AccountId: 011433970860
ContactId: 4830c205-e1ae-4ff6-a40e-7fdeb5552374
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500140 ms
Total Talk Time (AGENT): 131281 ms
Total Talk Time (CUSTOMER): 145520 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/4830c205-e1ae-4ff6-a40e-7fdeb5552374_20250124T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm just calling to verify benefits for a patient.
[AGENT][POSITIVE] Alright, I'm happy to check on benefits. What is the policy number?
[CUSTOMER][NEUTRAL] It is 02584425.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]
[AGENT][NEUTRAL] Thank you and date of birth?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Alright and we're looking for dental coverage, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the patient's plan is active. The effective date on this is [PII]. And if you need us to, we can also send a fax back with the benefits.
[CUSTOMER][NEUTRAL] So I, I actually did get a fax back, um, I guess I'm trying to figure out if our provider like what fee schedule or if um our, our provider participates with connection dental if you know I'm just a little confused I guess because uh this is the first I've ever seen this plan before.
[AGENT][NEUTRAL] Let me pull this up and see. I know some of our plans like will participate in.
[AGENT][NEUTRAL] A PPO network through like Carrington some don't um let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so on this one it looks like the fee schedule is by UCR, so usual customary reasonable fee. The policy does participate in the Carrington PPO network, but it's not required for them to use it.
[CUSTOMER][NEUTRAL] Uh, what does that mean exactly?
[AGENT][NEUTRAL] As far as like a provider and network, it's not required for them to use the plan.
[CUSTOMER][NEUTRAL] OK, how do we find out if we participate with Carrington?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Do you guys, you guys have never billed through us or anything I'm guessing, huh?
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] What's the name of the provider?
[CUSTOMER][NEUTRAL] Um, well, hopefully you can pull up she has two last names, but we'll go with, um, first name is [PII], so it's [PII]
[CUSTOMER][NEUTRAL] Her last name is [PII] She has a second last name, but it's sometimes crazy how it's listed, so it could also be [PII]
[CUSTOMER][NEUTRAL] I have her MPI too. I don't know if you can type that in or if that helps at all.
[AGENT][NEGATIVE] Yeah, nothing comes up like right off the bat when I do a search under providers.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like with either one of her last names doesn't pull up.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So, yeah, I don't see anything, but, you know, again, it
[AGENT][NEUTRAL] For the patient to use the actual insurance, like an in-network provider isn't.
[AGENT][NEUTRAL] It states on there it's not required.
[CUSTOMER][NEUTRAL] Yeah, I think they were just trying to go somewhere in network. I don't even know that, um, I guess we're just trying to figure out what fees use like if they had um like treatment that they needed to to be done, um, we haven't seen them. This will be the first time it'll be for cleaning this afternoon.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So yeah I mean um do you need to know if they have any sort of like history on file that would like um.
[CUSTOMER][NEUTRAL] I, I checked
[AGENT][NEUTRAL] Mess with any of the frequency?
[CUSTOMER][NEUTRAL] I don't think so. Um, I guess I was just trying to see if this plan, like, um, can you check one of our other providers? He's an endonnis, but I know that he participates with Carrington. I'm pretty sure, um, so maybe it could pull up his name if you checked.
[CUSTOMER][NEUTRAL] Um [PII], uh first name is [PII] and last name is [PII]
[AGENT][NEUTRAL] Yeah, what's that name?
[AGENT][NEGATIVE] I don't see anything that's come up when I search by that name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there like a number like that I could call Carrington to find out?
[AGENT][POSITIVE] Yeah, absolutely. They have a phone number which is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK and they should be able to tell me if we're participating with them, which and then we would use their fee schedule, right?
[AGENT][POSITIVE] Mhm. Yup, absolutely.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, I will do that. um, thank you so much for your help.
[AGENT][POSITIVE] You're welcome have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.