AccountId: 011433970860
ContactId: 2e834004-fa0e-4779-86b9-b0ac47eb06c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334730 ms
Total Talk Time (AGENT): 165355 ms
Total Talk Time (CUSTOMER): 118636 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/2e834004-fa0e-4779-86b9-b0ac47eb06c0_20250311T17:06_UTC.wav
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[CUSTOMER][NEUTRAL] So they're no longer
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, yes, I'm checking for dental benefits for a patient, please.
[AGENT][POSITIVE] Sure, I can take those benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 02596530.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, the insured is [PII].
[AGENT][NEUTRAL] Or it could be for the patient that you're seeing, that's fine.
[CUSTOMER][NEUTRAL] OK, OK, it's, um, it's actually a child of the subscriber, but it's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that, [PII]. Uh, so the policy is active. Effective date was [PII], uh, excuse me, [PII]. Uh, and if you'd like, I can send you a copy of the fax back that shows all of the coverage procedures and benefit information.
[CUSTOMER][POSITIVE] Oh, that'd be awesome.
[AGENT][NEUTRAL] Of course. All [PII]. What was that uh fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, I'm gonna read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alrighty, I will get this sent to you. Uh, should get it within 1015 minutes. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'm just gonna ask you while we're on the phone, um, in case I don't get the facts, what is um what is the benefits? Are we in network?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, OK, uh, and of course I will I'll let you know that um verification of coverage is not a guarantee of payment for claims, so this policy, uh, participates in the Carrington uh PPO network, um, but of course the provider does not have to be within the network, um, so it's not a part of anything else this plan also really just has preventative and basic coverage there's no major coverage under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, that calendar year maximum is $500 and there is a $50 deductible, um, up to $150 per family, and that does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK, so 500 pre we have preventative and basic only.
[AGENT][NEUTRAL] Correct, well, um, there's FMX, uh, as well, but just no major coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, $500.50 dollars max, I mean deductible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, you said pays in or out of network do you pay our fees?
[AGENT][NEUTRAL] So it does go off of the Carrington PPO network um off of a percentage, so preventative at 100%, um, radiographs and basic are at 80%.
[CUSTOMER][NEUTRAL] I'm sorry, I'm writing it down.
[AGENT][NEUTRAL] Oh no, you're fine.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there any way to get a copy of your?
[CUSTOMER][NEUTRAL] Fees
[AGENT][NEUTRAL] It's so it wouldn't be through us uh as this plan participates in the Carrington PPO network um I don't have that information but I can give you Carrington's phone number if you'd like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to get that for you?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, one moment, let me get that.
[AGENT][NEUTRAL] OK, uh, so that phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I believe that's it if you'll just send me that I would appreciate it so there's.
[AGENT][POSITIVE] Of course. Yes, ma'am. I did just send that, so you should be getting it shortly. Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] this child's [PII], so are there any limitations with his age? Can he get fluoride?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see. What, do you have that procedure code by chance?
[CUSTOMER][NEUTRAL] I do, um, it's 12:06.
[AGENT][NEUTRAL] OK, so 1206 is not a covered benefit under this plan.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] A covered, OK, OK.
[CUSTOMER][NEUTRAL] Um, with that being said, can I give you like we're gonna do just a regular exam and a, a pro fee. Can I give you our fee and you can tell me above or below, or you don't know that either?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I wouldn't know that again I would just know, um, so are you not sure if y'all participate in the Carrington PPO?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, um, so of course Carrington will have that information for you. Um, all I can see here is the percentage, um, of the covered expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] You are very welcome. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you so much and I'll just wait on the fax bye bye.
[AGENT][POSITIVE] Thank you. Sounds good bye bye.