AccountId: 011433970860
ContactId: a0de3a45-57b3-49a3-996c-0ec5447f00dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226720 ms
Total Talk Time (AGENT): 96887 ms
Total Talk Time (CUSTOMER): 106824 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/a0de3a45-57b3-49a3-996c-0ec5447f00dc_20250602T19:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Um, it's spelled [PII], I, I'm calling, uh, if I have specific questions regarding benefits for patients.
[AGENT][NEUTRAL] OK, I can help you with benefits. And may I please get your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mhm it's [PII]. Um, the facility name is La Prada Family Dentistry.
[AGENT][NEUTRAL] OK, and you said your name was [PII], [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] OK, thank you, Ms. [PII].
[AGENT][NEUTRAL] What is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth is [PII]. The policy number I have here is 02.
[CUSTOMER][NEUTRAL] 607-843.
[AGENT][NEUTRAL] OK, let me look her up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, I do show that [PII] does have an active policy. The effective date of her policy is [PII], and if you give me your fax number, I'll send you a fax back with the benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, OK, I did receive a fax already, um, so I was able to get some information on there, but I was just wondering I have like a couple specific questions.
[AGENT][POSITIVE] OK, sure, I can help you with your benefit questions.
[CUSTOMER][POSITIVE] Um, yes, so thank you. I would like to know the fillings downgrade to amalgam.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK, and then there's no major coverage, is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so it's only what's on the fax that's what's covered. um, I wasn't able to find 4341 like for the SRP.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, if there's a code that you're looking for that is not on the fax back then it's gonna be a non-covered procedure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it, got it. OK, and um does the annual max apply to the preventative?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, and then the fee schedule will be Carrington, um, we do have a new provider that's considered out of network right now. Does the policy accept assignment of benefits?
[AGENT][NEUTRAL] We don't do assignment of benefits, um, the insured can use any um carrier they want to use because we use the UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the schedule.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No matter who's sending it in.
[CUSTOMER][NEUTRAL] Mhm, OK, got it.
[CUSTOMER][POSITIVE] OK, thank you so much. I think that's all. Oh, I'm sorry, is there a group name or a group number for this policy?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am. Let me give you both. The group number is 70073.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It the group name is Vers Stella.
[AGENT][NEUTRAL] B E R S T E L A A Tara Services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Services, OK, I got that thank you so much. May I get a reference number from you?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], in today's date.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][POSITIVE] And today, OK, got it. Thank you so much. You have a good day.
[AGENT][POSITIVE] You too, Ms. [PII]. have a blessed one. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm