AccountId: 011433970860
ContactId: d6f8ea6f-dcb6-42eb-90f1-884394748221
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337609 ms
Total Talk Time (AGENT): 150945 ms
Total Talk Time (CUSTOMER): 91709 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/d6f8ea6f-dcb6-42eb-90f1-884394748221_20250512T19:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from a dental provider's office.
[AGENT][POSITIVE] Alright, and I'll be more than happy to assist you today, [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, so I am trying to verify a patient's benefit policy.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Policy number is 02521271.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you 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 let me see what type of policy they have. Hold on one moment.
[AGENT][NEUTRAL] And were you needing a copy of the fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] Um, both if you don't mind.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what questions did you have in reference to the fax back?
[CUSTOMER][NEUTRAL] Um, is this gonna be a PPO policy HMO?
[AGENT][NEUTRAL] Um, this policy is not on the network.
[CUSTOMER][NEUTRAL] Oh, it's not on the network, so how does this policy work?
[AGENT][NEUTRAL] So we use Carrington, all of our dental policies, uh we use Carrington, but this is through UCR, so on the fax back you'll see the calendar year max and deductible, um, and all the percentages. And so depending on what's being done, um, if it's preventative, we'll cover at 100, if it's basic 80, major 40. There is a 12-month waiting period, so they wouldn't be able to use any of the major until [PII]. um Yeah.
[AGENT][NEUTRAL] I mean, you would just bill for whatever the patients being, you know, seen for and we would pay.
[AGENT][NEUTRAL] Depending on what category that percentage.
[CUSTOMER][NEUTRAL] Yeah, but there's just no network, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] Um, can I get your billing address?
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Sure, um, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Is there an electronic payer ID?
[AGENT][NEUTRAL] Yes, it's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK, and then um is this a calendar year policy or a fiscal year?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] Calendar year and you said you mentioned that waiting period is 12 months for major, right? So when can you let me know that date one more time when he's able to use his major benefits?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Major for us includes endogenic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that's all gonna be in the facts, right?
[AGENT][POSITIVE] Yes, all of this is in the fax, the address and everything too. Um, it'll be on the fax back for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then can I get um the effective date and the group number please?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] Um, so the policy has been effective since [PII].
[AGENT][NEUTRAL] And you said group number or name or both?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, group number.
[AGENT][NEUTRAL] OK, it's 17626.
[CUSTOMER][NEUTRAL] OK. And what was your, oh, is there a missing two calls, by the way?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] Yes, there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK, and can I get your name one more time?
[AGENT][NEUTRAL] Yes, my name is [PII] initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, can I get your reference number, [PII]?
[AGENT][NEUTRAL] Yes, but hold on one moment. What's a good fax number for you?
[CUSTOMER][NEUTRAL] Oh yes. Oh perfect, sorry, 713?
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] 473-720-6.
[AGENT][NEUTRAL] Should I put attention to Shari?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was 713473-7206?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right. And so for the call reference number, there's no um call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Alrighty thank you so much for your help today [PII].
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that was everything. Thank you.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.