AccountId: 011433970860
ContactId: a6ddec79-2351-4292-a156-c0161633ff7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447649 ms
Total Talk Time (AGENT): 126078 ms
Total Talk Time (CUSTOMER): 135256 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/a6ddec79-2351-4292-a156-c0161633ff7e_20250515T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? My name is [PII]. I am calling to get a benefit breakdown for a patient.
[CUSTOMER][NEUTRAL] I'll have to give you a call back. Let me speak to the.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with Be facts back. Um, can I get your call back number, ma'am, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII] give me uh let me give you a call back.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, Jersey City Dental.
[AGENT][NEUTRAL] OK, and then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, patient's name is [PII]. Date of birth is, give me one second, [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the policy number is 025.
[CUSTOMER][NEUTRAL] 97264.
[AGENT][NEUTRAL] OK, let me look up Miss [PII] real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, I do show that she does have an active policy with us. The effective date of her policy is [PII], and if you can give me your fax number, I'll get that benefit breakdown and fee schedule over to you.
[CUSTOMER][NEUTRAL] Perfect. Uh, is there, I'm sorry, is there a way to see if the doctor participates with this plan?
[CUSTOMER][NEUTRAL] I've never heard of this plan before. That's why.
[AGENT][NEUTRAL] OK, yes, um, the, the plan does go through [PII], but the.
[AGENT][NEUTRAL] Plan offers they do not have to be in network with Carrington. They can see any provider that they want to see with this policy.
[CUSTOMER][NEUTRAL] OK, so what if we are out, what fee schedule do we follow?
[AGENT][NEUTRAL] You're gonna follow the UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, and is there anything on the fact that they wouldn't.
[CUSTOMER][NEUTRAL] That wouldn't be
[CUSTOMER][NEUTRAL] I mean, is there any information that wouldn't be on the fax?
[AGENT][NEUTRAL] If it's uh if the procedure that you're looking for is not listed on the fax back then it's a non-covered procedure.
[CUSTOMER][NEUTRAL] OK, so if it's not on the list and it's not covered, um, but does the factual frequencies and history.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It does not show history but it will show your frequencies.
[CUSTOMER][NEUTRAL] OK, so how would I know if the patient has any history?
[AGENT][NEUTRAL] Let me look and see if she's had any claims.
[AGENT][NEUTRAL] She's not had any claims sent in yet. This is a new policy for her. She just received it in February.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a calendar year.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and I have the group number 070094 effective date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, is this a PPO plan or is it was the group voluntary dental?
[AGENT][NEUTRAL] It's group voluntary dental.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so you're sending over the fee schedule and the codes of what's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much. Oh, our fax number.
[AGENT][NEUTRAL] Thank you, but I'll need your fax number, yes ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a quick hold while I get this fax ready for you and I will be right back.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Good
[AGENT][POSITIVE] Thank you, Ms. [PII] for holding for me. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I, I just have one more question. Uh, do you, the payer, what's the payer ID? Yeah, uh, can you confirm your email address?
[AGENT][NEUTRAL] Uh, the payer ID is going to be 60801.
[CUSTOMER][POSITIVE] And I'll have it sent over, OK? Thank you so much and what's your name? thank you.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII], and can I get a reference number please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I really appreciate it.
[AGENT][POSITIVE] It's no problem at all, Miss [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yeah, that's all thank you.
[AGENT][POSITIVE] You're welcome you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye-bye.