AccountId: 011433970860
ContactId: 6abe6591-9539-41b3-aeb5-a808a93d2e3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454140 ms
Total Talk Time (AGENT): 170223 ms
Total Talk Time (CUSTOMER): 159663 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/6abe6591-9539-41b3-aeb5-a808a93d2e3e_20250604T18:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, ma'am. This is [PII]. I'm calling about the benefits. Can you help me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the benefits and [PII], for my notes, can you spell your first name for me and provide a good contact number?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] The callback number is [PII] and you're asking about the provider's name, is that correct?
[AGENT][NEUTRAL] No, I'm just asking you to spell your first name for me.
[CUSTOMER][NEUTRAL] Uh sorry, ran spells like [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, hold on one moment, please. Is this the uh policy or cert certificate number? 02623443?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] For the member, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax back or did you have particular questions about the fax back?
[CUSTOMER][NEUTRAL] Um, anyway, by the way, the patient is [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So wait a minute, so [PII] is not the patient?
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] OK, because this is an individual policy, only [PII] is covered.
[CUSTOMER][NEUTRAL] Oh, I see. So no other um member since this is an individual, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So since [PII] is only uh covered in here.
[CUSTOMER][NEUTRAL] Uh, let me gather the dental information, um.
[CUSTOMER][NEUTRAL] OK, before I proceed further, can you kindly check if Doctor [PII] is in working on the policy and wants to reschedule?
[AGENT][NEUTRAL] Um, this policy is on the Carrington PPO network. If you'd like to see if your provider is a Carrington provider, I do have their phone number to call, um, but the benefits are the same whether you're a Carrington provider or not.
[CUSTOMER][NEUTRAL] If we can use Carrington, then we are in network. If not, then we're out of network, right?
[AGENT][NEUTRAL] There's no out of network benefits. If you're a Carrington provider, there's an additional uh discount. If you're not, you just don't get the discount, but the benefits are the same.
[CUSTOMER][NEUTRAL] OK, um, is there, I'm sorry, just would like to confirm, is there an out of network benefits for this for this plan?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] There's no out of network.
[CUSTOMER][NEUTRAL] Is that right? No. So, so for example, for example, if you're not in network with Carrington, so we do not, the patient doesn't have any or doctor doesn't have any coverage on, I'm sorry, what do you call this?
[CUSTOMER][POSITIVE] So patient
[CUSTOMER][NEGATIVE] Dental benefit is not.
[CUSTOMER][NEUTRAL] Um, eligible for Doctor [PII]. Is that right?
[AGENT][NEGATIVE] No, that's not correct.
[AGENT][NEUTRAL] If your doctor is a Carrington or if your dentist is a Carrington dentist, there's a percentage that the patient gets off of the bill.
[AGENT][NEUTRAL] If your provider is not a Carrington provider, the patient does not get that percentage. The benefits do not change. The benefits are the same. There's no in or out of network, it's one set of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK, thank you. Um, is there a, uh, what I'm sorry, what is the coordination and benefits?
[AGENT][NEUTRAL] Um, there's no coordination of benefits.
[CUSTOMER][NEUTRAL] No, it will be is is a calendar year plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, may I have the, uh, yearly maximum and the deductibles, please?
[AGENT][NEUTRAL] Is it for [PII]?
[CUSTOMER][NEUTRAL] Uh, for [PII].
[AGENT][NEUTRAL] The calendar year max is $500.
[AGENT][NEUTRAL] And the deductible is $50.
[CUSTOMER][NEUTRAL] Is very
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Sorry, go ahead, it's OK, go ahead.
[AGENT][NEUTRAL] The deductible is $50 per person up to $150 per family.
[AGENT][NEGATIVE] And it doesn't apply to preventative.
[CUSTOMER][POSITIVE] Alright, awesome. Is there a waiting period in missing the bus?
[AGENT][NEUTRAL] There is a missing tooth cloth, there is no waiting period.
[CUSTOMER][NEUTRAL] Is there an or coverage?
[AGENT][NEUTRAL] Um, there's no orthodontic treatment.
[CUSTOMER][NEUTRAL] Alright, no worries. So may I have the coinsurance for preventive basic and major?
[AGENT][NEUTRAL] Sure, major is not covered on this policy. Preventative is covered at 100%.
[AGENT][NEUTRAL] Basic, basic restorative and radiograph and FMX expenses are all at 80%.
[CUSTOMER][NEUTRAL] Uh, no major coverage, is that right?
[AGENT][NEUTRAL] Correct. Major for us includes endodontic, perdontic, prosodontic, and oral surgery codes.
[CUSTOMER][NEUTRAL] Can you send me the copy benefits via fax, please?
[AGENT][POSITIVE] Yes, it's a good fax number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And does that need to be attention ran?
[CUSTOMER][NEUTRAL] Uh, no, it's OK.
[AGENT][NEUTRAL] Alright, that was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, and I'm sending that over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, last question, is there any history on file for the, for [PII]?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, no, there's no history on file yet.
[CUSTOMER][NEUTRAL] And I'm sorry, I just have a couple of questions in regarding with the policy though my apology, um, in regarding with the exam all type of exam shares frequency.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All types of exams share frequency. Um, for all evaluations code 120, 140, 150, and 60 share frequency or um per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about the 0 180?
[AGENT][NEUTRAL] No, just 1 2040, 50, and 60.
[CUSTOMER][POSITIVE] OK, anyway, uh, that will be all, ma'am. Thank you for your help. I really appreciate that. Bye for now.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day.
[AGENT][NEUTRAL] Bye-bye.