AccountId: 011433970860
ContactId: 89045d87-531c-4298-b63e-a20e24a6176f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622500 ms
Total Talk Time (AGENT): 296084 ms
Total Talk Time (CUSTOMER): 161429 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/89045d87-531c-4298-b63e-a20e24a6176f_20250626T12:03_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey. Good morning, [PII]. I have a patient that is in our office right now. Um, I'm just trying to find out if he has any dental embedded in this medical plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're wanting to see if there are dental benefits included in his medical plan, is that correct?
[CUSTOMER][NEUTRAL] Correct, because the car just looks like it's medical, but I just wanna be sure.
[AGENT][NEUTRAL] Sure, yes, ma'am. I can help you with that. And first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's a direct line [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] It's D 49800058.
[AGENT][NEUTRAL] OK, now thank you, but [PII], that is not even an APO policy number. That is a 90 degree benefit number.
[CUSTOMER][NEUTRAL] Oh, I gave you the, that's the ID. So the policy number is 026421117.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] OK, so first off, any information [PII] that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, his name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, just for your information in our system, his name is [PII].
[AGENT][NEUTRAL] And then it looks like it cuts it off. Uh, we just have [PII].
[AGENT][NEUTRAL] Is there an ER on the end of it?
[CUSTOMER][NEUTRAL] Well, he gave us an ER. Let me see, his driver's license is scanned and he just showed up, um.
[AGENT][NEUTRAL] What did you
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, he's, yes, it's, he's [PII].
[AGENT][NEUTRAL] OK, so in our system, of course it's not enough space. The names for his full name, so it's [PII] is how it looks in our system. Now on the policy you gave me, that's his limited benefit plan number. He does have a separate policy that is dental with a different policy number, so give me just a second to get that information pulled up and I'll provide you that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and can I please ask you, [PII], um, just to know that he, he's in network with us at all and if he actually has out of network benefits if it is out of network?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I will be able to provide you that information in just a moment.
[AGENT][NEUTRAL] And is he gonna need a fax back of his benefits on his dental policy, [PII], or you're just needing to verify if it's active?
[CUSTOMER][NEUTRAL] Um, well, I need a full breakdown. Um, he's already in the chair. I don't know if that's something you can provide over the phone or not.
[AGENT][NEUTRAL] Well, it's a lot of information.
[AGENT][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment and let me get it pulled up and any information again that's provided will be a verification of benefits and not a guarantee of payment so one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can always just ask some of the basic main ones and then I can wait on a fax.
[AGENT][NEUTRAL] It's still loading some information for me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so he is a subscriber on this general policy and that policy number is 264.
[AGENT][NEUTRAL] 2119.
[AGENT][NEUTRAL] And this policy has an effective date of excuse me, [PII].
[AGENT][NEGATIVE] And as of now, there is no history on file.
[AGENT][NEUTRAL] And this plan participates in the Carrington PPO network. however, they are not required to utilize a Carrington provider.
[CUSTOMER][POSITIVE] Oh, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there um a group number associated with the plan?
[AGENT][NEUTRAL] There he is.
[AGENT][NEUTRAL] 70103.
[CUSTOMER][NEUTRAL] Um, 70173.
[AGENT][NEUTRAL] Correct. 2, I'm sorry, 7, let me see if I said that wrong.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 70103.
[CUSTOMER][NEUTRAL] OK, it's not Monday, is it? I feel like it's Monday for me.
[AGENT][NEUTRAL] It feels like every day has been Monday this week or [PII] the [PII].
[CUSTOMER][NEGATIVE] Oh gosh, yeah, don't say that.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, does it run on a calendar year? Does he have any?
[AGENT][NEUTRAL] Truth. I try to tell the truth, [PII]. I try to tell the truth. I love my job, but it's been like a [PII] every day this week. Um, this plan is a calendar year plan and has benefit maximum per calendar year for covered out or covered services is $750. That information will also be on the fax back with the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] 00 gosh. Oh.
[CUSTOMER][NEUTRAL] OK, does he have any waiting periods?
[AGENT][NEUTRAL] No, he doesn't, and this policy only has benefits for basic and preventative. No major and no, none of that, just basic and preventative.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] No endo. OK, does he, can I just ask you one last thing, um, does he, is he eligible for a [PII] exam?
[AGENT][NEUTRAL] That falls under basic, so that would be subject to the calendar year deductible and would be covered at 80% of the allowable.
[AGENT][NEUTRAL] Again we have no history on file for him.
[CUSTOMER][POSITIVE] OK, perfect, um.
[CUSTOMER][NEUTRAL] And then I can give you our number for the fax. I just wanna verify, um, did the claims go to the attention [PII]? OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh, no, ma'am, they don't. And our
[CUSTOMER][NEUTRAL] Oh, that's medical. OK.
[AGENT][NEUTRAL] That's medical and the claim's mailing address will also be on the fax back along with the payer ID and claims fax number.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Um, so yeah, I mean, do you still need it verbally?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, that's OK as long as it's on there, um, and then I can give you our fax number. Do you know if the faxes come over pretty quick?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, hopefully I'm fixing to send it to you right the second they go, you know, electronically, just one moment.
[CUSTOMER][POSITIVE] OK, perfect. OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is your fax number please, [PII]?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. And I'm just gonna repeat that back to make sure I heard you correctly. [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I have just sent that to you so you should be receiving that soon if you're nothing, not, you know, if we don't have some type of technical glitch and then one last thing, once you all do file a claim and it's been processed by APL, we have a portal, [PII], that you should be able to check his claim status in and the website that you would go to for that is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And did you say secure or secured with a D?
[AGENT][NEUTRAL] With ad on it with ad secured. a.
[CUSTOMER][NEUTRAL] OK, so [PII].
[AGENT][NEUTRAL] Yes, ma'am, that is it.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, well, it's
[CUSTOMER][POSITIVE] OK, well thank you so much, [PII].
[AGENT][POSITIVE] Well, you are very welcome. And is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Uh, no, that's it. Thank you. Bye-bye.
[AGENT][NEUTRAL] OK. Well, have a