AccountId: 011433970860
ContactId: 26e6b82b-3136-40d5-b3e2-e2c831c311b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 810799 ms
Total Talk Time (AGENT): 342733 ms
Total Talk Time (CUSTOMER): 186809 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/26e6b82b-3136-40d5-b3e2-e2c831c311b3_20250411T12:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APLs. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello. You're speaking with [PII]. Today I'm calling from dental office. I need dental benefits for my patient.
[AGENT][NEUTRAL] Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, [PII] and you're needing eligibility and dental benefits for a number, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I just need dental benefits for my patients.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And [PII], for our dental policies, we have fax backs of the benefits for the member's plan, but I will send to you and all information regarding coverage would be also on the fax back. So first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the policy number for the patient?
[CUSTOMER][NEUTRAL] 02555514
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I do that show that she is the subscriber on this dental policy and it is active, [PII] with an effective date of [PII].
[CUSTOMER][NEUTRAL] It's activated [PII] and Wi Fi is in or out of network?
[AGENT][NEUTRAL] I'm sorry, uh, this plan participates with the Carrington PPO network. however, they are not required to use a network provider.
[CUSTOMER][NEUTRAL] If my provider is in that bank Carrington so my provider is in network, correct?
[AGENT][NEUTRAL] You would have to if you do not know if your provider participates with Carrington, you would have to speak to them directly and I can give you their phone number if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can you confirm me the group number and group name?
[AGENT][NEUTRAL] The group number is 70055. The group name is TRC Staffing Services Incorporated.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] And uh yeah, yeah, I'm still there. Is there any waiting period I'm missing tooth loss?
[AGENT][NEGATIVE] There is not.
[AGENT][NEUTRAL] There is a missing tooth cloth, or are no waiting periods.
[CUSTOMER][NEUTRAL] OK. And what is the maximum and how much?
[AGENT][NEUTRAL] Calendar, your maximum is $500 per covered insured for covered services and there is a $50 calendar year deductible per covered person per.
[AGENT][NEUTRAL] Yes, per person per calendar year and again [PII], on the fax back that I can send to you, it has all of this information.
[AGENT][NEUTRAL] Regarding the calendar year.
[CUSTOMER][NEUTRAL] No, but I have a few questions. The annual maximum is 5000.
[AGENT][NEUTRAL] No, 500.
[CUSTOMER][NEUTRAL] 500, got it. And how much use?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] As of now for this calendar year, she has used $190.40.
[CUSTOMER][NEUTRAL] 190.40 cents. What is in with family deductive and how much you?
[AGENT][NEUTRAL] 19 she has used 190. I'm sorry, let me start that again. The amount used is 190.40.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she has met her deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. The individual deduct 150 and 50 has been met, correct?
[AGENT][NEUTRAL] The deductible has been met.
[CUSTOMER][NEUTRAL] OK. And what's the family and how much ma?
[AGENT][NEUTRAL] The family, Max.
[CUSTOMER][NEUTRAL] No family deductible.
[AGENT][NEUTRAL] It's up to, it's
[AGENT][NEUTRAL] This is a 5, OK. I'm sorry, what are you asking me again? A family deductible?
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] And how much use from the family?
[AGENT][NEUTRAL] As of now, $50.
[AGENT][NEUTRAL] She has met her deductible.
[CUSTOMER][NEUTRAL] OK. And what is the person?
[CUSTOMER][NEUTRAL] So continue, please.
[AGENT][NEUTRAL] That's all I was going to say.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah. OK. The family deductible is 150 and 50 has been used.
[AGENT][NEUTRAL] It is the deductible is $50 per covered insured up to $150 per family.
[AGENT][NEUTRAL] She has met her calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, so she met both deductibles, both individual and family?
[AGENT][NEUTRAL] She doesn't have to meet the family. She only has to meet her deductible, which has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What is the percentage of preventive basic and media services?
[AGENT][NEUTRAL] Major services are not covered, only preventive and FMX and basic expenses and basic restorative preventative is 100% of allowable radiographs and FMXs. Basic and basic restorative are 80% of allowable once the deductible has been satisfied on the last three categories.
[CUSTOMER][NEUTRAL] OK. Is there a history for this patient? Can you give me the procedure code, please? Whatever history she has.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what code would you like for me to check?
[AGENT][NEUTRAL] For history?
[CUSTOMER][NEUTRAL] I have no specific code.
[AGENT][NEUTRAL] OK. I would need codes to check for history for you.
[CUSTOMER][NEUTRAL] So you need to check for the history, correct?
[AGENT][NEUTRAL] I need the codes you would like checked for history.
[CUSTOMER][POSITIVE] OK, I have, I have lots of food. Are you ready for it?
[AGENT][NEUTRAL] OK, so there's history on file for 127-2025 for 11/10.
[AGENT][NEUTRAL] Same data service for 0330.
[AGENT][NEUTRAL] Same data service for 0120.
[AGENT][NEUTRAL] 1218 2024 for 0230.
[AGENT][NEUTRAL] And for 1016 244 0230.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 10 6
[CUSTOMER][NEUTRAL] That's all.
[AGENT][NEUTRAL] 10:16 also for 1110.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0274.
[AGENT][NEUTRAL] And 0120.
[AGENT][NEUTRAL] And that is all of the history on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any, any basic or any major history for the patient?
[AGENT][NEGATIVE] I didn't understand what you asked.
[CUSTOMER][NEUTRAL] Any basic history because maybe it's not covered any basic history for this patient.
[AGENT][NEUTRAL] That is all of the history on this patient.
[CUSTOMER][NEUTRAL] OK. May I have your call reference number and your name?
[AGENT][NEUTRAL] My name is [PII] and the call reference number would be my name in today's date and if you all do file a claim with APL.
[CUSTOMER][NEUTRAL] Can you spell out your name?
[AGENT][NEUTRAL] One moment, please, and I will, yes, I will in just one moment.
[CUSTOMER][NEUTRAL] Can you spell out the name?
[AGENT][NEUTRAL] Once a claim has been processed with APL, we have a portal, [PII], that you all should be able to check claim status in by going to [PII].
[AGENT][NEUTRAL] And my name is spelled, my, again, my name is [PII] spelled [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And last initial.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. [PII], can you give me a fax copy for this patient also?
[AGENT][NEUTRAL] So you also need to fax back?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] For me to get that information pulled up.
[AGENT][NEUTRAL] And does the facts need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] On the backs back?
[AGENT][NEUTRAL] Yes. Do I need to put your name on it? Or, or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah, it's no, it's it's.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][POSITIVE] No, it's so good. Mm.
[AGENT][NEUTRAL] Is that how you spell it?
[CUSTOMER][NEUTRAL] No, it's not necessary.
[AGENT][NEUTRAL] It's not necessary to have your name on it?
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And again, that is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct. Yes, [PII].
[AGENT][NEUTRAL] OK. So, [PII], that fax back has been sent to you, so you should be receiving that very shortly.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for this help and have a great weekend. Bye-bye.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][POSITIVE] I hope you have a nice weekend too. Is there anything else I can help you with this morning, [PII]?
[CUSTOMER][POSITIVE] No, no, no, thank you so much, [PII], for this help.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome and thank you again for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Bye-bye. You too.
[AGENT][POSITIVE] Bye bye. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK, you have been removed from the call. Goodbye.