AccountId: 011433970860
ContactId: 73fec41b-b857-496e-b466-4b3654cf2af5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293660 ms
Total Talk Time (AGENT): 129992 ms
Total Talk Time (CUSTOMER): 118633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/73fec41b-b857-496e-b466-4b3654cf2af5_20250326T17:40_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental office. I was just trying to verify um.
[CUSTOMER][NEUTRAL] Dental eligibility and benefits for patients.
[AGENT][NEUTRAL] OK, well, I can help you with both the eligibility and the benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh yes, contact number [PII] and.
[CUSTOMER][NEUTRAL] It's the policy number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, policy number.
[CUSTOMER][NEUTRAL] 02606086
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] This is gonna be for [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. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need like a copy of the fax back or you have particular questions about it?
[CUSTOMER][NEUTRAL] Is this like um is this an HMO plan or a PPO plan?
[AGENT][NEUTRAL] Um, this particular policy is on the Carrington PPL network. Um, however, if the provider is not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] OK, so we are a Carrington provider. Um, so how does, what, I'm just not familiar with this insurance. Is it one like it pays a percentage or do we go off of the Carrington fee schedule?
[AGENT][NEUTRAL] Um, so a little both. So it's, it's a standard Carrington fee schedule. Um, the policy covers preventative and basic, um, also radiographs and FMX. Preventative is at 100%, everything else is at 80%, um, and then the fax that will show you like the frequency and all the exclusions, and there's a list of covered codes and if the code you're looking for isn't on this list, it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But there's no like coordination of benefits or anything if they have another dental policy.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] All right, and then, um, can I get a a fax pack of benefits or or uh benefits.
[AGENT][NEUTRAL] Of course, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, that's fine.
[AGENT][NEUTRAL] OK, and it was [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] All right, so I'm sending this over to you now. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, one, and then what fee schedule do we go off of for this one? I know you said the Carrington, but I have like 3 different Carrington fee schedules.
[AGENT][NEUTRAL] Um, uh.
[AGENT][NEUTRAL] What's the options?
[AGENT][NEUTRAL] Like what's the 3.
[CUSTOMER][NEUTRAL] Uh, let's see, I have.
[CUSTOMER][NEUTRAL] Let me get them pulled up, uh, insurance schedule. OK, I have.
[CUSTOMER][NEUTRAL] I have a Carrington POS, uh, I have a Carrington Platinum.
[CUSTOMER][NEUTRAL] Uh, let's see if I can move this over.
[CUSTOMER][NEUTRAL] This is the platinum. I have a Carrington RHRP, so it's the platinum. Then there's just the regular.
[CUSTOMER][NEUTRAL] I guess the regular Carrington, the CIA.
[AGENT][NEUTRAL] I would just use the
[AGENT][NEUTRAL] Yeah, I would just use the um because the other ones don't.
[AGENT][NEUTRAL] It's not specified on the policies. I would just, yeah, I would just put the standard Carrington. Um, it is the PPO network, but
[CUSTOMER][NEUTRAL] Sounds familiar?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] It doesn't have those that you mentioned, so I don't wanna say that, and it's not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's OK. And then, uh, last thing I was gonna ask is, um, is there a payer ID number that we should use for claims?
[AGENT][NEUTRAL] Yes, our payer ID is 60801.
[CUSTOMER][POSITIVE] Perfect. OK, OK, that should do it then.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, nope, that's it. Thank you so much for all your help.
[AGENT][NEUTRAL] You're very welcome. Well, thanks for calling APL. I have already sent the um fax to you, but the box just popped up again, so you might get two copies because I just sent it again.
[CUSTOMER][POSITIVE] Oh, OK, all right, I'll be on the lookout. Thank you so much.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling API. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.