AccountId: 011433970860
ContactId: 5dea1dbc-13a9-49e6-8878-082e7efe4c14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495660 ms
Total Talk Time (AGENT): 220801 ms
Total Talk Time (CUSTOMER): 202719 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/5dea1dbc-13a9-49e6-8878-082e7efe4c14_20250519T20:00_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm calling from my dental provider's office. Um, and I was trying to verify a patient, um, and I wanted to see if you'd be able to help me if I have the right department for dental.
[AGENT][NEUTRAL] OK, [PII], are you needing to verify eligibility and get a fax back of the benefits?
[CUSTOMER][NEUTRAL] Or the right company.
[CUSTOMER][POSITIVE] Yeah, and benefits, yeah, and get a benefits um to our doctor's schedule.
[AGENT][NEUTRAL] Yes, ma'am. I can send over the uh fax back of the member's benefits. I can help you with this stuff, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, great. Uh, and callback number is [PII], and that's a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] And policy number is 02559769.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payments. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm calling in regards to [PII]. Last [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With the date of birth of [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then again any information provided will be a verification of benefits and not a guarantee of payment. So I do show that she is a subscriber on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And let's
[CUSTOMER][NEUTRAL] And then does this go through you guys or?
[AGENT][NEUTRAL] We do process the claims here at APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] And what is a good fax number for [PII], and I'll be happy to send the fax back of her benefits.
[CUSTOMER][NEUTRAL] Um, OK, sure, uh, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Oh, it's taking a moment to, to load for me. Mhm.
[CUSTOMER][NEUTRAL] OK, jet load.
[AGENT][NEUTRAL] Does it need to be put to your attention, Gan or is that not necessary?
[CUSTOMER][NEUTRAL] Um, that's not necessary. It should be OK.
[AGENT][NEUTRAL] OK, and again, the fax number is [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so I have just sent that to you and Gan if you all do file a claim for her with us once it's been processed here at APL, we do have a portal in which you should be able to check claim status in and our website for the portal is located at secured.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Public, OK.
[AGENT][NEUTRAL] Mhm secured. [PII]. OK, I'm gonna say it all again secured. [PII].
[CUSTOMER][NEUTRAL] Public, what was the last?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Secured with the D on it, on the end of it, S [PII] secured.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so we can check them there once we submit and um I had a payer ID they said was 60801. I'm in the chart is that the correct payer ID? OK and then um.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] That is correct, and that's also gonna be on the fax back that I sent to you.
[CUSTOMER][NEUTRAL] OK, perfect. OK. And then is this on a regular PPO plan, um, is our doctor what the schedule we with you?
[AGENT][NEUTRAL] This is a Carrington. This plan participates with the Carrington PPO network.
[CUSTOMER][NEUTRAL] For the plan.
[AGENT][NEUTRAL] However, they are not required to use a network provider.
[CUSTOMER][NEUTRAL] Oh, OK, so they're not required. So if, um, we're not a part of Carrington, um, would it be just like UCR fee?
[AGENT][NEUTRAL] They can still participate. It's based off the [PII] schedule.
[CUSTOMER][NEUTRAL] Oh, OK, they'll still base it. OK, so it's still based off the Carrington fee schedule. OK. And do we need to call [PII] to get that copy of that fee schedule for the doctor, or I mean if, if we're like send a predetermination to know.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] Yes, if you have any specific note.
[AGENT][NEUTRAL] Predeterminations would come to APL.
[AGENT][NEUTRAL] Uh, but if you have any specific network questions, then yes, ma'am, you would have to speak to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK, I got it. OK, OK, and then this number I called is the good number to use for you guys for the APL to get to you directly.
[AGENT][NEUTRAL] Was it [PII]?
[CUSTOMER][POSITIVE] 2 yes, yeah, 8606. OK, perfect. OK, well, thank you so much for helping me to verify. I appreciate it. And there's no history that'll be on the facts, right?
[AGENT][NEUTRAL] Yes, ma'am. That is it.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Well, you are certainly very welcome.
[AGENT][NEUTRAL] Uh, there's, the history is not on the facts, um, for this calendar year, as of now, she has not used any of her benefits. If you want a specific code checked, you will have to just give me the code.
[CUSTOMER][POSITIVE] Oh yeah, you're, thank you. uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That you want checked.
[CUSTOMER][NEUTRAL] Oh, OK, could we just double check to make sure, uh, no FMX the 0210.
[CUSTOMER][NEUTRAL] And a DE 4341.
[AGENT][NEUTRAL] OK, so on the 0 and then again, anything too I didn't tell you this, but if it's not on the fact fact, the code's not on the facts back, that means it would not be covered under the plan. But there's no history for the 0 to 10 and I don't believe the 4341 is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh, OK, so 4341, OK.
[AGENT][NEUTRAL] Mm, I don't think that's on, but I can check that.
[AGENT][NEGATIVE] Yes, that's not covered under this plan.
[CUSTOMER][NEUTRAL] That's not covered. Oh, OK. OK. All right, so if I don't see the code on the fax, then I'll know it's not covered.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Not correct, OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, and no FMX show, no FMXX extreme, nothing.
[AGENT][NEGATIVE] There's no correct. There's no history for 0210. Correct.
[CUSTOMER][NEUTRAL] No history, OK.
[CUSTOMER][POSITIVE] OK. All right, great. OK, I think that'll do it. Thank you so much for all the help. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you're very welcome. So again, if that is all I can help you with, [PII], thank you for calling APL and I hope you have a great evening.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK. Thanks. Bye-bye.