AccountId: 011433970860
ContactId: 7dc349e5-098f-4fcc-8b34-9268ed87502f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370109 ms
Total Talk Time (AGENT): 135737 ms
Total Talk Time (CUSTOMER): 80639 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/7dc349e5-098f-4fcc-8b34-9268ed87502f_20250512T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I needed to get a breakdown of dental benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with benefits for a patient. May I please get your name and your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] And Modesto Oral Surgery [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 02569980.
[CUSTOMER][NEUTRAL] And patient is [PII], [PII].
[AGENT][NEUTRAL] OK, let me look up [PII] real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, I am showing that [PII] does have an active policy with us. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And if you can give me your fax number I'll send you a fax back with the benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'll give you that 1st, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm assuming we're out of network, but I wanna just double check.
[AGENT][NEUTRAL] OK. All right. I will check that for you. Actually, um, on this policy, they can use anybody they want to use.
[AGENT][NEUTRAL] Uh, it is associated with Carrington, but they do not have to use a Carrington network provider. They can use anybody. Um, the fee schedule is gonna be, um, UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I'm gonna do is I'm gonna put you on a quick hold while I get that fax ready for you so that you can have the complete benefit breakdown and the schedule, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][NEUTRAL] All right. You're very welcome, Ms. [PII]. It's gonna be a quick hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You are.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that uh fax on its way to you now, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I'll see what's on there and call back for what's not.
[AGENT][NEUTRAL] OK, if there's a procedure that you're looking for a code that you're looking for on the fax back if it's not listed, then it's noncovered.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got that. You know, one thing I can ask that's never on the fax backs are we required to build medical for any anesthesia or oral surgery?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like to bill medical first.
[AGENT][NEUTRAL] Uh, the
[AGENT][NEUTRAL] Right. So the um policy itself, this particular policy only covers um preventative, basic, and basic restorative. It does not have any medical benefits and it just goes by the CDT code.
[AGENT][NEGATIVE] So if it's something that is not listed under the CDT code, then it's not covered by the policy at all.
[CUSTOMER][NEUTRAL] But we're not required to build their medical plan first for anything we can bill it straight to dental.
[AGENT][NEUTRAL] No, ma'am. Right.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Awesome, OK, I just need a reference number please.
[AGENT][NEUTRAL] OK. You can use my name. It's [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful week, Ms. [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.