AccountId: 011433970860
ContactId: cd468354-cbc6-4328-9c18-aa71d4810c9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361899 ms
Total Talk Time (AGENT): 116230 ms
Total Talk Time (CUSTOMER): 220366 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/cd468354-cbc6-4328-9c18-aa71d4810c9a_20250324T17:19_UTC.wav
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[AGENT][NEUTRAL] I I how may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I need some information regarding my dental coverage.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the callback number for you just in case your call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number that you're calling?
[AGENT][NEUTRAL] In regards to today.
[CUSTOMER][NEUTRAL] It is um it is 02310962.
[AGENT][NEUTRAL] Could you verify um your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] Yes, my mailing is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][NEUTRAL] Yes, that's correct. You're calling today to verify your benefits or you just had particular questions about your benefits?
[CUSTOMER][NEUTRAL] Well, well, I had, I had called and got some information and then um.
[CUSTOMER][NEUTRAL] I need some more information.
[CUSTOMER][NEUTRAL] Um, I've, I have to use a dentist that was not in, I didn't know what dentist was available to me. So when I called the last time, I got the, the person, the gentleman that helped me, sent me an email that had the, the link to go to the coverage of all the dentists that were in the network. So the dentist that I used on [PII] or [PII].
[AGENT][NEUTRAL] The list of providers.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Was not in your internet, was not, was not in the group that was sent to me. So what I wanted to find out is, even though they're outside of the group, would I still be able, would they still pay something towards my dental bill?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am, because Ms. [PII], your policy is a PPO like you even though Carrington is your network, it does not mean that you have to utilize a Carrington network provider because it's a PPO and the PPO means that you are open to go wherever you desire to go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how would I know about how much they would pay because I think the, the gentleman that helped me like said I had a $50 deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have a $50 deductible.
[CUSTOMER][NEUTRAL] On my dental, and then.
[CUSTOMER][NEUTRAL] OK, and then how much, what percentage of the of the payments would they pay, is it a certain percent, like 50% or 30% or?
[AGENT][NEUTRAL] So preventative is covered in.
[AGENT][NEUTRAL] So say if you got preventative services, it's covered at 100% or if you got basic services, it's covered at 80%. So I'm not sure what you got.
[CUSTOMER][NEUTRAL] OK, um, I got, um, they cleanse, they cleaned my teeth for me. They cleaned it, and then they did um an x-ray to see, you know, like where the X-ray your top and your bottom, and then they um they did like a clip or something where they put the um the X-ray thing in your mouth and take a X-ray of what inside your teeth look like in your mouth.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it sounds like you got preventative and basic, preventative and basic services, so I'm not sure. I can't tell you like.
[CUSTOMER][NEUTRAL] So that's basically what they did.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Directly what would be paid because we don't have a claim on file. We should have one if you said you went the beginning of March, but we definitely don't have a claim on file.
[CUSTOMER][NEUTRAL] OK, well, well this is.
[CUSTOMER][NEUTRAL] No, no, you haven't got a claim as yet. What I'm gonna do is, um, I'm fixing to go to the dental office when I got off from work today and give them the claim, give them my insurance, and then they should be submitting a claim. So I guess I would need to to wait until that and then when you guys get it, um, do I need to, are you gonna send me a bill online to let me know what was paid and what my my balance was?
[AGENT][NEUTRAL] We're gonna send you an EOB so each time we process the claim on behalf of a member, we send the payment even though the payment goes to the provider, we still send the member a notification as well with the EOB allowing them alert them that someone had submitted a claim on their behalf because some, you know, we do that just because people do, um, somebody will submit a claim for a member and then they actually haven't received services for their mem for that member.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we send them out.
[CUSTOMER][POSITIVE] Right, great.
[CUSTOMER][NEUTRAL] OK, alright, so what I'm gonna do today is I'm gonna, um, because I didn't even have my card printed up so I had to go online and print it up. So what I'm gonna do today is I'm gonna go by the dentist's office and take my, um, my insurance card and have them file a claim and then see, um, because I'm pretty much gonna have to pay the $50 deductible plus I guess whatever is left over after a Carrington pays it all pay the.
[CUSTOMER][NEUTRAL] The percentage of the bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, no, basically that's what I was wanting to check with you guys and see if you guys would still cover something even though I went outside of the network.
[AGENT][POSITIVE] All righty. Well, thanks for calling APL and you have a great day today.
[CUSTOMER][POSITIVE] You too. Thanks for your help. I appreciate it. Bye-bye.
[AGENT][POSITIVE] You're welcome [PII] thanks for calling APU.