AccountId: 011433970860
ContactId: 2de8d6b6-13d1-4dc7-80b9-cd950527f822
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416989 ms
Total Talk Time (AGENT): 154509 ms
Total Talk Time (CUSTOMER): 107127 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/2de8d6b6-13d1-4dc7-80b9-cd950527f822_20250127T18:28_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I am a CSR for Carrington customer service claims, and I have a dental office on the phone for verification.
[AGENT][NEUTRAL] Alright [PII], we can verify their benefits. Do you have a policy or anything like that I can pull up?
[CUSTOMER][NEUTRAL] Yes, 49010875.
[AGENT][NEUTRAL] All right. And what's the caller's name?
[CUSTOMER][NEUTRAL] Her name was um [PII].
[AGENT][NEUTRAL] OK, you can go ahead and transfer [PII] over [PII] if you'd like.
[CUSTOMER][NEUTRAL] Alrighty, give me one moment and what was your name again?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] All right, [PII], give me one moment.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi, this is [PII] with American Public Life Insurance. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] Yes, hi.
[AGENT][NEUTRAL] Hi, [PII]. So I understand that you just needed to verify some benefits on a dental plan, is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Alright, happy to help with that. Uh, [PII] from [PII] did give me, um, I believe the policy number, but that's not coming up, so let me just verify what I have here, um.
[AGENT][NEUTRAL] I copied down 49010875, is that what you have?
[CUSTOMER][NEUTRAL] No, it's um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, the policy number is 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 492 8.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up here.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is.
[CUSTOMER][NEUTRAL] Uh semi spelled [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last name is [PII], spelled [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. So the patient's plan is active. The effective date on this plan is [PII].
[AGENT][POSITIVE] And we can send you a breakdown, um, a fax back with the benefits on it, or I can give them verbally, whatever works best for you.
[CUSTOMER][NEUTRAL] OK. Um, well, actually, I really need to know if we work for this insurance.
[AGENT][NEUTRAL] Alright, let me take a.
[AGENT][NEUTRAL] OK. Do you have a facility name, doctor name?
[CUSTOMER][NEUTRAL] Yes, um, the facility name is Value Dental.
[CUSTOMER][NEUTRAL] And the doctor's name is [PII].
[CUSTOMER][NEUTRAL] And you need the address?
[AGENT][NEUTRAL] Um, let me see if that'll work. I may need the address. Give me just one sec.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, why don't you, [PII], go ahead and give me the address.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so yeah, when I do a search, it doesn't look like you guys come up as a dental provider in network um the plan itself does say it looks like it participates in the Carrington PPO network, however, it's not required to use the plan.
[CUSTOMER][NEUTRAL] I'm sorry, so we're not in network with the plan?
[AGENT][NEGATIVE] It's not coming up on the search results for providers, no.
[CUSTOMER][NEUTRAL] OK, and so the benefits wouldn't apply to us, right?
[AGENT][NEUTRAL] Well, the plan itself doesn't require a network for usage. The plan just pays off of UCR, so it's a percentage of usual customary fees.
[CUSTOMER][NEUTRAL] OK. So, if the patient comes, it would cover. For example, for cleaning, the plan would cover for it.
[AGENT][NEUTRAL] Correct, so we cover 100% of allowable of usual customary fees. So if they're coming to see you for preventative, their plan covers 100% of that, even if not in network.
[AGENT][NEUTRAL] The network's not required to use the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for basic it's 80, right?
[AGENT][NEUTRAL] Mhm, correct, and there's no major coverage on the plan, it's just preventative and basic.
[CUSTOMER][NEUTRAL] OK, and this is the same for.
[CUSTOMER][NEUTRAL] Her husband, right? Her husband, [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, OK, thank you.
[AGENT][POSITIVE] Yeah, not a problem, [PII]. Have a good rest of your day.
[CUSTOMER][POSITIVE] You too thanks have a nice day bye bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.