AccountId: 011433970860
ContactId: 49607401-f839-4104-97c1-e1f6595e0338
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281260 ms
Total Talk Time (AGENT): 147985 ms
Total Talk Time (CUSTOMER): 91674 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/49607401-f839-4104-97c1-e1f6595e0338_20250109T16:58_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was just calling in regards to um a patient's benefits and eligibility.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please, ma'am?
[CUSTOMER][NEUTRAL] Um, let me see here if I have this.
[CUSTOMER][NEUTRAL] 255-2506.
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII]. I was earlier.
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with the eligibility and benefits for Ms. [PII]. I am showing that her policy is active. Effective date is [PII].
[AGENT][NEUTRAL] And you're needing dental benefits, correct?
[CUSTOMER][NEUTRAL] Yeah, I actually have her here in the office if I could check on a certain code.
[AGENT][NEUTRAL] Sure, it would be my pleasure. Now I will tell you that this is a limited dental policy. It does not cover major procedures.
[CUSTOMER][NEUTRAL] OK, and so what she's needing is a 70 to 10. Does that fall under basic or major for this policy?
[AGENT][NEUTRAL] 7210 is not a covered benefit under this limited dental plan.
[CUSTOMER][NEGATIVE] So it's not covered at all.
[AGENT][NEUTRAL] That's right. Would you like for me to fax you a breakdown with the covered procedures listed?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, yes, if you don't mind.
[AGENT][POSITIVE] I don't mind at all and I can send that to you right now, um.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] I don't, the policy, let me try that again. The fax back will not include the group name and number. Do you need that as well?
[CUSTOMER][NEUTRAL] Uh, no, that's OK.
[AGENT][NEUTRAL] Alright, I'm fixing to send this to you, but you will get the calendar, your max deductible frequencies, limitations and billing information.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let me just do this super quick.
[AGENT][POSITIVE] I know she's there, so I'm trying to make it really quick for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Well, come on.
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What is the fax number? Um.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And just to verify that fax number, I am sending this to [PII].
[AGENT][NEUTRAL] [PII]? I didn't write it all down.
[CUSTOMER][NEUTRAL] No ma'am, so [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I got it now. [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright, thank you. I apologize for that. Now I just hit send so you should be receiving that breakdown shortly.
[CUSTOMER][POSITIVE] Oh thank you so much and then before I do get you off the phone, can I just verify one more thing with you?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Um, for 7140, what would the coverage be on that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7140 is in fact a covered benefit and we cover that at 40%. Now the policy does
[AGENT][NEUTRAL] Participate in the Carrington PPO network, but network participation is not required for benefits.
[CUSTOMER][NEUTRAL] OK, so just 40%.
[AGENT][NEUTRAL] That's correct. And if you would please note all benefits given over the phone. It's a verification of coverage, not a guarantee of payment.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] Anything else I can help you with, Destiny?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] No, that was all thank you so much.
[AGENT][POSITIVE] Well, thank you for calling APL. I hope you have a wonderful day and it was a pleasure to assist you with that breakdown. Take care.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][NEUTRAL] Bye bye.