AccountId: 011433970860
ContactId: 5f34a102-6de5-4df5-8494-fd77eb01f51c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 590710 ms
Total Talk Time (AGENT): 144283 ms
Total Talk Time (CUSTOMER): 91120 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/5f34a102-6de5-4df5-8494-fd77eb01f51c_20250217T17:46_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I need to verify eligibility for a patient please.
[AGENT][NEUTRAL] Sure, I can assist you with the eligibility. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And where are you?
[CUSTOMER][NEUTRAL] [PII], do me a favor. Write your social up here. I'm sorry, I'm calling from North Springs Dental Care.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I don't see it on his card, so let me give you his social.
[AGENT][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said 655-140614?
[CUSTOMER][NEUTRAL] No, [PII], so [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] OK, and may I have his date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And this is for medical or dental?
[CUSTOMER][NEUTRAL] For dental?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And let's see, so we have an effective date on this member of [PII].
[AGENT][NEUTRAL] It is active at the moment and this is a basic dental policy.
[CUSTOMER][NEUTRAL] Can you see if we're in network please?
[AGENT][NEUTRAL] With this one there's no network. If the provider participates with Carrington, they can use their PP on their PPO schedule, but it is not required because we're not contracted.
[AGENT][NEGATIVE] So it's no work.
[CUSTOMER][NEUTRAL] OK, um, what's the group number?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, let me get that for you.
[AGENT][NEUTRAL] The group number is 70056.
[CUSTOMER][NEUTRAL] What is the um group name?
[AGENT][NEUTRAL] MAU
[CUSTOMER][NEUTRAL] OK, the claims mailing address?
[AGENT][NEUTRAL] OK, that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and let's see um.
[CUSTOMER][NEUTRAL] Is this based on a calendar year or fiscal year policy?
[AGENT][NEUTRAL] This is a calendar year policy.
[CUSTOMER][NEUTRAL] OK, what is the yearly max?
[AGENT][NEUTRAL] OK, let me get that for you on this 11 moment.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. We have a $500 calendar year maximum with a $50 deductible.
[CUSTOMER][NEUTRAL] Any waiting periods or missing tooth claws?
[AGENT][NEUTRAL] Not on this one because it's just basic, there's no major service.
[CUSTOMER][NEUTRAL] OK, how do you coordinate benefits?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] OK. And for the um diagnostics and preventative, what's the percentage of breakdown?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me give you the full breakdown.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so on this one we have the preventatives cover 100%. Radiograph FMX is covered at 80%, basic expense and basic restorative is covered at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And you said FMX and panel are covered at 80?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, can you send me a breakdown of his plan via fax?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. Yeah, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling EPO. Have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] OK, thank you.