AccountId: 011433970860
ContactId: 6f88ff3b-9168-4b45-b027-89592127faca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603219 ms
Total Talk Time (AGENT): 140827 ms
Total Talk Time (CUSTOMER): 83466 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/6f88ff3b-9168-4b45-b027-89592127faca_20250108T16:12_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I was calling. We have a patient coming in for a dentist appointment. We were calling to see if we can get a faxed back of his dental benefits.
[AGENT][NEUTRAL] Mhm. Sure, I can assist you with the faxack of benefits. And may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02569606
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, perfect. Thank you, Miss. And what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right. And this is gonna be to your attention?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. All right, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me repeat this number back to you. The fax number is [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, right, one moment please. I'm gonna put you on a brief hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, what is the max amount of benefits that, um, [PII] has?
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. The calendar year maximum is $500 per cover insurer with a $50 deductible and deductible does not apply to preventatives.
[CUSTOMER][NEUTRAL] OK, and then what percentage do you all cover for extractions?
[AGENT][NEUTRAL] Is it a simple extraction? 7140?
[CUSTOMER][NEUTRAL] It is a, let me see.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Um, we haven't seen them yet, so it's either gonna be a 7140 or a 7210.
[AGENT][NEUTRAL] OK, the only one we cover is 7140 because um we only cover um simple extraction. um major service is not covered under this policy. So the simple extraction is covered under 80%, which is the 7140.
[CUSTOMER][NEUTRAL] OK, and what, uh, on what the schedule are you all on?
[AGENT][NEUTRAL] If uh the
[CUSTOMER][NEUTRAL] Is this, uh, would that be on, go ahead.
[AGENT][NEUTRAL] If the provider participates for Carrington, we can, they can use that fee schedule Carrington PPO. If not, it's just gonna pay under the usual and customer rates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And on my fax back, is it gonna have um like a detailed breakdown or is it just gonna tell me how much the the patient has right now?
[AGENT][NEUTRAL] It's just gonna have a full breakdown of all the costs that are covered, percentages, amounts, frequencies, limitations.
[AGENT][NEUTRAL] Um, everything that is on the fax that is was covered. Um, it does have the mailing address, fax number, uh, electronic payer ID, um, common exclusions, uh, all that information is there. Um, it doesn't have the amount that is remaining, but it started all over again this year.
[AGENT][NEUTRAL] It's a calendar year benefit.
[CUSTOMER][NEUTRAL] Hm. And.
[CUSTOMER][NEUTRAL] OK, and is there do you guys have like a provider portal or is it just a call service?
[AGENT][NEUTRAL] Um, for benefits, it's gonna be for benefits and eligibility, it's just gonna be calling in.
[CUSTOMER][NEUTRAL] Got you, got you, OK, and how long does it take for the fax to come through?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In a few minutes if you don't get it within 15 minutes, just give us a call back and we can resend it again, but it should be there by then.
[CUSTOMER][POSITIVE] OK, well thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. Have a good day. It's fine.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.