AccountId: 011433970860
ContactId: 8fc75dcc-a744-4a4b-b62e-bf2dd7dd02f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350570 ms
Total Talk Time (AGENT): 132209 ms
Total Talk Time (CUSTOMER): 91088 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/8fc75dcc-a744-4a4b-b62e-bf2dd7dd02f0_20250127T16:32_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. We were just calling on behalf of a patient.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][POSITIVE] All right. Well, it would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] And a good call back number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is Ms. [PII]'s policy number?
[CUSTOMER][NEUTRAL] 00616609
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And are you needing a breakdown or?
[CUSTOMER][NEUTRAL] Um, eligible and benefits.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I can help you with that. Bear with my computer just a minute.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Or 2
[AGENT][NEUTRAL] I apologize, bear with me just a second.
[AGENT][POSITIVE] OK, fine, thank you for your patience. I appreciate that.
[AGENT][NEUTRAL] Can you see I'm showing that [PII]'s policy is active. Effective date is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] This is a Carrington PPO policy option A.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I do have a breakdown I can fax to you.
[CUSTOMER][NEUTRAL] And what?
[CUSTOMER][NEUTRAL] Do you have the annual maximum?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, it is a $1000 calendar year max. Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, and what's the remaining balance?
[AGENT][NEUTRAL] For [PII], let me get that for you.
[AGENT][NEUTRAL] For [PII], she has a full benefit remaining.
[CUSTOMER][NEUTRAL] OK, and what's the annual deductible?
[AGENT][NEGATIVE] There is a $50 deductible. It does not apply to exam exams or pro fees. She has not met her deductible for [PII].
[CUSTOMER][NEUTRAL] OK, and what's the remaining?
[CUSTOMER][NEUTRAL] OK, and then the preventive and diagnostic.
[AGENT][NEUTRAL] Uh, it's a, it's a speed schedule.
[CUSTOMER][NEUTRAL] Yeah, the percentages of the preventive and diagnostic and then basic and major.
[AGENT][NEUTRAL] So there's no percentages, it is a benefit amount that is paid for the policy guidelines.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is that?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Like 150, 80 or.
[AGENT][NEUTRAL] There's no percentages.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So when you get this breakdown.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is, give me a, a CPT code and I'll tell you.
[AGENT][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Um, let's let me see.
[CUSTOMER][NEUTRAL] [PII] I think.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Or just for an example for the [PII], the oral examination, the benefit amount we pay is $25.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it's not paid as a percentage.
[CUSTOMER][NEUTRAL] OK, it'd be D3348.
[AGENT][NEUTRAL] 334 8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Actually, that is not a listed benefit on her plan.
[AGENT][NEUTRAL] So that would be non-covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] But I can send you this breakdown, and on the left hand side of the breakdown are the procedure codes, and then all the way to the right is the benefit amount that we would pay for that procedure.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I guess you can just send that um.
[CUSTOMER][NEUTRAL] Send it to [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I will get that right over to you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No ma'am, that's all thank you.
[AGENT][POSITIVE] And thank you for calling APL. You have a wonderful day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.