AccountId: 011433970860
ContactId: a29c561a-68c4-4621-afb7-deefc1fc6b5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260019 ms
Total Talk Time (AGENT): 111340 ms
Total Talk Time (CUSTOMER): 99382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/a29c561a-68c4-4621-afb7-deefc1fc6b5f_20250114T19:32_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from a provider's office, and I have a patient that is saying she has this insurance. I'm just trying to say we network.
[AGENT][NEUTRAL] Can you provide me with the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] callback number [PII].
[AGENT][NEUTRAL] Thank you. And can I have the policy number of the member?
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] I don't have the policy number I have her social.
[AGENT][NEUTRAL] What is the social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is this member's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're calling about dental or medical?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] Can you verify her um date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And this policy is a is a Carrington policy. However, she does not have to utilize the Carrington network provider because the policy is a PPO, but I can't verify if you're in network, but I can transfer you to Carrington if you would like.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So everything has to go through [PII]?
[AGENT][NEUTRAL] No, this, the network is through [PII].
[AGENT][NEUTRAL] You said that you wanted to verify if you were in network, but do you want to verify benefits because I can verify benefits for you. I just can't verify if you're in network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me check the network first. Well, no, actually, let's do the benefits. I'm sorry, yeah, go ahead. What are the benefits?
[AGENT][NEUTRAL] This member's policy has been active since August, I'm sorry, since [PII] and is currently active. She has a maximum benefit amount of $500 per calendar year.
[AGENT][NEUTRAL] With a $50 deductible that does not apply to preventative services, and this is not a guaranteed benefits that's a disclaimer of the policy's coverage. So her policy basically only covers preventative at 100 and basic at 80. No major endopperiorosthesis or surgery crowns, bridges orthos.
[AGENT][NEUTRAL] Carryo in though none of that is covered under the policy and nor does it fall on the basic services.
[CUSTOMER][NEUTRAL] So no peria no and uh no oral surgery.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And just basic. So does that include fillings?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Fillings, simple extractions, and X-rays.
[CUSTOMER][NEUTRAL] Simple.
[CUSTOMER][NEUTRAL] Do the fillings sound great?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] And no waiting periods and no missing tooth claws?
[AGENT][NEGATIVE] There is a missing tooth cloth, however, [PII]. I'm not sure why there's one because nothing major is covered under the policy.
[CUSTOMER][NEUTRAL] Oh, OK, so no period no end no surgery, no prosthetics.
[CUSTOMER][NEUTRAL] OK, so it's a pretty simple plan I guess.
[AGENT][NEUTRAL] Mhm. Very simple.
[CUSTOMER][NEUTRAL] 500, um, and the 500, does that apply to preventative?
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, can you give me a reference number please? Or is there something that I can get faxed over?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] It is 888.
[CUSTOMER][NEUTRAL] 505-595-8
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Yeah, would that include the claims address?
[AGENT][NEUTRAL] Yes, so we have the claims address, the payer ID, and a fax number.
[CUSTOMER][POSITIVE] OK perfect and that's gonna be sent soon?
[AGENT][NEUTRAL] Yes, it will be.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Would you like for me to transfer you over to [PII]?
[CUSTOMER][NEUTRAL] Um, no, but can I get a reference number please?
[AGENT][NEUTRAL] We don't provide those unfortunately, but you can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK thank you have a good day.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL Jos and you have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.