AccountId: 011433970860
ContactId: cb5a6aed-8f33-408e-ba3e-db9bcccbb584
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402100 ms
Total Talk Time (AGENT): 162437 ms
Total Talk Time (CUSTOMER): 161526 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/cb5a6aed-8f33-408e-ba3e-db9bcccbb584_20250609T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I want to verify, um, eligibility and benefits for our patient.
[AGENT][POSITIVE] All right, I'm happy to verify eligibility and benefits. What's the policy number?
[CUSTOMER][NEUTRAL] 02607343.
[AGENT][NEUTRAL] Thank you. And then for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh [PII] option two.
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII], um, [PII].
[AGENT][NEUTRAL] Thank you. Are you looking for dental coverage or medical?
[CUSTOMER][NEUTRAL] For dental coverage.
[AGENT][NEUTRAL] OK. Patient is active. Uh, looks like the effective date on here is going to be [PII].
[AGENT][NEUTRAL] And if you guys need us to we can also send a fax back with a breakdown of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh perfect um.
[CUSTOMER][NEUTRAL] Does that um back back include the frequencies and the.
[CUSTOMER][NEUTRAL] Percentages on there as well.
[AGENT][POSITIVE] Mhm, yep, it sure does. The only thing it won't include is the amount used for the year, but I can definitely give that to you if you need me to.
[CUSTOMER][NEUTRAL] Oh perfect um yes please, um, and typically how long does that take to go through the fax?
[AGENT][NEUTRAL] Um, usually it just takes about 5 minutes for you to get it on your side.
[CUSTOMER][NEUTRAL] Oh perfect. OK, now I'll just um get some information here and I'll just get the rest through fax. Would there be a uh a group name or group number for this plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let's take a look.
[AGENT][NEUTRAL] Group name is BG, so B as in boy, G as in girl, staffing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group number is 70019.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like the annual max on this plan is $500 for the calendar year. Patient does have a $50 deductible. Looks like both are still remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said that was $500 for the individual or annual max and then the $50 deductible.
[AGENT][POSITIVE] Mhm, yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and also what would be the fee schedule? Is it gonna be Carrington for the plan?
[AGENT][NEUTRAL] So it does participate in the Carrington PPO network. Um, it does go by UCR, but you can use that network if you guys need to.
[CUSTOMER][NEUTRAL] Oh OK and what's the claims mailing address?
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is gonna be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think I found I'm just gonna repeat again that [PII] just to make sure I got that right. Was this [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, with the payer ID is 60801?
[AGENT][NEUTRAL] Yes, ma'am. Yeah.
[CUSTOMER][NEUTRAL] Alright, perfect, um, and does this plan uh accept assignment of benefits to an out of network provider?
[AGENT][NEUTRAL] Uh, they do like no network is required for usage, so yeah.
[CUSTOMER][NEUTRAL] OK, perfect, um, and are there any waiting periods or missing two claws?
[AGENT][NEUTRAL] Let's see, so no waiting period patient plan is for um preventative and basic only.
[AGENT][NEUTRAL] It looks like the policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so there's no major coverages at all in the plan?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, um, for endoperio and oral surgery, do those fall under major or does that fall under basic?
[AGENT][NEGATIVE] Falls under major.
[CUSTOMER][NEUTRAL] Major, OK, so just mainly preventative and basic.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, does the periodontal maintenance um fall under preventative or
[AGENT][NEGATIVE] No, it actually falls under major, major.
[CUSTOMER][NEUTRAL] Um, basic re
[CUSTOMER][NEUTRAL] Major, OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And just to double check with the oral cancer screening be covered?
[AGENT][NEUTRAL] Uh, probably not. Do you have a procedure code for it?
[CUSTOMER][NEUTRAL] Yes, um, 0431.
[AGENT][NEUTRAL] Yeah, I don't see it listed on the fax back so it wouldn't be covered.
[CUSTOMER][NEUTRAL] Oh OK, no worries then, uh, I'll just wait for the fax back just to get the rest of the.
[CUSTOMER][NEUTRAL] Um, coverages, let me see.
[AGENT][NEUTRAL] OK. What's a good fax number?
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, fax is on its way, so you should have that in a few moments. Did you need me to check on anything else?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, actually, yeah, uh, just one more thing. Is there any downgrades at all on this plan?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEGATIVE] There's not OK.
[CUSTOMER][NEUTRAL] Alright, and I believe that is it. Oh, is there any ortho covered on this plan though?
[AGENT][NEUTRAL] There is not, uh-huh.
[CUSTOMER][POSITIVE] There's no or, OK, alright, and if I can just get a reference number, sir, I am all set. Thank you so much for your help.
[AGENT][NEUTRAL] Yeah, no worries. Call reference is going to be my name with today's date. My name again is [PII], that's [PII] Last initial is gonna be [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alright, well thank you so much have a good rest of your day.
[AGENT][NEUTRAL] You too bye bye.