AccountId: 011433970860
ContactId: 607cacf5-2b4c-42e2-bc80-599cd427414a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422839 ms
Total Talk Time (AGENT): 161147 ms
Total Talk Time (CUSTOMER): 128964 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/607cacf5-2b4c-42e2-bc80-599cd427414a_20250331T14:32_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hello, I'm calling from a provider's office and I wanna see if we are in network with this plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with that. Could I get your name and a callback number?
[CUSTOMER][NEUTRAL] Um, name is [PII] callback number is [PII].
[AGENT][NEUTRAL] Thank you, one second. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02607936
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, the patient's name, it will be [PII].
[CUSTOMER][NEUTRAL] And date of birth, um.
[CUSTOMER][NEUTRAL] Um, date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy and you're calling to see if your provider is in network.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this policy is a non-contracted policy. Uh it does pay based on a fee schedule, uh, and it's paid according to usual and customary.
[CUSTOMER][NEUTRAL] She has her next appointment.
[AGENT][NEUTRAL] So they are able to go to any provider.
[CUSTOMER][NEUTRAL] Um, would I know the exact fee schedule would we be using?
[AGENT][NEUTRAL] Uh, as far as the cover policy, I'm sorry, the procedures, I can, um, fax you over a um copy of her benefits showing all procedures that are covered through her policy and at the percentage.
[AGENT][NEUTRAL] Would you like me to send that information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold one moment, let me get it pulled up.
[CUSTOMER][NEUTRAL] Carrington.
[CUSTOMER][NEUTRAL] The the
[CUSTOMER][NEUTRAL] And the insurance is paying by.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and will I be sending this to your attention?
[CUSTOMER][NEUTRAL] Mm that's fine, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And could I get the correct spelling of your name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is the uh fax number I'll be sending that over to?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I have [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it is on its way. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, yes, please, um, this card has that caring, uh, Carrington Solutions is this is not being not using Carrington fees, is it?
[AGENT][NEUTRAL] No, it is not using uh their fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and da da da da, can you does this plan have any history on file while I have you on the phone?
[AGENT][NEGATIVE] I show no, yeah, I show no history on file.
[CUSTOMER][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] And is the 4341 um the frequency and is it a 4 quads or two quads are allowed.
[AGENT][NEUTRAL] Let me see if that's a cover policy. I mean cover procedure 4341.
[CUSTOMER][NEUTRAL] 43.1, yes.
[AGENT][NEUTRAL] OK. 43.
[CUSTOMER][NEUTRAL] the insurance
[AGENT][NEUTRAL] OK, please be advised verifying that if this is not guaranteed payment, I do not show 4341 as a covered procedure.
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] I did do this
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that again?
[AGENT][NEUTRAL] I do not show 4341 as a covered procedure.
[CUSTOMER][NEUTRAL] Not covered, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] the one that.
[CUSTOMER][NEUTRAL] And OK, so I guess I'll, uh, just wait on the fact, um, could I please get the maximum and the deductible for this?
[AGENT][NEUTRAL] Uh, I show the maximum for this policy is $750 per calendar year. Um, and the deductible is $50.
[CUSTOMER][NEUTRAL] And may I have the PO box and payer ID?
[AGENT][NEUTRAL] PO box is for claims is 248,950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In another two quick questions, uh, this plan, is it a PPO plan?
[AGENT][NEUTRAL] It is a non-contracted policy, so there, like I said, it, it just pays um a percentage of the usual and customary.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And are we in
[CUSTOMER][NEUTRAL] I are we in network with this plan?
[AGENT][NEUTRAL] There's not a network.
[AGENT][NEUTRAL] It is a base, yeah.
[CUSTOMER][NEGATIVE] No network OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can I just get the pers um percentage for um preventative diagnostic?
[AGENT][NEUTRAL] Preventative expenses are paid at 100% of the allowable.
[CUSTOMER][NEUTRAL] And basic
[AGENT][NEUTRAL] And basic, I'm sorry, it's paid at 80%.
[CUSTOMER][NEUTRAL] 80 oral.
[AGENT][NEUTRAL] Uh, as far as oral surgery is, is not covered.
[CUSTOMER][NEUTRAL] Oral surgery?
[CUSTOMER][NEUTRAL] In endedonic.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Per, per you said not cover and major like crowns and dentures.
[AGENT][NEGATIVE] I do not show major benefits on this policy.
[CUSTOMER][POSITIVE] OK, I will wait on that fax. Thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful day, [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.