AccountId: 011433970860
ContactId: a7e3abb4-7c06-4948-9c12-9671ca224e7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371899 ms
Total Talk Time (AGENT): 163877 ms
Total Talk Time (CUSTOMER): 172712 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/a7e3abb4-7c06-4948-9c12-9671ca224e7d_20250225T21:28_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental office. Um, I am trying to verify eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I can help with the eligibility and benefits. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Um, I have subscriber number as 258-093-1.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my direct line is [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. Um, now these policies have $500 per calendar year, the maximum. It is just a verification of those benefits, not a guarantee of payment. I have a fax back that I can send to you, or is there anything in particular I could tell you about this limited benefit policy?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I will definitely take the fax back, um, but, um, I do have a couple of questions that I normally don't find on a fax back, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So first of all, what would be the fee schedule? I don't.
[CUSTOMER][NEUTRAL] I don't know if we're in network or not.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Well, we don't have a network. Um, the policy uses the Carrington PPO fee schedule, um, but you do not need to be a member of Carrington in order for that policy to pay out. Uh, we don't have a network of doctors that, uh, that we, um, use, so we just, uh, yeah, just as long as you, this, it's basic, basic, restorative and preventative services only. So as long as you're, you're not charging for me uh major services like endedonics, periodontal sort of thing, we're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oral surgery implants, all that stuff. OK, so it's really just filling and preventative.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] That's exactly right.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK and then um the other thing um that I don't typically find on fax backs um is what is the timely filing?
[AGENT][NEUTRAL] There is no timely filing on these policies. So if this was a service from some time ago, you know, as long as it's within the uh the period that was active, we're good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then, um, do you require, well it would be no because it's not a covered benefit, um, and then is there a uh coordination of benefits rule at all?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK. And then, um, is there any waiting period?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK perfect and then as far as the fillings um since those are covered benefit, is there any downgrades with those?
[AGENT][NEUTRAL] They don't downgrade to amalgam though.
[CUSTOMER][NEUTRAL] OK, OK, and do they have a frequency limitation?
[AGENT][NEUTRAL] Yes, um, now for the fillings, let me see if I can grab that here really quickly.
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] OK, so they they replace existing only if in place for 24 months, and it's a maximum of 1 each tooth for 24 months.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, perfect, perfect. And then um as far as uh this patient specifically, has she used any benefits yet, uh, this year?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Check here.
[AGENT][POSITIVE] OK, it doesn't look like anything's been used for the calendar year [PII], so we are good.
[CUSTOMER][NEUTRAL] OK. And does this policy have a deductible?
[AGENT][NEUTRAL] There's a $50 deductible that does not apply to the preventative services.
[CUSTOMER][POSITIVE] OK perfect and then um.
[CUSTOMER][NEUTRAL] Is this an individual policy?
[AGENT][NEUTRAL] It looks like it's a family policy.
[CUSTOMER][NEUTRAL] Family policy OK perfect and um let's see here um as far as um sending claims um do you accept electronic submission if so what is the payer ID?
[AGENT][NEUTRAL] Yes, you can do this electronically, you can do it through the mail, uh, fax it, or we do have an online service center. Our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, perfect. And are there any group numbers associated with this policy?
[AGENT][NEUTRAL] Yes, now the group number for this is 70087.
[AGENT][NEUTRAL] And that is partner personnel.
[CUSTOMER][NEUTRAL] OK, perfect. And um does this patient have any preventative history at all on this policy?
[AGENT][NEUTRAL] No. So when you get this fax, um, everything will be available that um we don't have any history for and we don't pick up the, yeah, we don't pick, and we don't pick it up from other dental, dental policies, so it's, it's, uh, we're starting out fresh. Everything will be available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For history and stuff? OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it. OK, perfect, um, then I feel like everything else is pretty um.
[CUSTOMER][NEUTRAL] You know, simplistic it should be on the the fax back um so I think that was all the questions I had for now um I do need um a reference number from you for our call and then you let me know what all you need as far as to be able to fax that to me.
[AGENT][NEUTRAL] Um, yes, my name is [PII]. The [PII] my last [PII] is [PII]. We're gonna need that date.
[AGENT][NEUTRAL] Excuse me, and then I just need your fax number.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Sure, my direct fax is [PII].
[AGENT][POSITIVE] [PII]. Great. Thank you. I've already got this ready for you. You should be getting it just in the next few moments. And then once you get this, if you have any questions, please just let us know and uh we'll try to answer any questions you've got.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your time.
[AGENT][POSITIVE] OK, thanks for contacting AT have a good one.