AccountId: 011433970860
ContactId: a45384ec-804c-4752-8845-da8ca93f05df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 404970 ms
Total Talk Time (AGENT): 167548 ms
Total Talk Time (CUSTOMER): 162976 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/a45384ec-804c-4752-8845-da8ca93f05df_20250519T16:18_UTC.wav
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[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Hi, how are you? I need to um verify a patient's benefits.
[AGENT][POSITIVE] OK, I can get those benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell that for me? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, um, I, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] So it's um [PII].
[AGENT][NEUTRAL] Thank you, do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number um sure I do, so it's 02625526.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] So it's [PII] and it's 53086. Now the policy number, is that his um member ID number?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Uh, so, so what is the group number?
[AGENT][NEUTRAL] Uh, go one moment, let me get that for you.
[AGENT][NEUTRAL] Uh, group number for this number is 70094.
[CUSTOMER][NEUTRAL] And what is the group name?
[AGENT][NEUTRAL] So it's Noor, that's N 00 R Staffing group LLC.
[CUSTOMER][NEUTRAL] Can you say fasting?
[AGENT][NEUTRAL] Uh, staffing, so S T A F F I N G.
[CUSTOMER][NEUTRAL] Alright, and N like Nancy, O like orange, O like orange, R like Robert Staffing LLC?
[AGENT][NEUTRAL] Staffing group LLC.
[CUSTOMER][NEUTRAL] 00, staffing group, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] All right and um and what's the fee schedule?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So give me just a minute let me get this one pulled up um.
[CUSTOMER][NEUTRAL] Yeah, what is the name of the fee schedule?
[AGENT][NEUTRAL] Of course this one I believe is Carrington uh participates in the Carrington PPO but let me get this pulled up.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure, you're fine.
[CUSTOMER][NEUTRAL] Sure, is it OK if I put you on hold for a moment?
[CUSTOMER][POSITIVE] Alright thanks.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sorry about that. Yes, so this policy, um, it does participate in the Carrington PPO network, um, and if you'd like, Latara, I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Alright, so it's the Carrington Care POS and PPO?
[AGENT][NEUTRAL] Uh, Carrington PPO Network is the the what this uh policy participates in.
[CUSTOMER][NEUTRAL] OK, all right, so, um, another question I have, so from what I understand from the breakdown I got you, it covers cleaning, X-rays at 80%, correct?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So yes, so this policy, it does not offer any major coverage, uh, preventative would be at 100 and then uh FMX radiographs and basic are all going to be at 80%.
[CUSTOMER][NEUTRAL] OK, so basic it doesn't cover any per any perio or Indo correct?
[AGENT][NEGATIVE] Correct, that would be considered major and this policy doesn't offer any of that coverage.
[CUSTOMER][NEUTRAL] OK, now is there any downgrades on the fillings?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there out of network benefits? Do you guys pay out of network?
[AGENT][NEUTRAL] So this policy, sure, so, uh, with this policy utilization of a provider within the Carrington network is not required, it's just uh what network it does participate in we will still honor those benefits.
[CUSTOMER][NEUTRAL] Alright, so are we out of network? Do you need my ID number, the tax ID?
[AGENT][NEUTRAL] Um, I have no way of looking at that, um, for that I would have to get you with Carrington, um, if you'd like to check that, but either way again you can still send those claims to us and we'll still pay those benefits.
[CUSTOMER][NEUTRAL] OK, um, hm.
[CUSTOMER][NEUTRAL] All right, so.
[CUSTOMER][NEUTRAL] OK, so my question my next question is I understand that it doesn't matter if you're we're in or out of network do you guys pay the member or pay us?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It depends on who files the claim. So if the provider uh is the one to file the claim, we'll send that uh benefit payment to them. If the member files the claim, we would send it to the member.
[CUSTOMER][NEUTRAL] Oh, OK, I understand.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Hm, so there is out of network benefits.
[AGENT][POSITIVE] Yeah, absolutely, it would, yes.
[CUSTOMER][NEUTRAL] OK, that was my question.
[CUSTOMER][POSITIVE] Great and let me see if I have any more questions.
[CUSTOMER][NEUTRAL] Is there orthodontic benefits?
[AGENT][NEUTRAL] No, Ortho treatment is not covered.
[CUSTOMER][NEUTRAL] OK, and there is a $50 deductible. When does the deductible apply?
[AGENT][NEUTRAL] So this policy is on a per calendar year basis, so $50 per calendar year, um, but that deductible does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK, so it only applies to like fillings and stuff like that?
[AGENT][NEUTRAL] Yeah, basic or uh FMX.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, and um I'll just take a reference number I think I don't need to call [PII] and he pretty much gave me all the.
[AGENT][NEUTRAL] OK, sure, yeah, reference number would just be my first name, last initial, and today's date, um, so my name is spelled [PII] oh I'm sorry, sure.
[CUSTOMER][NEUTRAL] Necessary information.
[CUSTOMER][NEUTRAL] Hold on, just hold on just just just a moment ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi ma'am hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, what's your name?
[AGENT][NEUTRAL] It's uh [PII] and then my last initial is [PII]
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Yes, um, so the reference number would be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] Of course thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Alright you too dear bye.
[AGENT][NEUTRAL] Bye bye.