AccountId: 011433970860
ContactId: 615bc7db-0162-449b-b8cc-e969f829dbb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510720 ms
Total Talk Time (AGENT): 161975 ms
Total Talk Time (CUSTOMER): 246674 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/615bc7db-0162-449b-b8cc-e969f829dbb7_20250429T22:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. I'm looking for eligibility benefit for patients.
[AGENT][NEUTRAL] You're looking for eligibility?
[CUSTOMER][NEUTRAL] And benefit, yeah, calling on behalf of office.
[AGENT][POSITIVE] I'm happy to check on eligibility. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, policy certificate number, I have 02514844.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] and date of birth I give you one moment, just a moment.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] As for the chart business date of birth, I have one moment.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So just a moment can you just hold.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 39273.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's a [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] So what kind of plan is PPO HMO like?
[AGENT][NEUTRAL] Are you looking for medical coverage or dental?
[CUSTOMER][NEUTRAL] Uh dental, dental, looking for routine dental.
[AGENT][NEUTRAL] This is a dental plan. It does participate in the Carrington PPO network, however, it's not required for usage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's not required for usage. So it is PPO kind of plan like, right, sir?
[AGENT][NEUTRAL] Correct, it pays by UCR, yes.
[CUSTOMER][NEUTRAL] Fine, but please schedule your CRPs will be used like that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Any benefit breakdown copies available for document purpose like that?
[CUSTOMER][NEUTRAL] How it's covered and what's benefits.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Yeah, any bed flex bed is available for breakdown, dental breakdown benefits.
[CUSTOMER][NEUTRAL] Can you send me the facts of benefits?
[AGENT][NEUTRAL] You need a breakdown of the benefits?
[CUSTOMER][POSITIVE] Yes, yes, yes, yes.
[AGENT][NEUTRAL] So the calendar maximum for this patient is $500.
[AGENT][NEUTRAL] Calendar year deductible is 50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient has both amounts remaining for the year. They have not used anything.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative is covered at 100%.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] FMX and basic is at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No waiting period.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Pro fee is allowed once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oral evaluation 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Light wing once for 12 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Full mouth X-rays and pano once every 5 years.
[CUSTOMER][NEUTRAL] They are busy, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Orthodontic treatment is not covered, nor is implant placement removal services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And about the group name number anything like?
[CUSTOMER][NEUTRAL] Uh, I do.
[AGENT][NEUTRAL] Group name is Adept HR, that's A as in apple, D as in Delta, E as in Echo, P as in Papa, T as in Tango, HR.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Group number is 70,050.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And any history of this patient?
[AGENT][NEUTRAL] Uh, let me check one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] No sure. And about the claim, mailing address and pay ID anything like?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And about major services are covered or not like that ground bridge or not?
[AGENT][NEGATIVE] No, they are not.
[CUSTOMER][NEUTRAL] They are not only basic covered 180 like that, right? OK.
[AGENT][POSITIVE] Correct, plan is basic and preventative.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Only thank you very much and this is a calendarages likely right.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] January to December.
[CUSTOMER][NEUTRAL] This 500 calendar year basis, right, like that every January to December.
[AGENT][POSITIVE] Yes, it's a calendar year plan, correct.
[CUSTOMER][NEUTRAL] OK. And about the timely filing limit for the claim?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] No timely filing limit. OK. And any quotation of benefits you'll be like?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No CB. OK, that's good. And once to know about, can you send me the fax of benefit this breakdown via fax.
[AGENT][NEUTRAL] What's a good fax number?
[CUSTOMER][NEUTRAL] It's my same phone number, [PII].
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][POSITIVE] Direct, you can put my name, no issues. [PII]
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] OK. Give me about 5 minutes and you should have that. Is there anything else I can check for you?
[CUSTOMER][NEUTRAL] Yeah, yeah. OK, your, your name, your name, how your name spelled by the way?
[AGENT][NEUTRAL] My name is spelled [PII].
[AGENT][NEUTRAL] My last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm. Any reference?
[CUSTOMER][NEUTRAL] OK. Any call reference number?
[AGENT][NEUTRAL] Call references my name with my last initials and today's date.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK. OK. And this member ID is correct, right? which I have given policy certificate number.
[CUSTOMER][NEUTRAL] Like that?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, this is good. And it's a subsidiary of uh like with Carrington and we use UCRP, right? We don't need like Carrington fees. OK, this is good confirmation. Thank you very much for helping the information. Have a great day and one for the doctor. Thank you. Have a great day. Bye.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Mhm. Have a good day.