AccountId: 011433970860
ContactId: 7ae94b79-fcc6-495f-82aa-fc0a0e4514c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234619 ms
Total Talk Time (AGENT): 109910 ms
Total Talk Time (CUSTOMER): 74697 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/7ae94b79-fcc6-495f-82aa-fc0a0e4514c3_20250304T16:47_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, how are you calling from a dental office. We'd like to find out coverage and eligibility information for patients.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII], what is the policy number of the member that you're inquiring eligibility for today?
[CUSTOMER][NEUTRAL] 49069522
[AGENT][NEUTRAL] Is this a policy number showing or a social?
[CUSTOMER][NEUTRAL] Member member ID.
[AGENT][NEUTRAL] That's listed on the card.
[CUSTOMER][NEUTRAL] Yeah, there is a separate policy number as well.
[AGENT][NEUTRAL] OK, so that's not pulling up a policy here, so could you verify the policy number to make sure it's correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, it's a lot of zeros in the front. Let me count how many zeros.
[CUSTOMER][NEUTRAL] There are 500 in in the beginning followed by 2586.
[CUSTOMER][NEUTRAL] 433.
[AGENT][NEUTRAL] OK, so that's the policy number. I'm not sure what you provided me the first time.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] What is this member's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Spell her first name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what did you say her policy number was?
[CUSTOMER][NEUTRAL] 2586433 and then there's a lot of zeros in the beginning.
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You're calling to verify benefits and eligibility. This member's policy has been active since [PII] and is currently active.
[CUSTOMER][NEUTRAL] OK, um, what is the fee schedule that this, uh, plan pays on?
[AGENT][NEUTRAL] It's based on the UCR. This is a Carrington network. however, the member does not have to utilize the Carrington network provider because the policy is a PPO.
[CUSTOMER][NEUTRAL] OK, and what is the maximum per year?
[AGENT][NEUTRAL] The max per year is $500 per calendar year with a $50 deductible that does not apply to us preventative services and showing this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] It's $500 per year?
[AGENT][NEUTRAL] Yes, that is correct. The policy only covers preventative and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Basic services, no major endopperoprosthesis or surgery crowns, bridges or ortho is covered under the policy.
[CUSTOMER][NEUTRAL] OK, what is preventive cover that?
[AGENT][NEUTRAL] 100%.
[CUSTOMER][NEUTRAL] And basic
[AGENT][NEUTRAL] 80.
[CUSTOMER][NEUTRAL] OK, and where do we send claims to?
[AGENT][NEUTRAL] It'll be addressed to American public life.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. That's [PII], [PII]. We have a payer ID as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have a fax?
[AGENT][NEUTRAL] We do. [PII]. That's [PII].
[CUSTOMER][NEUTRAL] It's 866 you said?
[AGENT][NEUTRAL] I said 18, I said [PII].
[CUSTOMER][NEUTRAL] 800 or 8
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I appreciate your help thank you very much.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] That's all for now thank you.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks. Goodbye.