AccountId: 011433970860
ContactId: 64f5d6bb-e81c-4873-9c15-a35f8e3a7fcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542780 ms
Total Talk Time (AGENT): 169813 ms
Total Talk Time (CUSTOMER): 151971 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/64f5d6bb-e81c-4873-9c15-a35f8e3a7fcb_20250204T16:57_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] at Aspen Demo in [PII]. Um, I was calling because I need a breakdown on benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] It's 02584719.
[AGENT][POSITIVE] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, [PII], and you are needing benefits?
[CUSTOMER][NEUTRAL] Yes, um, if you could check, I'm so sorry, if you could check if we are in network, please.
[AGENT][NEUTRAL] OK, I can help you with that. Our network goes through Carrington.
[AGENT][NEUTRAL] So I'm not sure if you're a provider with Carrington or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We should be, yes.
[AGENT][NEUTRAL] And you just want to break down the benefits?
[CUSTOMER][NEUTRAL] Yes, if you could give me the group name and number before the effective date.
[AGENT][NEUTRAL] The group number is 70055.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is TRC Staffing Services.
[CUSTOMER][NEUTRAL] OK, and then when was the effective date?
[AGENT][NEUTRAL] The effective date is [PII] and any benefits given over the phone is not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK and then what's the um.
[CUSTOMER][NEUTRAL] The fee schedule?
[AGENT][NEUTRAL] It's not paid on a pay schedule, it's paid by usual and customary rate.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is it a discount plan?
[AGENT][NEUTRAL] It's not a discount plan, it's just paid by usual and customary rate.
[CUSTOMER][NEUTRAL] I'm so sorry. I'm so sorry. Say that one more time. It was, it's not the Carrington 500 plan discount.
[AGENT][NEUTRAL] You would charge whatever you signed up with Carrington.
[AGENT][NEUTRAL] And then we would pay by usual and customary rate.
[AGENT][NEUTRAL] Like preventative is paid at 100% of usual and customary rate and basic is paid at 80%.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Um, is this a PPO policy?
[AGENT][NEUTRAL] There's no
[AGENT][NEUTRAL] It is through Carrington, but we do uh accept assignment to non-providers as well.
[CUSTOMER][NEUTRAL] What's the um claim address?
[AGENT][NEUTRAL] [PII] Box.
[AGENT][NEUTRAL] 248,950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 73 1 24.
[CUSTOMER][NEUTRAL] OK, let's see 2.
[CUSTOMER][NEUTRAL] I'm looking for it. Give me 1 2nd.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You said it was PO Box 248, what else?
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Yes, it's OK and what's the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Perfect. OK, and then what is the.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] What did you say?
[AGENT][NEUTRAL] I couldn't hear you.
[CUSTOMER][NEUTRAL] I said what was the, uh, you're OK, the deductible and maximum?
[AGENT][NEUTRAL] The deductible is $50 on everything except for preventative. The maximum would be $500.
[CUSTOMER][NEUTRAL] OK, um, has any of it been used?
[AGENT][NEUTRAL] Hold on just a moment, I'll check.
[AGENT][NEUTRAL] No, ma'am. She has no history.
[CUSTOMER][NEUTRAL] OK, um, is it a calendar contract?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK. And then is there any ortho coverage?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Right. And then what is the diagnostic, preventative, basic, and major group coverage?
[AGENT][NEUTRAL] Major is not covered at all under this policy endodontics periodontics or surgery, crowns, bridges, partials, dentures.
[AGENT][NEGATIVE] Implants are not covered.
[AGENT][NEUTRAL] Under Basic, it is basically the fillings and simple extractions. So preventative is paid at 100% of usual and customary rate and basic is paid at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said only simple extractions, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh no perio maintenance at all either.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloths?
[AGENT][NEGATIVE] It doesn't apply.
[CUSTOMER][NEUTRAL] OK, and then now I need frequencies. Do you want me to give you um the codes that I need or do you wanna go one by one?
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] OK, I, I can fax it to you and every code will be on that fax.
[CUSTOMER][NEUTRAL] OK, um, are crown, uh, crown crown and bridge restorations on Mueller's downgraded?
[AGENT][NEGATIVE] They're not covered.
[CUSTOMER][NEUTRAL] OK, um, and then you are posterior composite fillings downgraded?
[AGENT][NEUTRAL] We do not downgrade on anything.
[CUSTOMER][NEUTRAL] And then is predetermination mandatory?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And then how many quads in 24 hours or in one visit?
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you said there was no history on SRPs so um right because it's not covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh thanks, the benefits to you but.
[AGENT][NEUTRAL] Every code that's on there it has the uh frequency at on the last page.
[AGENT][NEGATIVE] If it's not on there, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll have our address, payer ID, and all of that on there as well.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye