AccountId: 011433970860
ContactId: bc1f1345-ae43-4af0-84f6-50e10f4dbce5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380600 ms
Total Talk Time (AGENT): 125776 ms
Total Talk Time (CUSTOMER): 150232 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/bc1f1345-ae43-4af0-84f6-50e10f4dbce5_20250220T15:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi, good morning. This is [PII] and uh I'm calling from a dental office and I have a patient for whom I wanted to verify eligibility for.
[AGENT][POSITIVE] I'm surely I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Um, yes, it's area code [PII] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Um, I do have her social and it's um [PII].
[AGENT][POSITIVE] Thank you, and one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And please verify her name and date of birth.
[CUSTOMER][NEUTRAL] Um, name is [PII] with the date of birth [PII].
[AGENT][NEUTRAL] OK, thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I have her policy number here. Do you need that information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK. Her policy number is 025.
[AGENT][NEUTRAL] 71301.
[CUSTOMER][POSITIVE] OK, got it. Thanks.
[AGENT][NEUTRAL] OK, thank you. And the effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK, and uh.
[CUSTOMER][NEUTRAL] Uh, are we in network with this patients plan?
[AGENT][NEUTRAL] Yes, sir, you are.
[CUSTOMER][NEUTRAL] Um, using a Carrington PPO schedule.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, got it. And uh what's, what's her annual maximum and deductible?
[AGENT][NEUTRAL] OK, one moment. And for a breakdown of all of her benefits, I can fax that over to you.
[CUSTOMER][NEUTRAL] Um, yes, so I do have a fax, uh, uh, from last year. It was in December, um, and I just wanted to also, you know, make sure that, um, uh, the percentages are same, right? It, it only covers preventative and basic services.
[AGENT][NEUTRAL] Yes, sir. That's correct. And the annual year maximum is $500 per calendar year with a $50 deductible.
[CUSTOMER][NEGATIVE] Mhm and nothing has been uh meant or used.
[AGENT][NEUTRAL] Um, let me verify that one moment.
[AGENT][POSITIVE] That's correct. Nothing's been met or used so far this year.
[CUSTOMER][NEUTRAL] OK and uh can you help me um.
[CUSTOMER][NEUTRAL] Uh, in, uh, I mean like what services are covered under basic?
[AGENT][NEUTRAL] Yes, sir, under the basic, let's see.
[AGENT][NEUTRAL] OK, there's several. Um, do you have a code you would like for me to look up?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, um, uh, uh, this endo and oral surgery covered?
[AGENT][NEUTRAL] Yes, some are covered. What um code?
[AGENT][NEUTRAL] Be more specific.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, OK, so 4341.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] OK, let's see. 40.
[CUSTOMER][NEUTRAL] And 4355.
[AGENT][NEUTRAL] Um, no, sir. I'm not showing any of those codes on the fee schedule on the breakdown of benefits.
[CUSTOMER][NEUTRAL] Yeah, OK. Got it. So, uh, whatever is on the fax back, only those codes are covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, well, in that case, uh, can you send over, uh, her fax to her fax?
[AGENT][NEUTRAL] Yes, sir. What's your fax number, please?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's attention [PII] [PII].
[CUSTOMER][POSITIVE] Uh yes, that is correct, yeah.
[AGENT][NEUTRAL] OK. Well, you should receive it in about 10 minutes. I just sent it. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, well, um, that's all about, and one more thing, uh, is there a group name and a group number for this plan?
[AGENT][NEUTRAL] Um, yes, sir. The group number is.
[AGENT][NEUTRAL] 70036.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group name is Crown Services.
[AGENT][NEUTRAL] Incorporated.
[CUSTOMER][NEUTRAL] And cooperation, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Alrighty, got it. Well, um, thanks a lot. Can I please have a reference ID to this call?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] I'm well, that's, that's all I needed. Thanks a lot of future help there.
[AGENT][POSITIVE] OK, thank you again, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] Have a good one bye.
[AGENT][POSITIVE] Thank you.