AccountId: 011433970860
ContactId: cde9b123-299d-460c-9666-ad05c8669d48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 518097 ms
Total Talk Time (AGENT): 185215 ms
Total Talk Time (CUSTOMER): 212164 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/cde9b123-299d-460c-9666-ad05c8669d48_20250219T14:50_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] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Inspire Dental of [PII]. I just wanna get information on a patient.
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you this morning. What is the callback number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Say it again I'm sorry, I didn't understand you.
[AGENT][NEUTRAL] A callback number.
[CUSTOMER][NEUTRAL] A good call back number would be [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is the patient's policy number?
[CUSTOMER][NEUTRAL] The patient policy number is 0258.
[CUSTOMER][NEUTRAL] 7042.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] Ah [PII]
[CUSTOMER][NEUTRAL] And then the date of birth is [PII].
[AGENT][NEUTRAL] Alright thank you this is for dental?
[CUSTOMER][NEUTRAL] Yes, this is for dental.
[AGENT][NEUTRAL] All right. Are you needing a breakdown?
[CUSTOMER][NEUTRAL] Um, I'm gonna need that second and then for the first thing I just wanna confirm their um insurance plan information, their like their group plan number, their address, and payer ID and their fee schedule.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Not a problem. So, I'm showing the TA's policy is active with the effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy does participate in the Carrington PPO network, but network participation is not required.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And group number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I have the carrier name as American Public Life. Should I change it to Carra and PPO?
[AGENT][NEUTRAL] No, uh, the carrier is.
[AGENT][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] OK, just making sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then your street address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and then your group number please?
[AGENT][NEUTRAL] Group number is.
[AGENT][NEUTRAL] 70055
[CUSTOMER][NEUTRAL] And then is this plan in network with us? I can give you some information.
[AGENT][NEUTRAL] So network participation is not required with our processing that would be through Carrington. If you're in network, you would use the Carrington fee schedule. If not, you would just use your fee schedule.
[CUSTOMER][NEUTRAL] OK, let's see, and you said just use our fee schedule?
[AGENT][NEUTRAL] Yes ma'am, if you're not a network provider, if you're not a carrington provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Alright, and then the payer ID for me please. I have 60801, is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you and then for let's see.
[CUSTOMER][NEUTRAL] What is the maximum for this plan?
[AGENT][NEUTRAL] And I can help you with those benefits. Now all benefits given over the phone is a verification of coverage, not a guarantee of payment. And I tell you what, Serenity, if you wanna go ahead and give me that fax number, I can get this on the way for you, and we'll go over those benefits.
[CUSTOMER][POSITIVE] Oh yes, thank you, it is just let me know when you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It is 770.
[CUSTOMER][NEUTRAL] 828
[CUSTOMER][NEUTRAL] 0234.
[AGENT][NEUTRAL] And just to verify that fax number I'm sending this to [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's on the way for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Now, this, you're very welcome. This policy does have a $500 calendar year max.
[CUSTOMER][NEUTRAL] 500.
[AGENT][NEUTRAL] Mhm. There is a $50 deductible. Deductible does not apply to preventive services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And then what about the family deductible?
[AGENT][NEUTRAL] Up to 150.
[CUSTOMER][NEUTRAL] 150 have the deductible been met?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] He has no history. He's not used any of his benefits nor met his deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see one thing, and is there a missing tooth clause on this on this plan?
[AGENT][NEGATIVE] There is a missing tooth claws.
[CUSTOMER][NEUTRAL] And then for crown or bridges, is it paid on seat date or prep date?
[AGENT][NEUTRAL] Major is not covered. That includes oral surgery, prosthodontic repairs, endodontic services, and periodontic services.
[CUSTOMER][NEUTRAL] OK, so Peridontus is not um covered in in crowns.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty and then let's see one more thing.
[CUSTOMER][POSITIVE] Alright sorry about that. I was handling a patient.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And all of this should include the the fax back correct?
[AGENT][NEUTRAL] Yes ma'am, it will have the calendar year max deductibles, frequencies, limitations, and the procedures listed that are covered.
[CUSTOMER][NEUTRAL] Alrighty, hold on one second. I wanna get a little bit more information and then you said it already started on January?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And do they have a waiting period?
[AGENT][NEUTRAL] There's no waiting period.
[CUSTOMER][NEUTRAL] OK, and they do have out of network uh benefits, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and then for this coverage, is it only for him only for just him?
[AGENT][NEUTRAL] Yes, it is an individual policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Thank you, let me double check to see if any of that came to my email.
[CUSTOMER][NEUTRAL] Let's see, I haven't received it in my email yet. I'm gonna just get a, let me just get his cleaning information because he should be coming in soon.
[CUSTOMER][NEUTRAL] Let me see, and then for diagnostics, how much is that covered by?
[AGENT][NEUTRAL] The, um,
[CUSTOMER][NEUTRAL] And preventative.
[AGENT][NEUTRAL] So the preventive is 100%.
[AGENT][NEUTRAL] Of allowable rate and the radiographs FMX basic and basic restorative expenses are covered at 80%.
[CUSTOMER][NEUTRAL] 80
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then basic is one second.
[CUSTOMER][NEUTRAL] And then basic is covered at 80%. What about other um restorations? Would that be covered at 80% as well, or that's no coverage?
[AGENT][NEGATIVE] Um, no coverage.
[CUSTOMER][NEUTRAL] OK, and what about orthodontics?
[AGENT][NEGATIVE] No coverage.
[CUSTOMER][NEUTRAL] No coverage? OK.
[CUSTOMER][NEUTRAL] Um, what about implants?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, so endoperial implants and like prosthodontists and oral surgery and Crohn's, all of that is not covered, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much um I will be on the lookout for that fax.
[CUSTOMER][NEUTRAL] And then if not I'll just give you a call.
[AGENT][POSITIVE] Yeah, you should be receiving it shortly.
[CUSTOMER][POSITIVE] Alright thank you I'll be on the lookout for it thank you so much.
[AGENT][POSITIVE] Um, thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you Serenity bye bye.
[CUSTOMER][NEUTRAL] Mm.