AccountId: 011433970860
ContactId: 78da1d9c-7e60-4fb0-be7d-3f9ea5e8ead8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315239 ms
Total Talk Time (AGENT): 119389 ms
Total Talk Time (CUSTOMER): 127793 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/2025/06/10/78da1d9c-7e60-4fb0-be7d-3f9ea5e8ead8_20250610T17:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, this is [PII]. I'm calling from provider's office.
[AGENT][NEUTRAL] Hi [PII], how are you doing today?
[CUSTOMER][POSITIVE] Good. How are you doing?
[AGENT][POSITIVE] I'm doing good. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling to see if a patient has an active policy for dental.
[AGENT][NEUTRAL] OK, I can help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] and it's a direct number.
[CUSTOMER][NEUTRAL] And then the policy number they provided is 02606095.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] [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].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] [PII] and then what is the group name?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Creative Circle LLC.
[CUSTOMER][NEUTRAL] Creative circle. OK give me one second. Creative circle LLC LLC and this is, and this is through [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, this is on the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. Um, are you able to, um, let me know if the plan is a you said it was a PPO. I'm sorry, you just said that, right?
[AGENT][NEUTRAL] Mhm, it is.
[CUSTOMER][NEUTRAL] OK, and then the plan, um, I'm trying to see if somebody has it so we don't have to go through the whole thing. Give me one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need a copy of the fax back?
[CUSTOMER][POSITIVE] Um, yes, it's gonna be the dental benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I checked on the um her policy to see if there's any history, so there's no history on file, but on the fax back, you'll see the calendar year max, deductible, percentages, frequencies, exclusions, limitations, all the ways to file a claim, and then there's a list of covered codes. If the code you're looking for is not on this list, it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] OK. Would you be able to send me a fax back?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII] and you guys don't have a portal, do you?
[AGENT][NEUTRAL] We do, uh, in terms of like for providers, it will be for claim status.
[CUSTOMER][NEUTRAL] Oh, OK, but like do you benefit, you don't have anything?
[AGENT][NEUTRAL] Uh, that wouldn't be on the portal, not yet. Um, it, it's just the fax back that I'll send to you. It'll be a copy of that when it is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Um, OK, let me.
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said her effective date is on there as well. I heard you say earlier, but I totally didn't um write it down.
[AGENT][NEUTRAL] Um, no, the effective date isn't on there, but it's [PII].
[AGENT][NEUTRAL] Of [PII] and it's still active.
[CUSTOMER][NEUTRAL] [PII]. Well, uh, will the missing tooth cloths be on there?
[AGENT][NEUTRAL] Yes, that's part of the exclusion. So the missing tooth cloth, orthodontic treatment, implant, and TMJ services are all covered under all uh spoken about under the exclusions. Mhm.
[CUSTOMER][NEUTRAL] In the fact.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and then I think I have one more patient. Give me 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually this one is a different one. This one's uh Carrington through.
[CUSTOMER][NEUTRAL] Do you guys do through Cigna?
[AGENT][NEUTRAL] Cigna, no.
[CUSTOMER][NEUTRAL] This, no, OK, it's a different one. OK, I'll call this other one. OK, perfect. I'll just wait for the fax back. Do you know how long it takes?
[AGENT][NEUTRAL] Um, I've already sent it. So if you haven't received it by end of day today, let us know, um, and we can resend it, but we usually say to give it about an hour to receive.
[CUSTOMER][POSITIVE] An hour. OK. I'll keep it, I'll keep a lookout for it. Thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that'll be it. You have yourself a great day.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mm. Bye-bye.