AccountId: 011433970860
ContactId: 4fd71180-d7a0-499c-9947-20c40f887733
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482320 ms
Total Talk Time (AGENT): 175485 ms
Total Talk Time (CUSTOMER): 146202 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/4fd71180-d7a0-499c-9947-20c40f887733_20250110T20:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Doctor Davis Louis dental office, and, uh, we had a patient today who, uh, had your insurance, and we have, if we've never worked with you guys before, so I wanted to get an idea of the, uh, fee schedule and the range you guys pay.
[AGENT][NEUTRAL] OK, are you calling on a medical plan? What type of policy does this member have?
[CUSTOMER][NEUTRAL] Uh, dental.
[AGENT][NEUTRAL] OK. So, it's a dental policy?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, let me
[CUSTOMER][NEUTRAL] Mhm let me take a look at their file.
[AGENT][NEUTRAL] OK, so you're needing eligibility and benefit information, uh, cause we have facts backs of the benefits.
[AGENT][NEUTRAL] For the different dental plans that I'll send to you if you've not already received that.
[CUSTOMER][NEUTRAL] Mhm and
[CUSTOMER][NEUTRAL] I believe we had that sent over but we wanted it's because it's a new plan we wanted to get an idea of the a range of how much they pay if it's a low fee plan.
[AGENT][NEUTRAL] OK, [PII], I can try and help you with this. First off, what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, let me take a look real quick, sorry about that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] See there
[CUSTOMER][NEUTRAL] Their group number?
[AGENT][NEUTRAL] No, ma'am. The policy certificate number.
[CUSTOMER][NEUTRAL] OK, let me take a look.
[CUSTOMER][NEUTRAL] I don't think we were given that, but I have their ID if that works.
[AGENT][NEUTRAL] Um, when you say ID, they didn't give you a copy of an ID card.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, no, I, for, from a previous call the representative gave gave us here.
[CUSTOMER][NEUTRAL] Uh, ID number for their insurance.
[AGENT][NEUTRAL] OK, what is, OK, um, I don't know if that's the number I'll need. What is the, what is that number?
[CUSTOMER][NEUTRAL] Uh, the 616-604-035.
[AGENT][NEUTRAL] OK, now that is not a number for our company.
[CUSTOMER][NEUTRAL] Uh, would you be able to find them through Social Security and name? Oh, I think that's the Social Security.
[AGENT][NEUTRAL] It is your patient the subscriber?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you do have the full social you said?
[CUSTOMER][NEUTRAL] Yes, sorry, I think what they put in was the social security number.
[AGENT][NEUTRAL] OK, so just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information that I provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So she is the subscriber on this dental policy. The correct policy number is 02559648.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Can I repeat that for you just to double check 022559648?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the policy is active effective [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on the fact, you, you said that you did receive a fax back of benefits?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So anything that is not on that back back is not covered.
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] On fax back not covered, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and then I was hoping to get the range of this uh fee that you guys pay.
[AGENT][NEUTRAL] Um, there we
[AGENT][NEUTRAL] There's not a, I mean I can't provide that information. This plan participates with the multi-plan network, however, they are not required to utilize a network provider on this policy.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] But again, the percentages are
[CUSTOMER][NEUTRAL] And in that case you guys would, OK.
[CUSTOMER][NEUTRAL] And in that case you guys pay the UCR fee?
[AGENT][NEUTRAL] Um, on this policy, just one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We follow the Carrington PPO schedule, but you do not have to be a member of Carrington to participate.
[CUSTOMER][NEUTRAL] Carrington PPO schedule.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And how would you spell that?
[AGENT][NEUTRAL] C A R E I N G T O N.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And uh you so out of network would also follow that fee schedule.
[AGENT][POSITIVE] Yes, because it's really not, there's no fee schedule with this plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK I understand thank you so much for your help.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Absolutely you're very welcome. So is there and then I don't know if the the representative that you spoke to earlier, um, [PII] gave you our website, but we do have a portal that once the claim has been filed and processed with APL, you should be able to access the claims EOB.
[CUSTOMER][NEUTRAL] Mhm let me see.
[AGENT][NEUTRAL] And that website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you're certainly very welcome. So again, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That will be all thank you so much.
[AGENT][POSITIVE] OK. Absolutely. You're very welcome and thank you again for calling. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you, bye bye.