AccountId: 011433970860
ContactId: 5e22a310-795d-4051-8c74-9af07fb68761
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548940 ms
Total Talk Time (AGENT): 198838 ms
Total Talk Time (CUSTOMER): 82742 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/5e22a310-795d-4051-8c74-9af07fb68761_20250602T17:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. This is [PII]. I need a full breakdown of benefits for one of our patients.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the dental benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] Thank you for that. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 02607936
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And hold on one moment, I'm waiting for the fax back to populate.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, ma'am, could you please provide a verbal breakdown for this patient?
[AGENT][NEUTRAL] Right, that's what the fax back is. I'm just waiting for it to populate so I can give you the details.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] All right, go ahead.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am, hello.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, um, for the calendar year max, it's $750 per covered insured.
[AGENT][NEUTRAL] There is a $50 deductible, up to $150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Irma has used $203.20 and has $546.80 left for the year.
[AGENT][NEUTRAL] She has met her deductible?
[AGENT][NEUTRAL] The policy covers preventative at 100% of allowable.
[AGENT][NEUTRAL] Radio graphs and FMX basic and basic restorative expenses are all covered at 80%.
[AGENT][NEUTRAL] This policy does not cover major expenses.
[AGENT][NEUTRAL] Major for us includes endodontic, periodontic, prosodontic, and oral surgery codes.
[AGENT][NEUTRAL] Profies and cleanings are once every 6 months.
[AGENT][NEUTRAL] Oral evaluations are 2 for 12 month period.
[AGENT][NEUTRAL] Bite wings at once per 12-month period.
[AGENT][NEUTRAL] Full mouth X-rays and panels are once every 5 years.
[AGENT][NEUTRAL] The policy does have a missing tooth clause.
[AGENT][NEUTRAL] TMJ services are not covered?
[AGENT][NEUTRAL] Orthodontic treatment is not covered?
[AGENT][NEUTRAL] Implant placement, removal, and all related services are not covered?
[AGENT][NEUTRAL] This policy is on the Carrington PPO network.
[AGENT][NEUTRAL] However, if your provider is not a Carrington provider, the benefits are still the same.
[AGENT][NEUTRAL] Would you like our payer ID, um, mailing address and fax number as well?
[CUSTOMER][POSITIVE] Yes ma'am. I love to have the claims mailing address and payer ID please.
[AGENT][NEUTRAL] OK. And the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] And our payer ID is [PII].
[CUSTOMER][POSITIVE] All right, got it, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And could you please confirm as well if there, is there any history for this patient that could affect the frequency?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so we only have, we processed one claim for the insured code 0150 and 0210 were both used on [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And yes, ma'am. Could I please also confirm if the plan includes any alternate benefits specifically for fillings?
[AGENT][NEUTRAL] As in like downgrades?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] There's no downgrades.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] And could you please also confirm the group number for this plan?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] The group number is 70084.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right. Got it.
[CUSTOMER][NEUTRAL] And yes, ma'am. That's actually it for this patient. But before I let you go, could you please also provide a call reference number?
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] And let me know when you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] All right. Um, so for the call reference number, it'll just be my name and today's date, and again, that's [PII], first initial to my last name is [PII], and then today's date.
[AGENT][NEUTRAL] And also again for the call, all the information provided is a verification of benefits, not a guarantee of payment. And [PII], was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] All right thank you so much.
[CUSTOMER][POSITIVE] No, ma'am. I've covered everything for you today and thank you so much for your time and you have a wonderful day.
[AGENT][POSITIVE] Thank you also thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye.