AccountId: 011433970860
ContactId: cb082876-c633-4bb5-a989-544860023881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329989 ms
Total Talk Time (AGENT): 149947 ms
Total Talk Time (CUSTOMER): 83887 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/cb082876-c633-4bb5-a989-544860023881_20250429T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from the provider's office. So I'd like to check patient's dental benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the member's dental benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, that would be 02576161.
[AGENT][POSITIVE] Thank you and just for my notes, can you spell your first name for me please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. I just need you to verify the member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment I'm just waiting for the benefits to populate.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I pull up the policy benefits?
[CUSTOMER][NEUTRAL] Oh yes, sir.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right, so this is gonna be a problem.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Just make it easy for care team for once.
[AGENT][NEGATIVE] It's ridiculous
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. So did you need a copy of the fax back or you just wanted to go over over the phone?
[CUSTOMER][NEUTRAL] Yeah, um, so that would be OK.
[AGENT][NEUTRAL] OK, um, so on the fax back you'll see the calendar year max and deductible, all the percentages, frequencies, exclusions, all the ways to file a claim, and then there's a list of covered codes and the um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it's a list of covered codes. If the code you're looking for isn't on this list, it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] I see. Uh, all right, thank you. Uh, does that include the group name and group number as well?
[AGENT][NEUTRAL] It doesn't, but I can give that to you. The group number is 70,030.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group name is Creative Circle.
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] All right, thank you. And uh just to confirm as well if are we in or out of network for this plan?
[AGENT][NEUTRAL] Um, so the policy is on the Carrington PPO network. Um, however, if you are not a Carrington provider, the benefits are still the same.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK. All right. Thank you. And also, uh, the history is included in the fax pack?
[AGENT][NEUTRAL] You're welcome. And then what's it?
[AGENT][NEUTRAL] Um, history is not included. Let me see if there's any. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so far there's no history for the patient. We haven't, um, filed or processed any claims.
[CUSTOMER][NEUTRAL] Oh, I see. All right. Thank you very much. Um, how about for the, uh, missing class or waiting periods or any downgrades?
[AGENT][NEUTRAL] Yes, that would be on the facts, but, but I can tell you as well, um, there's no, um there is a missing tooth clause. This policy does not cover major, major for us includes endodontic, periodontic, prosodontic, and oral surgery. So all those clothes are not covered on this policy. And then what was the last question?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Um, for the
[CUSTOMER][NEUTRAL] Waiting periods
[AGENT][NEUTRAL] Um, oh, OK, so major would have, if major was covered, it would have a 12-month waiting period, but major is not covered, so this policy doesn't have a waiting period.
[CUSTOMER][NEUTRAL] Oh, OK. The only major is not covered under the plan.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] You're welcome. And then [PII], what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, well, I will go ahead and fax this over to you now. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that would be all. Thank you very much for the help.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.