AccountId: 011433970860
ContactId: 24095947-2bb6-449d-b353-7aa32a077967
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238320 ms
Total Talk Time (AGENT): 115651 ms
Total Talk Time (CUSTOMER): 102009 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/24095947-2bb6-449d-b353-7aa32a077967_20250305T15:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, um, this is [PII] calling from a digital provider office. I was calling to get benefits and eligibility, please.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, 02594906.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] and it's [PII]
[AGENT][POSITIVE] Oh, JE oh [PII], just call you [PII]. I'm so sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You OK?
[AGENT][NEUTRAL] And uh I thought it was different, uh, but verify the patient's name and date of birth for me, please.
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy, and now you just need a general breakdown or I can send you a fax back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I would like a fax, but can I ask you, uh, questions too? It's just like the other one, OK, um.
[AGENT][NEUTRAL] Sure. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, for the fax, um, you want the fax number? [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I'll send that out to you and you said you had uh some other questions.
[CUSTOMER][NEUTRAL] Yeah, so, uh, y'all run under, is it Carrington like PPO or is it like something else because I know we're out of network either way.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, uh, we don't, well, with this type of policy it's a group dental plan, so it just pays by UCR so we don't follow any schedule from Carrington and the insurer can go to Carrington provider, but we just pay by UCR.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. All right. Um, you got a, she got a deductible on the max?
[AGENT][NEUTRAL] Uh, yes, ma'am. Um, not a guarantee of payment, just a verification of coverage. She has a benefit max of $500 per calendar year and a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, and um what's the coverage for basic major and preventative?
[AGENT][NEUTRAL] Uh, preventive pays 100% of UCR. Basic, basic restorative FMX panoramic pays at 80%, and major services are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Not covered, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] What exactly falls upon the major category does not cover it.
[AGENT][NEUTRAL] Um, endo perio oral surgery, crowns, bridges, partial, dentures, those are considered major.
[CUSTOMER][NEUTRAL] OK. OK, you said endoerio, crowns, bridges, and what else? Oral surgery?
[AGENT][NEUTRAL] Partial stents and oral surgery. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, that's pretty much all I needed thank you.
[AGENT][POSITIVE] Uh, yes, ma'am. You should get this faxed back in a few moments. I'm just now sending it.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] Alright, you're welcome and thank you for calling APL Ms. [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.