AccountId: 011433970860
ContactId: b4154834-68d1-4765-8e7f-447a7677195c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515479 ms
Total Talk Time (AGENT): 195933 ms
Total Talk Time (CUSTOMER): 284453 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/b4154834-68d1-4765-8e7f-447a7677195c_20250217T17:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you hello?
[CUSTOMER][NEUTRAL] Yes. Yes, good afternoon. This is [PII], and I'm calling you on behalf of our dental office. On this recorded line, I would like you to help me with the patient eligibility and benefits. But before that, may I have your good name and your last name initial?
[AGENT][NEUTRAL] My name is [PII]. The last name initial is [PII], and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh-huh. And
[CUSTOMER][NEUTRAL] OK, sorry to interrupt you. My callback number is [PII]. This is a direct line number and we don't have extensions for this.
[AGENT][NEUTRAL] OK, thank you [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Um, the policy number I'm having is 02581028.
[AGENT][NEUTRAL] OK, and let me just repeat that to you, [PII]. I have that as 02581028.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] Last name [PII] with the date of birth, [PII].
[AGENT][POSITIVE] Thank you very much for that information, [PII]. I have the number pulled up and again you're calling for eligibility and benefits, OK, I can assist you with both.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the policy shows effective as of [PII] and it shows active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know for the benefits.
[CUSTOMER][NEUTRAL] OK. So you said the effective date is uh [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and the coordination benefits are standard or?
[AGENT][NEGATIVE] So they do not coordinate benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And is this a calendar year plan or a benefit year one?
[AGENT][NEUTRAL] This is a calendar year plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And can you help me like, are we in network with you or out of network? Do you pay for out of network benefits as well?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the free schedule that is to be followed?
[AGENT][NEUTRAL] This plan follows the Carrington PPO network. Let me provide you their number so you can check to see if you're a participating provider. Their number is 1800-290-0523.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1800.
[AGENT][NEUTRAL] 290
[AGENT][NEUTRAL] 0523.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for the information you provided me, and I really appreciate it. Let me check for the Carrington series.
[CUSTOMER][NEUTRAL] Just a moment, and can you also help me meanwhile with the
[CUSTOMER][NEUTRAL] Couple of information more regarding the
[CUSTOMER][NEUTRAL] Payer ID, claims, mailing address, group name and group number also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][NEUTRAL] That is correct, yes, and the mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is, I am so sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII]. OK.
[AGENT][NEUTRAL] And would you like our fax number as well?
[CUSTOMER][NEUTRAL] Uh, no, that's all, uh, that's it. Now, can you help me with the, uh, information, uh, like what are the benefits covered under the plan? What are the deductibles, what are, uh.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Annual max.
[AGENT][NEUTRAL] OK, would you also like to know I'm sorry, the group name and number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The group name is Versella Aterra Services LLC Company.
[CUSTOMER][NEUTRAL] I'm sorry, can you just repeat it? Uh, how do you spell it?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, the first word is V Victor, E Edward, R Robert, S Sierra, T Tango, E Edward, L Lima, A Alpha.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next word is A, A like Alpha Alpha, third word is Tara, that's T like Tom, E R R A.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To log out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Next for is services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] LLC Company.
[CUSTOMER][POSITIVE] Mhm. Thank you so much for the information you provided me and I really appreciate it. And the payer ID is 60.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, 68001 60801. OK.
[AGENT][NEUTRAL] Right, and the group number also is 70073.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, now you're ready for the benefits?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. The member has a $500 calendar year max.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a $50 deductible, it does not cover any major services at all.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the member has not used anything out of the max or anything towards his deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The plan only covers preventative at 100% of allowable and basic services at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this
[CUSTOMER][NEUTRAL] OK, so preventative and diagnostics are 100%. Basics are 80%.
[AGENT][NEUTRAL] Diagnostic in regards to bite wings that's covered at 100% um FMX1 and pans are covered at 80%.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Just give me a quick one minute. And you said that the uh FMX and Penno are covered at 80%?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, uh, and can you also help me with the information, uh, regarding the, OK, major and other services are not covered, right?
[AGENT][NEUTRAL] Major services are not covered.
[CUSTOMER][NEUTRAL] Mhm and do you downgrade for the accounts?
[AGENT][NEUTRAL] We do not downgrade or anything on the plan that includes fillings or composites. There are no downgrades.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And can you also help me with the information regarding uh
[CUSTOMER][NEUTRAL] I'm sorry, there is no cumulations right you said?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. And no major or or or any other services are covered.
[AGENT][POSITIVE] Correct, your major or is covered. That's correct.
[CUSTOMER][NEUTRAL] Mhm. OK. And is there any history for the patient that is going to affect the frequency for the patient?
[AGENT][NEUTRAL] No, there is no history at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] And what about the missing tooth cloths and the waiting period, please?
[AGENT][NEUTRAL] OK, there is a missing tooth cloth.
[AGENT][NEUTRAL] There is no waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and pre-authorization is required or suggested?
[AGENT][NEUTRAL] It is not required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. And just a moment. Thank you so much for all the information you provided me, and I really appreciate it. All the information provided by you is very useful to me. So, [PII], that's for today. And before we end up this call, can you please help me with the call reference number to call, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, uh, we do not provide call reference numbers, [PII], but you can use my name in today's date, last initial [PII], and we thank you for calling us today at APL. You have a good day.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, same to you. Bye-bye. Take care. Have a great day ahead. Mhm.
[AGENT][NEUTRAL] Bye bye.