AccountId: 011433970860
ContactId: 9538be2e-fa60-4eb9-b37b-b39c4d65fd6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445510 ms
Total Talk Time (AGENT): 214523 ms
Total Talk Time (CUSTOMER): 206487 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/9538be2e-fa60-4eb9-b37b-b39c4d65fd6c_20250514T18:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a dental office provider. I have a new patient coming in for the first time and I never heard of your insurance before, so I just wanna make sure that, uh, I get some information from you please if possible.
[AGENT][NEUTRAL] OK, [PII], so you said this was for dental. Is that correct?
[CUSTOMER][NEUTRAL] Yes, mhm, mhm, yes.
[AGENT][NEUTRAL] OK, yes ma'am, so you're needing eligibility and benefit information for members, is that also correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], on our dental policies, we have fax backs with the member's benefit information on them that I'll be happy to fax over to you.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, and what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK, so let me, OK, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII] is that you want a phone call number or a fax back number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The first thing I need is your phone number.
[CUSTOMER][NEUTRAL] OK, [PII] at the end, yep, mhm, so it's [PII].
[AGENT][NEUTRAL] Is that the phone number?
[AGENT][POSITIVE] OK, thank you and the members.
[AGENT][NEUTRAL] Uh-huh. OK, thank you. And the policy number for the member?
[CUSTOMER][NEUTRAL] Sure, it's gonna be 02544413.
[AGENT][NEUTRAL] OK, thank you, so give me a moment to get that information pulled up please.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and containing any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see, um, it's gonna be um [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And his date of birth, please?
[CUSTOMER][NEUTRAL] And his OK and his date of birth is going to be [PII].
[AGENT][NEUTRAL] OK. And [PII], do you spell your name with a [PII] or a [PII]?
[CUSTOMER][NEUTRAL] You got it with a [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. [PII], is that correct?
[CUSTOMER][POSITIVE] You're welcome. You got it, yep, you got it.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so I do show that Mr. [PII] is the subscriber on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now can I ask you a quick question, is this a PPO plan?
[AGENT][NEUTRAL] And we do not have any history on file. This this plan participates in the caring yes, no history.
[CUSTOMER][NEUTRAL] OK, no history? OK.
[AGENT][NEUTRAL] The plan participates in the Carrington PPO network. however, they are not required to use a Carrington provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, but so he can, he can be seen. OK, that's fine. OK, current provider, OK, OK. And so you said, so he got, you have no history of FMX on him, correct? No history at all? OK.
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is correct. We have no history at all on correct, since the policy went into effect with us.
[CUSTOMER][NEUTRAL] OK, and then uh what fees?
[CUSTOMER][NEUTRAL] And what fees do you guys cover a usual customary fees or a schedule fee?
[AGENT][NEUTRAL] Yes, it's based off of the, um, Carrington fee schedule.
[CUSTOMER][NEUTRAL] Carrington
[CUSTOMER][NEUTRAL] The schedule now does the patient have a hold of that?
[CUSTOMER][NEUTRAL] Does the patient have access to that so that way they know have an idea of how much the insurance carry and so can they get, can they go online to have that access to them for themselves to know?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, they can't. No.
[AGENT][NEUTRAL] There's no way for them to know that, no, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, I'll let them know. OK, and then, uh, what else do I need to know? OK, so, uh, what else I need to know? I pretty much got everything else you said, and then the checks, do the checks come to us, to the provider office, or does the patient get billed? I mean, get that receive the checks for the payments.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's typically to whomever files the claim unless there is something different on the assignment of benefits listed on the claim form.
[CUSTOMER][NEUTRAL] OK, and is it scheduled from January to December?
[AGENT][NEUTRAL] Yes ma'am, it's a calendar year and that it does say that on the um fax back as well.
[CUSTOMER][NEUTRAL] OK, and just a couple more things and I'll let you go uh what is his yearly max?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $500 for covered services with a $50 calendar year deductible.
[CUSTOMER][NEUTRAL] 0 $50 also it's not that OK now, uh, OK, I see what you're saying. Yeah, we might have to have them pay up, yeah, OK, and then on the printout that you gave me is gonna tell you per uh huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] And there's no, there's no coverage. There's no benefits for any type of major services. It is only for preventative and basic.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] OK, hold on, prevent it, thank you. That's what I need to know that I'm feeling.
[AGENT][NEUTRAL] And that information is also, yeah, all that's on there, on the fax that. Mhm, it is.
[CUSTOMER][NEUTRAL] On the printer? OK.
[CUSTOMER][POSITIVE] OK, you're awesome love. Can I get a reference number for today's call, please?
[AGENT][NEUTRAL] Sure. Well, can I get your fax number first so that I can send this to you if you'd like?
[CUSTOMER][POSITIVE] Oh yes, oh girl, I'm gonna, yes please. Oh yes, I really much need that 510595-4311.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And does it need to be put to?
[CUSTOMER][NEUTRAL] So it's 510595, yeah, it doesn't matter whoever it's fine.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So I'm just gonna repeat it. 510595-4311.
[CUSTOMER][NEUTRAL] think we put some money.
[CUSTOMER][POSITIVE] You got it love you're awesome thank you so much.
[AGENT][NEUTRAL] Well, you are certainly welcome. And then one last thing, [PII], um, if you will end up seeing the patient and filing a claim with us, once the claim has been processed by APL, we do have a portal in which you should be able to check claim status for him, and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, OK, I do see that here in the back of the card it says it right here. OK, well thank you so much. I really appreciate you, you've been more than a help. OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, you're very welcome. Oh, well, you're very welcome. So again, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, I'm just, I'll wait for the fax. Thank you so much. How long do you think the the fax is gonna take, uh, um, to come in?
[AGENT][NEUTRAL] Uh, well, because it goes through our computer system, it may take a few minutes, but I've already sent it. I've already, it's, it's on its way. It's in the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I appreciate you. Thank you so so much. I appreciate you. OK, bye-bye. Thanks.
[AGENT][POSITIVE] OK. Well, you're welcome. And again, [PII], thank you for calling APL. Bye-bye.