AccountId: 011433970860
ContactId: 51c47965-1001-4ee0-a606-b8a169223dd2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522210 ms
Total Talk Time (AGENT): 222466 ms
Total Talk Time (CUSTOMER): 168600 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/51c47965-1001-4ee0-a606-b8a169223dd2_20250516T13:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] I'm calling from a dental provider's office and I have a patient that I'm trying to locate dental coverage for.
[AGENT][NEUTRAL] OK, [PII], you're trying to verify eligibility and get a fax back of benefits if the member has active coverage with us. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 497, I'm sorry 49676292.
[AGENT][NEUTRAL] OK, now, that is not going to be a policy number for our company. You said 49676292?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on their ID card, what does it show is the name of the company?
[CUSTOMER][NEUTRAL] Uh, I don't have the ID card, but they said the employer name is APL.
[AGENT][NEUTRAL] OK, that's the name of the company that I work for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah and then the only other thing I have is um a group number and um they initially said that their insurance was through Carrington so the Carrington rep said she didn't handle this type of plan and then transferred me to you.
[CUSTOMER][NEUTRAL] And gave me that ID number um but I do have a different one that.
[CUSTOMER][NEGATIVE] She said was not correct.
[CUSTOMER][NEUTRAL] If you wanna try it.
[AGENT][NEUTRAL] What is that number?
[CUSTOMER][NEUTRAL] 02622119
[AGENT][NEUTRAL] That's the correct policy number. That would be an APL policy number.
[AGENT][NEGATIVE] But they don't work for APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] It is uh [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments to get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on this policy, and that this policy is active with an effective date of [PII]. And again, and we do not have any history on file for this member, [PII], and I have a fax back of the member's benefits that I can send over to you and it will have all of their covered benefit information on it along with our.
[AGENT][NEUTRAL] Mailing address, payer ID.
[CUSTOMER][NEUTRAL] OK. Will it have if there's like um waiting periods, missing tooth claws or downgrades?
[AGENT][NEUTRAL] There are no, yes, but there are no downgrades. It does have a missing tooth cloths and there's no uh waiting periods.
[CUSTOMER][NEUTRAL] OK, all right, and it'll have the group number and the.
[AGENT][NEUTRAL] And again, all covered services.
[AGENT][NEUTRAL] I can give you that if you don't have that. I thought, I'm so sorry. I thought you said that you have the group number. I apologize. Uh maybe I misunderstood.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well I just wanna make sure I just wanna make sure what I have is correct. I have 70101.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. That is what we show. Mhm.
[CUSTOMER][NEUTRAL] OK and then let's see for the group name uh they gave APL so what would the group name be?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The group name is Superior.
[AGENT][NEUTRAL] Skilled
[AGENT][NEUTRAL] Trades LLC.
[CUSTOMER][NEUTRAL] LLC OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Does it also follow a fee schedule?
[AGENT][NEUTRAL] Carrington.
[AGENT][NEUTRAL] This is this plan participates in the Carrington PPO network but they are not required to use a network provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] Would you be able to tell me if my provider would be in network with Carrington?
[AGENT][NEUTRAL] No, ma'am. You would have to speak to someone at Carrington to verify that information.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] And um OK then if we're not then there is out of network benefits.
[AGENT][NEUTRAL] Again, this goes by the Carrington fee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, well, I will see what I can do to see what we are.
[AGENT][NEUTRAL] Would you like
[AGENT][NEUTRAL] OK. Well, would you like for me to send you the fax back of this member's benefit information?
[CUSTOMER][NEUTRAL] In network.
[AGENT][NEUTRAL] So that you will know what is and is not covered, OK.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] What is a good fax number for you, please?
[CUSTOMER][NEUTRAL] It is um [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I'm just gonna repeat that back to you.
[AGENT][NEUTRAL] So again, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I have just sent that to you, [PII] so you should be receiving that very soon. Also, [PII], if you end up filing a claim for this number with us once the claim has been processed here, we do have a portal in which you should be able to check claim status in and the website for our portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Um thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else that I could help you with this morning?
[CUSTOMER][POSITIVE] Uh, no, that's all that I have. Thank you.
[AGENT][NEUTRAL] OK. [PII]ow, I can transfer you back to [PII], but did you, did I understand you to say you had already spoken with him?
[CUSTOMER][NEUTRAL] Yeah, but if I need to see if we're in network with them then if you can transfer me that would be good.
[AGENT][POSITIVE] Yes ma'am, well I'll be happy to do that as well. So again, if that is all I can help you with, thank you for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] All right, thank you. You too.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you. OK.
[AGENT][POSITIVE] You're welcome. Bye bye. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you for calling Carrington.