AccountId: 011433970860
ContactId: 4b0568ae-0e4f-41cd-a65a-5640665a017f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614619 ms
Total Talk Time (AGENT): 172688 ms
Total Talk Time (CUSTOMER): 224592 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/4b0568ae-0e4f-41cd-a65a-5640665a017f_20250327T21:31_UTC.wav
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[CUSTOMER][NEUTRAL] um.
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm just trying to locate a plan, uh, Carrington plan.
[CUSTOMER][NEUTRAL] Yeah if you want
[AGENT][NEUTRAL] OK, do you have the, are you with the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have the policy number of the number?
[CUSTOMER][NEUTRAL] Yeah, I don't know
[CUSTOMER][NEUTRAL] I do have the member ID, um, however, every person I've talked to has had to look him up by name and date of birth. Um, I can give you the member ID though and give it a try. It is 02596285.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII], but the subscriber's name is [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] OK, are you needing eligibility too or just uh benefits or?
[CUSTOMER][POSITIVE] Uh, benefits and eligibility and then if you could just, uh, read off the orthodontic information for [PII], that would be great.
[AGENT][NEUTRAL] OK, this is not a guaranteed payment, just a basic outline of the policy. Oh, can I get your name and a callback number, please?
[CUSTOMER][NEUTRAL] Absolutely it is [PII] and our callback number is [PII].
[CUSTOMER][NEUTRAL] And I guess before you get into it too I have just a quick question about uh is it a is it a Carrington PPO plan?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] If you can that's the way to go.
[CUSTOMER][NEUTRAL] Alright, any other questions for me?
[AGENT][NEUTRAL] Let me pull it up real quick. Just give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Sorry, our system's running just a bit slow.
[CUSTOMER][POSITIVE] Oh, you're OK. I get it.
[AGENT][NEUTRAL] Uh, yes, they do utilize the Carrington network. We don't require it, but the Carrington network is part of this, um, plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then what's the claims mailing address?
[AGENT][NEUTRAL] Uh, claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, let me just find that real quick here.
[AGENT][NEUTRAL] And I can send you a fax back too if you'd like.
[CUSTOMER][NEUTRAL] Um, I'll have that sent, but can you go over the benefits as well? She's sitting in the chair right now and I've just been on the phone for like 30 minutes. I'd rather just go over them real quick if you can.
[AGENT][NEUTRAL] Yeah, yeah, that's fine, uh.
[AGENT][NEGATIVE] I don't show any orthodontic uh coverage on this plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative services cover 100% up to a $500 calendar maximum. Basic covers 80% subject to a $50 deductible up to that same maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they don't have
[CUSTOMER][NEGATIVE] You said 50% for basic sorry.
[AGENT][NEUTRAL] Uh, 80% for basic and then there's no major services.
[CUSTOMER][NEUTRAL] 80
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, are endodontics, periodontics, and oral surgery covered at all?
[AGENT][NEUTRAL] Um, so it lists the way this plan works, it lists out codes, um, and, and tells if it's under basic or not.
[CUSTOMER][NEUTRAL] OK, I can give you some codes too.
[AGENT][NEUTRAL] OK, what codes do you have?
[CUSTOMER][NEUTRAL] Alright, um, 3310.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] I don't show that on here.
[CUSTOMER][NEUTRAL] OK, uh, 4341.
[AGENT][NEUTRAL] Not showing that either.
[CUSTOMER][NEUTRAL] OK, um, 7210.
[AGENT][NEUTRAL] Is that for an extraction?
[CUSTOMER][NEUTRAL] Yeah, it's oral surgery, um.
[AGENT][NEUTRAL] Um, they've got a errupted 7140. I don't show 7210.
[CUSTOMER][NEUTRAL] OK, alright, um, is the errupted basic?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, um, pero maintenance 4910, is that covered at all?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Don't show that listed on here.
[CUSTOMER][NEUTRAL] OK. Uh, is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK, um, exam 0120, what's the frequency on that?
[AGENT][NEUTRAL] Uh, that is.
[AGENT][NEUTRAL] One every 6 months.
[CUSTOMER][NEUTRAL] One every 6 months cleanings 1110. What's the frequency on that?
[AGENT][NEUTRAL] Um, that is.
[AGENT][NEUTRAL] Oh wait, did you say 0120 on?
[AGENT][NEUTRAL] Just before this.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that I'm sorry about that. That's one for 12 months and then what was the, I'm sorry, what was the other code?
[CUSTOMER][NEUTRAL] For 12 months, OK.
[CUSTOMER][NEUTRAL] It is 1110.
[AGENT][NEUTRAL] Uh, one every 6 months.
[CUSTOMER][NEUTRAL] One every 6 months, um, and then 0274.
[AGENT][NEUTRAL] 0274.
[AGENT][NEUTRAL] One bite wing X-ray for 12 month period.
[CUSTOMER][NEUTRAL] OK, um, full mouth series 0210.
[AGENT][NEUTRAL] Uh, limited to one per 5 year period.
[CUSTOMER][NEUTRAL] OK, um, and then is fluoride covered at all 1208?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I show fluorides covered, but I don't have that specific code. I've got like 1201, 1203, 12:04, 1205.
[AGENT][NEUTRAL] Um, and that's one.
[CUSTOMER][NEUTRAL] OK, is there an age limit on any of those?
[AGENT][NEUTRAL] Uh, looks like it's one every 12 months and that is.
[AGENT][NEUTRAL] Uh, it's for child, so that would be to age.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, age [PII].
[CUSTOMER][NEUTRAL] [PII], OK, um, and then scaling and rope planning 4341. I'm assuming that's probably not covered.
[AGENT][NEUTRAL] Uh, no, I don't have that code.
[CUSTOMER][NEUTRAL] OK, and then, um, oral cancer screening 0431?
[AGENT][NEUTRAL] Don't see that code on here either.
[CUSTOMER][NEUTRAL] OK, and then my last, well, I guess not last, but um I'm assuming dentures, bridges and crowns all fall under major which are not covered.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK perfect and then.
[CUSTOMER][NEUTRAL] Let's see if I need anything else just to verify you said $500 maximum.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK and then is there a group name or a group number on this plan?
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] Group number 70051.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then uh I was gonna ask you is that member ID I gave you accurate?
[AGENT][NEUTRAL] Yes, it is. Uh-huh.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK and then is there a group name?
[AGENT][NEUTRAL] Uh, group name is Focus Workforce Management.
[CUSTOMER][NEUTRAL] Work reports.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I think that was everything thank you so much for your help.
[AGENT][NEUTRAL] Did you want that faxed back or no?
[CUSTOMER][NEUTRAL] Actually, yeah, I'll have you send that um let me know when you're ready for that number.
[AGENT][NEUTRAL] OK, what's that number?
[CUSTOMER][NEUTRAL] It is 605-332.
[CUSTOMER][NEUTRAL] 5963.
[AGENT][NEUTRAL] OK, just I'll, I'll get this faxed over. Just give me just a few moments.
[CUSTOMER][POSITIVE] OK, fantastic thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.