AccountId: 011433970860
ContactId: cabccfc4-9da5-4512-a9d9-39e66065ed08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482619 ms
Total Talk Time (AGENT): 119887 ms
Total Talk Time (CUSTOMER): 280247 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/cabccfc4-9da5-4512-a9d9-39e66065ed08_20250409T19:06_UTC.wav
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[AGENT][NEUTRAL] [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. Um, yes, I'm calling, um, from Rich Rose Dental. My name is [PII]. Last initial B. Call back number [PII] direct line and I was calling to get.
[AGENT][POSITIVE] How can I assist you today?
[CUSTOMER][NEUTRAL] I was calling to get uh benefits for a patient.
[CUSTOMER][NEUTRAL] And see if we're network with this plan.
[AGENT][NEUTRAL] [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII] policy number 02592893.
[AGENT][NEUTRAL] Could you verify this patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. This policy has been active since [PII] and is currently active. This member has a maximum benefit amount of $500 per calendar year with a $50 deductible per insured up to $150 per family, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. This policy is a Carrington network, but the member does not have to utilize the Carrington network provider because the policy is a PPO.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Oh yeah, OK, great.
[AGENT][NEUTRAL] But if you would like to verify if you're in network I can be glad to, I can gladly transfer you to [PII] once I verify the benefits with you.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] Preventative is covered at 100% and basic is covered at 80%. [PII], the policy is very limited, so it does not cover major endoeroprosthesis or surgery crowns, bridges, or the perioendo, surgical.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Remove over to and it does not none of those services that I just named does not even fall on the basic either.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] It's very limited.
[CUSTOMER][NEUTRAL] So it just covers pretty much exam X-rays and regular cleaning?
[AGENT][POSITIVE] Yes ma'am, and fillings that don't downgrade and simple extractions of 7140.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So like a 41.
[CUSTOMER][NEUTRAL] Um, like a deep cleaning is not covered, right?
[AGENT][NEGATIVE] Not covered.
[AGENT][NEGATIVE] No, ma'am, unfortunately it's not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any way you could give me um like a fax pack?
[AGENT][NEUTRAL] Of course. What's your fax number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes, ma'am.
[AGENT][NEUTRAL] Alright, so I'm gonna send this over for you. What won't be on there is history, but the member has no history on file, or has he utilized any of these benefits for [PII] or met his deductible?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No ma'am that's all.
[AGENT][POSITIVE] Alrighty, thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Would you like for me to transfer you to Carrington so you can verify if you're in network with Carrington because I wasn't able to verify that for you.
[CUSTOMER][POSITIVE] Yes ma'am please.
[AGENT][NEUTRAL] Alright, so let me give you the number just in case the call is disconnected, but I'm gonna transfer you. The number is let me know when you're ready for it.
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] It is [PII]. That's [PII]. Hold one moment while I transfer you. Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assistencia espanol oprima elumino Nueve.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up.
[CUSTOMER][NEUTRAL] If you are a healthcare provider who is only calling to verify member eligibility, I would like to use our automated member eligibility verification system, please press 1. If you are a healthcare provider who is calling to verify member eligibility and you need assistance from a member service representative, press 2.
[CUSTOMER][NEUTRAL] If you are a participating Carrington provider requesting an updated fee schedule, please visit the provider portal at [PII] or press 3. If you are a dental provider who would like to join the Carrington network, please press 4.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] If you are a health care provider who is only calling to verify member eligibility, I would like to use our automated member eligibility verification system, please press 1. If you are a healthcare provider who is calling to verify member eligibility and you need assistance from a member service representative, press 2. If you are a participating Carrington.
[CUSTOMER][NEUTRAL] If you are calling regarding an insurance plan, press 1. If you are calling regarding a discount plan, press 2. If you are unsure of your plan type, press 3. For quality assurance and training purposes, this call may be monitored and or recorded. Please be advised that a quote of eligibility and benefits is not a guarantee of payment.
[CUSTOMER][NEUTRAL] All benefits are subject to eligibility terms, conditions, limitations, exclusions, and reimbursement of allowable amounts of the patient's plan at the time that services are rendered. Instead of waiting, we can give you a call back when an agent is available to speak with you. You will not lose your place in line. If you would like to receive a call back, you can press one at any time. Otherwise, please continue to hold for the next available agent.
[CUSTOMER][NEUTRAL] Your estimated wait time is approximately 6 minutes. Press 1 to schedule a call back or stay on the line for the next available agent.
[CUSTOMER][NEUTRAL] After confirming your callback number, please wait for the system to automatically disconnect your call. We see the number you were calling from is. [PII]. If you would like us to call you back at this number, press one.
[CUSTOMER][NEUTRAL] If you would like us to call you back at a different number, press 2 to cancel this callback request and resume your place starting with the area code, please enter the 10 digit phone number where you can be reached, followed by the pound sign.
[CUSTOMER][NEUTRAL] Thanks, we will call you back at [PII]. If this is correct, press one.
[CUSTOMER][NEUTRAL] If you would like us to call you back at a different number, thanks, we will hold your place in line and call you back at [PII]. When an agent is available to speak with you, the incoming call will come from the number. [PII]. Thank you for your call.