AccountId: 011433970860
ContactId: 7134ae18-3d2d-4d23-bc64-fba0ed19116e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377329 ms
Total Talk Time (AGENT): 188866 ms
Total Talk Time (CUSTOMER): 131775 ms
Interruptions: 3
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/7134ae18-3d2d-4d23-bc64-fba0ed19116e_20241230T17:25_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good I'm sorry, good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] No, good afternoon.
[CUSTOMER][NEUTRAL] I'm good. I'm good. uh, I'm calling from, uh, Merchant Square Dental. I'm just trying to check this breakdown for this patient.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] Same.
[AGENT][POSITIVE] Thank you, [PII] and a good call back number please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you, [PII]. And the policy number for the patient, please.
[CUSTOMER][NEUTRAL] I think I
[CUSTOMER][NEUTRAL] OK, it's 02573602.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And you were needing eligibility for [PII]?
[CUSTOMER][POSITIVE] Yes please, the effective date.
[AGENT][NEUTRAL] It would be my
[AGENT][POSITIVE] My pleasure to assist you, [PII]. The effective date for [PII] is [PII].
[CUSTOMER][NEUTRAL] OK, how much is the uh maximum allowance?
[AGENT][NEUTRAL] It now all benefits given over the phone is a verification of coverage, not a guarantee of payment. The maximum calendar year benefit is $500.
[CUSTOMER][NEUTRAL] OK, it's, uh, in, uh, how much money used with this patient?
[AGENT][NEGATIVE] As of right now, there's no history, nothing used, and nothing met.
[CUSTOMER][NEUTRAL] OK, and uh and uh deductible individual and family.
[AGENT][NEUTRAL] The the deductible is $500.
[AGENT][NEUTRAL] And it does not apply to preventive services, and that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, it's the individual is a 500.
[AGENT][NEUTRAL] And the individual benefit is $500 individual deductible is $50 up to $150 per family.
[CUSTOMER][NEUTRAL] OK, $50 and $150 for the family.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so preventative, basic and major all 100%.
[AGENT][NEUTRAL] Major is not an an included benefit on this policy. That does include oral surgery, prosthodontic repairs, endedontic services, and prosthodontic services.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so, so how much is preventative?
[AGENT][NEUTRAL] Preventative is 100%. Radiographs FMX basic and basic restorative is 80%.
[CUSTOMER][NEUTRAL] And major is 50 or 0?
[AGENT][NEUTRAL] Nature is not covered.
[CUSTOMER][NEUTRAL] Not score and not covered. OK, so age limit on fluoride and frequency.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do have a breakdown I can fax to you if you're interested in that as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has all the frequencies listed, um, limitations and the procedures that are covered. Would you would you like for me to fax that to you?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK.
[AGENT][POSITIVE] OK, let me just get that ready for you.
[CUSTOMER][NEUTRAL] So you want the fax number?
[AGENT][NEUTRAL] Yeah, what's that fax number, Sam?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] If you will bear with me just a minute, I'll go ahead and send that for you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, bear with me just one moment.
[AGENT][NEUTRAL] Just one moment now on the breakdown it will not have the group name and number.
[CUSTOMER][NEUTRAL] That's OK, what's the group name?
[CUSTOMER][NEUTRAL] In the summer time, we're gonna hold on OK.
[AGENT][NEUTRAL] Group name is Creative Circle.
[CUSTOMER][NEUTRAL] OK, and group number is?
[AGENT][NEUTRAL] The group number is 70,030.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And payer ID
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And free schedule goes with this?
[AGENT][NEUTRAL] Um, it participates in the Carrington PPO fee schedule but it's not required. We pay the same benefits both in and out of network.
[CUSTOMER][NEUTRAL] OK, yeah, OK.
[AGENT][NEUTRAL] And then can I just verify that fax number super quick? I'm sending this to [PII]. All right.
[CUSTOMER][NEUTRAL] OK 1 2nd.
[CUSTOMER][NEUTRAL] 986-091-5
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] That is on the way for you, [PII]. You should be receiving that breakdown shortly.
[CUSTOMER][NEUTRAL] Where.
[CUSTOMER][NEUTRAL] I I I'm on the phone.
[AGENT][NEUTRAL] Any, anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, so, uh, like there's no history, right for this patient.
[AGENT][NEUTRAL] That's correct, no history on file.
[CUSTOMER][NEUTRAL] And, and, and profy everything will be there on the fax like a frequency for prophy.
[AGENT][NEUTRAL] It will.
[CUSTOMER][NEUTRAL] And the FMX and panel, uh, do they share frequency.
[AGENT][POSITIVE] They do and the frequency is listed as well on the breakdown.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And our billing information is there as well. If you'll have the payer ID claim submission address, and fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, the few schedule you told me like PPO Carrington, right?
[AGENT][NEUTRAL] If you are a Carrington PPO network provider you use that fee schedule. If not, you'll use your own fee schedule and we pay according to the.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy guidelines.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][POSITIVE] No thank you so much thank you so much.
[AGENT][POSITIVE] Well, it's been my pleasure to assist you, [PII]. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.