AccountId: 011433970860
ContactId: 1c7874ce-4562-4724-8eb6-64af08dd8c85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584090 ms
Total Talk Time (AGENT): 253884 ms
Total Talk Time (CUSTOMER): 234313 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/1c7874ce-4562-4724-8eb6-64af08dd8c85_20250221T19:12_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah, I see.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon. My name is [PII] calling on behalf of the dental office to check an eligibility and verification of patient on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're only needing to verify if the policy is active or not. Is that correct?
[CUSTOMER][NEUTRAL] I also need the eligibility and benefit for the patient as well.
[AGENT][NEUTRAL] OK, so for dental policies, [PII], we have facts backs of the dental benefits for the member's plan that they have that I will send to you. Um, first off, so I can help you with this, what is the best callback number for you?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] It's [PII]. And it's a direct line.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, well thank you and the member's policy number?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Sure. The patient's member ID I have 635362109.
[AGENT][NEUTRAL] OK, now [PII], that is not a policy number for our company.
[CUSTOMER][NEUTRAL] to.
[AGENT][NEUTRAL] What company?
[CUSTOMER][NEUTRAL] It might be an assassin.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] You think that's a social security number for the subscriber on the policy?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] For.
[AGENT][NEUTRAL] OK, well I'll send the information that I do provide for you today will be a verification of benefits and not a guarantee of payment. I'm sorry, [PII], there's some noise in the background and I can't hear you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me one moment, let them, I, I will let them stop to speak something. Just give me one minute.
[CUSTOMER][POSITIVE] Uh, thank you for patiently waiting. Now it's better now.
[AGENT][POSITIVE] That is better.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So she is a subscriber on this general policy and this policy is active, [PII], with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is a good fax number that I can send you her benefit information to?
[CUSTOMER][NEUTRAL] [PII]. I repeat, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And does it need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, you can do that. That would be better to find it out because there are many facts coming.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Sure, so one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And I also want to confirm, well, in that fact, I will get the used amount of the history for the patient.
[AGENT][NEGATIVE] There is no history on file for this member.
[CUSTOMER][NEUTRAL] So no and about the use amount?
[AGENT][NEGATIVE] There is no history on file so there would be not, there would not be any used amount.
[CUSTOMER][NEUTRAL] Alright, and it runs on a calendar and the coordination of benefit is it standard?
[AGENT][NEUTRAL] Yes, it is, and that information is also on the fax stack.
[CUSTOMER][NEUTRAL] Is there any, what's the fee schedule for the policy?
[AGENT][NEUTRAL] This is a Carrington PPO network policy, however, they're not required to use a Carrington provider.
[CUSTOMER][NEUTRAL] So group name group number will be there on the fax.
[AGENT][NEUTRAL] I can provide you that information.
[AGENT][NEUTRAL] The group number is 70073.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] about that.
[AGENT][NEUTRAL] The name of the group is Verella, that's [PII]
[AGENT][NEUTRAL] Next word is the letter.
[CUSTOMER][NEUTRAL] Oh, hold on, hold on, hold on, hold on, hold on. Can you repeat once again?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] The first word is spelled in the group name.
[AGENT][NEUTRAL] VER
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] S T E L A.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then space and then it's a capital A space.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Capital T E R R A.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] LLC Company.
[CUSTOMER][NEUTRAL] Company. And just want to confirm you gave me the group number that is 70073.
[AGENT][NEUTRAL] And the current policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Uh, you were saying something. I'm sorry?
[AGENT][NEUTRAL] And the correct policy number?
[AGENT][NEUTRAL] Yes, sir. The correct policy number is 0258.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 883 7.
[CUSTOMER][NEUTRAL] Noted.
[CUSTOMER][NEUTRAL] And coordination of benefit is it standard in this plan?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right. And you said the effective date is [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it runs on a calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any missing tooth close on the waiting period for the policy?
[AGENT][NEUTRAL] There are no waiting periods, there is a missing tooth cloth, and that information is also on the fax back.
[CUSTOMER][NEUTRAL] OK, FMX panel do share the frequency with each other.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] OK, so on this policy there are no benefits. What are the two, OK, for me to answer the questions that are on the facts that first off, Ross, I'm sorry, but the background noise I'm barely able to hear you.
[CUSTOMER][NEUTRAL] So the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, now it's better.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] No one is uh speaking now.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I can hear you at the moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I was asking you, FMX and Penno, do they share the frequency with each other?
[AGENT][NEUTRAL] OK, and what are the two codes?
[CUSTOMER][NEUTRAL] It's 0210 and 0330.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] one more thing.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, that, that's the go.
[AGENT][NEUTRAL] Yes, limited to one X-ray.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] One X-ray.
[AGENT][NEUTRAL] Procedure 02 10, 0277 and 0330 for a five-year period.
[CUSTOMER][NEUTRAL] So they both share the frequency, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right. And deductible applies for diagnostic and preventative services?
[AGENT][NEUTRAL] No, not for preventative.
[CUSTOMER][NEUTRAL] Composite crown with the downgrades.
[AGENT][NEUTRAL] There are no, there is no coverage for major services on this policy. This is only for preventative and basic.
[CUSTOMER][NEUTRAL] So composites are downgraded?
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] They do not, they do not downgrades, OK. And oral surge, OK, they are available. What about consultation? Does consultation have any frequency?
[AGENT][NEUTRAL] Code
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 9310.
[AGENT][NEUTRAL] I don't believe that's covered. Just one moment.
[CUSTOMER][NEUTRAL] Are they
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That falls under basic.
[AGENT][NEUTRAL] So no, there is no limit that is correct. It falls under the basic, which would be.
[CUSTOMER][NEUTRAL] Basic
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] That is subject to the deductible and it's covered at 80% of the allowable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it's at 80%, right?
[AGENT][NEUTRAL] Yes, subject to the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] In.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And no frequency for it, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And how do you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Alright and the reference number?
[AGENT][NEUTRAL] And my name will be your my name in today's date and then if you all do file a claim with APO and you need to check claim status rules, you may go to our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To have access to the claim status and our explanation of benefits once the claim has been processed.
[CUSTOMER][NEUTRAL] All right. And just want to confirm, did you send me the fax?
[AGENT][NEUTRAL] I do, mhm.
[CUSTOMER][POSITIVE] OK, that's great. So, [PII], I just want to thank you for your help.
[AGENT][POSITIVE] You're very welcome, [PII]. Yes, you too, you too, and thank you again for calling APL if that's all that I can help you with, and I hope you have a nice weekend also.
[CUSTOMER][POSITIVE] It was a pleasure talking to you. Have a great day.
[CUSTOMER][NEUTRAL] Seem to
[CUSTOMER][NEUTRAL] Same to you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.