AccountId: 011433970860
ContactId: 45621292-e925-4009-abe9-fa436246a881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398369 ms
Total Talk Time (AGENT): 179096 ms
Total Talk Time (CUSTOMER): 149640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/45621292-e925-4009-abe9-fa436246a881_20250604T14:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes. Hi. Just checking for patients eligible then benefits.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility and benefits for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, then can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] I guess, no extension [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number showing here is 02615799.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, checking for [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII], and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Uh yes. Um, I need also the fax. Thank you.
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] Uh, same with our
[CUSTOMER][NEUTRAL] Phone number [PII].
[AGENT][NEUTRAL] OK, so the fax number is the same as the uh phone number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just confirming, um, let me read that back, make sure I heard that correctly that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] OK, I'll go ahead and get that sent now. Uh, you should get it within about 10 minutes or so. Uh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] I just want to verify as well if we are in or out of the network with the plan and what we we're following.
[AGENT][NEUTRAL] Sure, so this policy, uh, participates in the Carrington PPO network, uh, but utilization of a provider within Carrington is not required. We will still honor those claims regardless.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, yes, and sorry, um, because we don't have yet record for this type of plan. Um, are we considered as a network?
[AGENT][NEUTRAL] Yes, yes, absolutely, as this policy again it participates in the Carrington PPO network but we would still, uh, honor those claims regardless of who is within that network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, I see. So we can use like Carrington fee as well.
[AGENT][POSITIVE] Yes, excuse me, yes, absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And then, um, does this policy accept assignment of benefits?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Um, does this plan accept assignment of benefits?
[AGENT][NEUTRAL] Um, I'm not quite sure what you mean.
[CUSTOMER][NEUTRAL] Um, if, for example, if we send the claim, if it will be sent out to the provider or directly to the patient.
[AGENT][NEUTRAL] Oh, the benefits, uh, the payable benefits you mean?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, it depends on who files the claim um so if the provider files the claim we would send that be uh payable benefits to them.
[AGENT][NEUTRAL] If the insured does, then we would send it to them.
[CUSTOMER][POSITIVE] Mm thank you.
[CUSTOMER][NEUTRAL] And then, is there any coordination of the benefit on this plan, like standard or non-tu?
[AGENT][NEUTRAL] No. No, there is not.
[CUSTOMER][NEUTRAL] No COP. And then any waiting period or missing those claws?
[AGENT][NEUTRAL] Uh, no waiting periods. There is a missing tooth clause.
[CUSTOMER][NEUTRAL] Thank you. And then preventive services, does it count over to the max?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, um, preventative services does not apply to, uh, or the deductible doesn't apply to preventative services.
[CUSTOMER][NEUTRAL] But for the maximum, it will be applied.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And then for the code 4346, that it's shared with prophylaxis.
[AGENT][NEUTRAL] 4346 4346 is not a covered uh procedure under this policy.
[CUSTOMER][NEUTRAL] Thank you. And then for 341 SRP, all four quadrants can be done on the same service date.
[AGENT][NEUTRAL] Could you repeat that procedure code? I'm sorry.
[CUSTOMER][NEUTRAL] 4341 for the for SRP.
[AGENT][NEUTRAL] 4341 is not a covered procedure under this policy.
[CUSTOMER][NEUTRAL] Not a covered procedure.
[CUSTOMER][NEUTRAL] How about for the crown? Does it pay on preator C date?
[AGENT][NEGATIVE] Um, I don't believe that that's going to be covered under this policy either. So I'm so sorry. In short, this policy does not offer any sort of major coverage. It's going to be uh preventative at 100%. Uh, radiographs, FMX, and Basic are all going to be at 80%, but there is no major coverage, no endodontic, periodontic, oral surgery, nothing like that is covered under this policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh I see.
[CUSTOMER][NEUTRAL] No, endoreo and oral surgery. And is there any or benefit on the plan?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No. Orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] That covered as well. Thank you. And then, is there any history on file for this patient, uh, just preventive or pre uh just preventive services?
[AGENT][NEUTRAL] Oh let me see if I've got anything for this number. Give me just a moment.
[CUSTOMER][POSITIVE] Mhm. Yes, thank you.
[AGENT][NEUTRAL] OK, no, I have no, uh, history on file for this number so far.
[CUSTOMER][NEUTRAL] Oh, thank you. And then lastly, I'll just need a reference number.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, official and state. Uh, so my name is spelled [PII] Last [PII]ial [PII]
[AGENT][NEUTRAL] And there wasn't anything else I could help you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Uh, that's all the information needed. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Alright, of course, thanks for calling HI too bye bye.