AccountId: 011433970860
ContactId: 60b735ce-ed33-4e05-95a8-eeb60e34f28b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 599239 ms
Total Talk Time (AGENT): 200759 ms
Total Talk Time (CUSTOMER): 165111 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/60b735ce-ed33-4e05-95a8-eeb60e34f28b_20250508T22:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Precision Anodontics.
[AGENT][NEUTRAL] What, I'm so sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My name's [PII]
[AGENT][NEUTRAL] OK, and what can we help you with today?
[CUSTOMER][NEUTRAL] out
[CUSTOMER][NEUTRAL] Sorry, can I just place you on a brief hold?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Hi, sorry for the hold, um, I'm calling from a dental office. I just need to verify patients eligibility and benefits.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility and benefits for you. Um, can I go ahead and need to get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] I do it's 02576308.
[CUSTOMER][NEUTRAL] I'm so sorry I didn't catch your name.
[AGENT][NEUTRAL] That's all right. It's [PII]
[AGENT][NEUTRAL] And I apologize, you said your name was spelled, is it [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] Got it OK and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's for [PII]. Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and if you'd like I can send you a fax back that has all of the covered procedures and benefit information on it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, is it possible to get over the phone as well?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK, what's the um.
[AGENT][NEUTRAL] Did you still want me to send you the fax back as well?
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][NEUTRAL] Sure, let me go ahead and get that fax number for you if you uh if you don't mind.
[CUSTOMER][NEUTRAL] Sure it's 951.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 816
[CUSTOMER][NEUTRAL] 691 8.
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'll go ahead and get that sent to you now. I should get it within about 10 minutes or so, and then, uh, what kinds of questions did you have for me?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, what do you have a group name and a group number?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] OK, so that group number is 70052.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that group name is Oxford Global Resources.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, did you have any other questions for me?
[CUSTOMER][NEUTRAL] Does the patient have an annual maximum?
[AGENT][NEUTRAL] Yes, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so the calendar year maximum is $500. There is a $50 deductible, uh, that does not apply to preventative expenses and up to $150 for that deductible for the family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you know how much of the 500 maximum has been used?
[AGENT][POSITIVE] I could definitely check that one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So right now
[AGENT][NEUTRAL] OK, so so far this year, uh, [PII] has met that $50 deductible, and she has used $210.40 of that benefit.
[CUSTOMER][NEUTRAL] OK, so 500 minus $210.40.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so the patient is maxed out it looks like.
[AGENT][NEUTRAL] Um, well, the total benefit is 500.
[CUSTOMER][NEUTRAL] Um, can I give you?
[CUSTOMER][NEUTRAL] Right, but her general dentist has a claim pending. I'm sure that she was just there today.
[AGENT][NEUTRAL] Oh, I see. OK, I see.
[CUSTOMER][NEUTRAL] So after today she will be back so.
[AGENT][NEUTRAL] I see. OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, so, um, can I confirm what fee schedule we're gonna be using for the patient?
[AGENT][NEUTRAL] Sure, so this policy, uh, does participate in the Carrington PPO network.
[CUSTOMER][POSITIVE] Caring
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then can I just confirm the payer ID and your claims billing address?
[AGENT][NEUTRAL] Of course I've also got a fax number as well if you'd like that.
[CUSTOMER][NEUTRAL] I'm sorry, say that one more time.
[AGENT][NEUTRAL] I said I also have a fax number as well if you needed that but um you can go ahead and confirm what you've got sure.
[CUSTOMER][POSITIVE] Oh yeah, I'll take it.
[CUSTOMER][NEUTRAL] Um, the.
[CUSTOMER][NEUTRAL] Sorry, what was I looking at? Oh, the payer ID that we have is, is it the 60801?
[AGENT][POSITIVE] That's, yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then the claims billing address is the [PII].
[AGENT][NEUTRAL] No ma'am, uh, so that is an older uh address of ours. I'll go ahead and give you that, uh, updated one whenever you're ready.
[CUSTOMER][NEUTRAL] And then zip code
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, so that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, so that was [PII] excuse me, [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and update that and then just to confirm, do you have any tooth history for any lower left?
[AGENT][NEUTRAL] Uh, let me see. Give me just a moment.
[CUSTOMER][NEUTRAL] As far as like root canals or
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the only history I have on file for uh [PII] would be from [PII] and that was uh prophy, X-ray, and oral evaluation.
[CUSTOMER][MIXED] OK, but no major services like um crowns root canals or anything.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah, those those are the only procedures I have on file for her.
[CUSTOMER][NEUTRAL] Got it. OK, I think that's all I needed. Can I just get a reference number please?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh, so my last initial is A. Oh, is there anything else I could help you with, buddy?
[CUSTOMER][POSITIVE] Um, no, that is it. Thank you so much for your help.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks you too bye