AccountId: 011433970860
ContactId: 48680abf-1a91-45bb-987e-65864ac47cec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391250 ms
Total Talk Time (AGENT): 174630 ms
Total Talk Time (CUSTOMER): 82386 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/48680abf-1a91-45bb-987e-65864ac47cec_20250107T18:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I needed to see if a patient was eligible for some codes.
[AGENT][NEUTRAL] OK, when you say some code, is this for medical?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] Or dental.
[AGENT][NEUTRAL] OK, so you're needing some eligibility information for members, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, hang on one second, it is 02.
[CUSTOMER][NEUTRAL] 555-309.
[AGENT][NEUTRAL] OK, [PII], thank you. Give me one moment to get the member's information pulled up please.
[AGENT][NEUTRAL] Fax backup benefits on this number.
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] Have you received a fax back of benefits on this number?
[CUSTOMER][NEUTRAL] Um, not to my knowledge.
[AGENT][NEUTRAL] OK, I can also send you a fax back of the covered benefits and anything not on the fax back um would not be covered under her plan. So first off, any information, [PII] that I provided for you is a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][POSITIVE] Oh, that would be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is a subscriber on this policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And we do not have any history on file for her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me ask you a couple questions that may not be on that fast fax back. Is there a missing tooth clause?
[AGENT][NEUTRAL] There is and that is on the fax back.
[CUSTOMER][NEUTRAL] OK, um, do, do the, um, post compare composites downgrade?
[AGENT][NEGATIVE] They do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Think that might be.
[CUSTOMER][NEUTRAL] And you said she had no history.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And there is there there's no waiting periods, is there?
[AGENT][POSITIVE] There is no waiting period, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And what is a good fax number and I can send this fax back to you.
[CUSTOMER][NEUTRAL] It is going to be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, well let me to have your attention. Oh, I'm so sorry, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is that one on a calendar year also?
[AGENT][NEUTRAL] Yes it does. Uh huh. The calendar max deductible, all of that is on there and like I said before, any code that is not on the fax back means it would not be covered. If it's not on the fax back it's not covered. And then once the claim has been processed with APL, [PII], we do have a portal that you can, you should be able to check claim status and also gain access to the EOB for the claim and the website for that is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just a moment to get her fax um information put together so that I can send that to you so bear with me just a moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said it did not need to have your attention on there, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] It didn't need to be put to your tech.
[CUSTOMER][NEUTRAL] What is, what is the fee schedule on that?
[AGENT][NEUTRAL] This plan is that participates with the Carrington PPO network. however, they are not required to utilize a Carrington provider, a network provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I thought it was gonna let me fax it right in. Give me one second. All of a sudden it stopped. OK.
[AGENT][NEUTRAL] And again, that fax is [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, so I have just faxed that to you, [PII] provided there's not any kind of technical glitch, you should be receiving that within just the next few minutes.
[CUSTOMER][POSITIVE] OK, that sounds great thank you so much.
[AGENT][POSITIVE] OK, well, you are certainly very welcome and is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Um, no, that's gonna be it.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.