number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right. Thank you so much. And then if I could get the patient's date of birth?
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][POSITIVE] Thank you so much. So the patient is active. The effective date on here looks like [PII].
[AGENT][NEUTRAL] And then if you guys.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Need we can also send a breakdown uh with a fax back if you would like that as well.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Absolutely, are you able to confirm the group number?
[AGENT][POSITIVE] Yeah, absolutely. Let me take a look, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing the group number is 70083.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][NEUTRAL] OK, alrighty, uh, while I have you on the line, can you assist me with coinsurances?
[AGENT][NEUTRAL] Yeah, let's take a look at it. What information did you need?
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] If you can please start with the group name.
[AGENT][NEUTRAL] Uh the group name is Lark, L A R K L L C.
[CUSTOMER][NEUTRAL] Is this a PPO plan?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It looks like the policy does participate in the Carrington PPO network.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Alrighty, and does the patient have out of network benefits?
[AGENT][NEUTRAL] Uh, yeah, it looks like a network is not required for usage, so yes they do.
[CUSTOMER][NEUTRAL] OK, for diagnostic and preventative, what is the co-insurance?
[AGENT][NEUTRAL] Let's see, so preventative is covered at 100%.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the patient plan only, the only other expenses covered on here would be excuse me, FMX or basic, and that's at 80%.
[CUSTOMER][NEUTRAL] OK, so no endopperio, prosthodontics, oral surgery.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, yeah, none of that is covered on the member plan.
[CUSTOMER][NEUTRAL] OK, what about um like nitrous 90,230?
[AGENT][NEUTRAL] 9230. Let me check.
[CUSTOMER][NEUTRAL] Or any sort of sedation.
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] Let me see. Mhm.
[CUSTOMER][NEUTRAL] What's all considered basic? Is it just like fillings or does extractions fall under that?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] See, I don't see any sedation. Um, I do show like an extraction covered 7140. Um, it looks like some fillings like 2940.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What did, what did you say? I'm sorry.
[AGENT][NEUTRAL] Um, it does cover some things like extraction. I do see, um, an extraction code of 7140 that's covered under basic.
[CUSTOMER][NEUTRAL] No 72s.
[AGENT][NEUTRAL] No, 72.
[CUSTOMER][NEUTRAL] Like a 7210.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, so what all falls under basic? What codes?
[AGENT][NEUTRAL] Um, like 22, 20.
[AGENT][NEUTRAL] 7140.
[AGENT][NEUTRAL] 140.
[AGENT][NEUTRAL] 460.
[AGENT][NEUTRAL] There's not a whole lot that's covered on the plan, I'll be honest with you.
[CUSTOMER][NEUTRAL] OK, um, no problem if you don't mind, if I can please have you send me over a um fax back.
[AGENT][POSITIVE] Yeah, no, absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm, [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Alright, I'm sending that now, so you should have it in about 5 minutes. Did you need me to check anything else?
[CUSTOMER][POSITIVE] Uh, no, that'll be all. Thank you kindly.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry while I still have you, what is his, um, individual maximum?
[AGENT][NEUTRAL] Um, it looks like the calendar year maximum is 500.
[AGENT][NEUTRAL] And it does also have a $50 deductible.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there a family deductible?
[AGENT][NEUTRAL] It is up to 150 for family.
[CUSTOMER][NEUTRAL] OK, is there any ortho benefits?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK perfect and has he used any of his um yearly maximum?
[AGENT][NEUTRAL] Let me double check that for you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, looks like the patient still has their $50 deductible and the calendar max left of $500.
[CUSTOMER][POSITIVE] Alrighty thank you kindly.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.