AccountId: 011433970860
ContactId: 93015fbc-6d57-4c4a-be66-675c503144ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379890 ms
Total Talk Time (AGENT): 144506 ms
Total Talk Time (CUSTOMER): 153609 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/93015fbc-6d57-4c4a-be66-675c503144ba_20250212T15:59_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, and uh, uh, my name is [PII]. I'm calling to verify your patient's dental coverage.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the dental coverage. Are you saying in terms of eligibility or you'd like to go over the benefits as well, or both?
[CUSTOMER][NEUTRAL] Yes, both.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, direct number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, policy number is 011.
[CUSTOMER][NEUTRAL] 395738.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was 011395738?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Yeah, that one is incorrect. The representative gave me, um, I think that's 5 consecutive zeros and then 249.
[CUSTOMER][NEUTRAL] 8731.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, this is for um [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And hold on one moment, let me see what type of policy they have.
[AGENT][NEUTRAL] OK, and did you need a copy of the fax back sent over to you or you have particular questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I want a copy of fax back and yes, I do have specific questions. Yeah, usually it's not indicated there, so, yeah, that's why I need to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Call uh do you need the uh fax number?
[AGENT][NEUTRAL] OK, that's fine. I can fax it to you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh sorry. OK. 657.
[CUSTOMER][NEUTRAL] 888-724-3.
[AGENT][NEUTRAL] And that's attention Gladys?
[CUSTOMER][POSITIVE] Yes please thank you.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm sending that to you now and then what questions did you have as well?
[CUSTOMER][NEUTRAL] Um, yeah, first, is that, um, yeah, the previous representative was unable to pull up our, uh, contract. Can you please reverify if we are really out of network with this policy?
[AGENT][NEUTRAL] Um, that's through Carrington. Carrington is a different company than us. Um, the, the plan is a Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, all right, does the plan runs on the calendar here?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. [PII] that's the renewal date.
[CUSTOMER][NEUTRAL] And does it, do you know if the fax pack includes the annual max use amount and deductible?
[AGENT][NEUTRAL] Yes, it has the annual max, the deductible, the percentages, frequencies, exclusions, um, all the ways to file a claim and then a list of covered codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if the code that you're looking for is not on the list, it's not covered by the policy.
[CUSTOMER][POSITIVE] Oh perfect.
[CUSTOMER][NEUTRAL] OK. That, that, that will be great. And um is the plan, I mean, is the policy as missing class or uh waiting period?
[AGENT][NEUTRAL] There's no waiting period because major services are not included on this policy. Major for us includes endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] And it does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you. It, the missing tooth cloth, is it permanent?
[AGENT][NEGATIVE] Is it permanent? It doesn't specify, just, uh, so this policy does have a missing tooth cloth.
[CUSTOMER][NEUTRAL] Our lifetime.
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, you said major services are not covered.
[CUSTOMER][NEUTRAL] In the dantix, periodontics, and oral surgery. Yeah, I think.
[CUSTOMER][NEGATIVE] Also have to return that. How about RFL?
[AGENT][NEUTRAL] Or so it's not covered on the policy?
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][POSITIVE] OK, got you, thank you.
[CUSTOMER][NEUTRAL] So, that would be, I think I'm just gonna get the history on file, please. If there is any that can affect the frequency.
[AGENT][NEUTRAL] Um, so for history, we, let me, let me, hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so there's no history on file. We haven't processed any claims yet.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, I'm just rechecking the form. Give me one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] It's only 4. All right. I think that's it. Thank you, [PII]. And can I get the reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, my name is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Alright thank you so much have a good one.
[AGENT][POSITIVE] You also, Gladys and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.