AccountId: 011433970860
ContactId: 9058a96f-32cb-4a95-96f4-3cb90d84f839
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524460 ms
Total Talk Time (AGENT): 181103 ms
Total Talk Time (CUSTOMER): 220950 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/9058a96f-32cb-4a95-96f4-3cb90d84f839_20250325T19:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. I'm calling you today from the provider's office to check the eligibility and benefits for a specific patient on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] I can help you with that. Do you have a callback number?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Sure. Uh, it is 511.
[CUSTOMER][NEUTRAL] 116,680.
[AGENT][NEUTRAL] Is that the social security number? That's too many numbers for our policy number.
[CUSTOMER][NEUTRAL] Uh, yes, absolutely. [PII], the patient has given us this particular ID and uh the patient states that this is also the social security number.
[AGENT][NEUTRAL] OK, what is the name?
[CUSTOMER][NEUTRAL] Sure. The name of the patient is [PII].
[AGENT][NEUTRAL] And the date of
[CUSTOMER][NEUTRAL] Do you want me to spell the name for you?
[AGENT][NEUTRAL] You do not have to. What's the date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, I can help you with that. The policy number is 02.
[AGENT][NEUTRAL] 609329
[CUSTOMER][POSITIVE] Thank you so much. I'll repeat that for you once again. It is 02609329. Am I correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Great. Please go ahead with the effective date of the policy.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. Is this a single policy or family policy plan?
[AGENT][NEUTRAL] And any
[AGENT][NEUTRAL] Single
[CUSTOMER][POSITIVE] Thank you. Can you help me with the group name and the number, please?
[AGENT][NEUTRAL] The group number is 70062.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The name is the WorkSource.
[AGENT][NEUTRAL] Incorporated.
[CUSTOMER][NEUTRAL] Uh it is Work Stores, correct? S T O R E S.
[AGENT][NEUTRAL] No, S O U R C E source.
[CUSTOMER][NEUTRAL] OK. The work source.
[AGENT][NEUTRAL] Incorporated
[CUSTOMER][NEUTRAL] Incorporate.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Great. And um
[CUSTOMER][NEUTRAL] What about the provider details if you can please verify whether the provider is in network or this plan basically accepts any provider.
[AGENT][NEUTRAL] We do not, we do have a list of providers that go through Carrington, so it would depend on if you all are Carrington provider, we do not have that list here. I can give you their phone number if you do not know if you're a Carrington provider, you can call them and ask them if you all are providers, but we do accept non-providers as well.
[CUSTOMER][POSITIVE] Excellent. Thank you so much, [PII]. What about the
[CUSTOMER][NEUTRAL] Claims mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Amazing. I do appreciate that. What about the deductibles and the annrollments on the policy?
[AGENT][NEUTRAL] There's a $50 deductible on everything except for preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on just a moment, let me look up the maximum for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, the calendar year maximum is gonna be 500 and that applies to everything.
[CUSTOMER][NEUTRAL] Great. Is this, uh, basically the calendar year plan. What about orthodontics? Is this patient eligible for orthodontics?
[AGENT][NEGATIVE] Ortho is not covered and major work is not covered, so.
[AGENT][NEUTRAL] Endoontics, periodontics, oral surgery, crowns, bridges, partials, dentures, all of that is not covered. It's only for preventative and basic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you understand? So, end of period or surgery are not covered. Crowns, bridges, dentures, and implants are also not covered, correct?
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Thank you. What about the co-insurance for preventative and basic services?
[AGENT][NEUTRAL] Preventative is a 100% the usual and customary rate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic is at 80%.
[CUSTOMER][POSITIVE] Thank you very much. What about simple extractions? Are they covered on the policy?
[AGENT][NEUTRAL] They are covered under basic.
[CUSTOMER][NEUTRAL] 80%. Thank you. OK. And um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you also help me with any downgrades? Do we have any downgrades on the policy for billing?
[AGENT][NEUTRAL] We do not downgrade on anything.
[CUSTOMER][NEUTRAL] Thank you. Any missing tooth cloth or waiting period on the policy?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. Predetermination, is it mandatory or suggested?
[AGENT][NEUTRAL] Neither.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Now coming to the last set of questions, I do have some courses with me. If you can please help me with the frequency and the age limits.
[AGENT][NEUTRAL] OK, how many do you have?
[CUSTOMER][NEUTRAL] I hardly have 9 coats, 9 to 10 coats.
[AGENT][NEUTRAL] OK, I can fax you that schedule.
[CUSTOMER][NEUTRAL] OK. Uh, I, I just, you know, I have the appointment [PII] in the next 5 minutes. So is it possible for you to help me on call itself? Because I hardly have, uh, only preventative and basic quotes.
[AGENT][POSITIVE] I can help you this time, yes.
[CUSTOMER][POSITIVE] It would be very kind of you.
[CUSTOMER][POSITIVE] Thank you so much for being so kind. So the first one which I do have is 0120, which is exams.
[AGENT][NEUTRAL] All exams are 2 for 12 months.
[CUSTOMER][POSITIVE] Excellent. What about cleanings, 1110?
[AGENT][NEUTRAL] Every 6 months.
[CUSTOMER][NEUTRAL] What about Byte wings 0274?
[AGENT][NEUTRAL] They are under basic and they're every 12 months. I mean, they're under prevented, I'm sorry, in every 12 months.
[CUSTOMER][POSITIVE] Excellent. What about FMX 0210?
[AGENT][NEUTRAL] Basic.
[AGENT][NEUTRAL] They combined with the 330 and the 277 and they're every 5 years.
[CUSTOMER][POSITIVE] Thank you so much. What about 1208, right?
[AGENT][NEUTRAL] Every 12 months for children under [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you so much. What about uh 491?
[AGENT][NEUTRAL] If it's any period, it's not covered.
[CUSTOMER][NEUTRAL] OK. So period is basically not covered. Thank you. What about the 4341, is that covered? Even that is not covered, correct?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] What about 0431?
[CUSTOMER][NEUTRAL] Oral cancer screening, is that a covered benefit?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][NEUTRAL] Oh, thank you. What about sealants 1351?
[AGENT][NEUTRAL] Only for children under [PII].
[CUSTOMER][POSITIVE] Amazing. Thank you so much, [PII]. I think that this answers all my questions today. And uh if you can please help me with the caller reference number for this patient.
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Amazing. Thank you, [PII], for helping me today with this patient. And uh you have a blessed day ahead. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APLU as well. Bye-bye.