AccountId: 011433970860
ContactId: d93798c5-e95d-4a74-b7ca-7f7cc1b211c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569719 ms
Total Talk Time (AGENT): 142392 ms
Total Talk Time (CUSTOMER): 219034 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/d93798c5-e95d-4a74-b7ca-7f7cc1b211c9_20250604T22:27_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII]. I'm calling on behalf of the dental office to check on patients' eligibility and benefits. Can you assist me with that?
[AGENT][POSITIVE] Yes, I can help you with eligibility and benefits, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Thank you. That'll be [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh yes, it will be 02559646.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh first name is.
[CUSTOMER][NEUTRAL] It's [PII], and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so the policy is effective and active [PII].
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] Um, I can fax over a fax back that lists all of the codes that are covered and the frequency and duration for each of those, um, unless there's something that you need to go over on the phone.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, [PII]. I have a few questions only for this policy, so if you don't mind. And um, first, uh do you know, do you know if you can provide me the providers uh participation in or out of network?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so Carrington is the network and we don't have access to that information so you'd have to give them a call, um, which I can give them, give them, give you their number.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Uh, actually, I do have the number, so that's totally fine. And can you confirm the group name and group number?
[AGENT][NEUTRAL] Uh, group name.
[AGENT][NEUTRAL] The group name is Creative Circle LLC.
[AGENT][NEUTRAL] And the group number is 70,030.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And under this policy, will there be any missing too clause or waiting period?
[AGENT][NEUTRAL] Uh, there is a missing tooth clause. There is no waiting period.
[CUSTOMER][NEUTRAL] OK. Uh, type of coordination of benefits?
[AGENT][NEUTRAL] Uh, standard.
[CUSTOMER][NEUTRAL] Standard. OK. Will there be any alternate benefits for the fillings?
[AGENT][NEUTRAL] Like downgrades
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] There's no downgrades.
[CUSTOMER][NEUTRAL] The downgrade. OK. And for this year, has the patient used anything out of the annual maximum or met the deductible?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, give me just a moment.
[CUSTOMER][NEUTRAL] Uh sure.
[AGENT][NEUTRAL] Uh, it doesn't look like they've used anything for [PII].
[CUSTOMER][POSITIVE] like 2025. OK, thank you.
[AGENT][NEGATIVE] And not met the deductible.
[CUSTOMER][NEUTRAL] And any history on file that may affect frequency, especially for the preventive services.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, not a guarantee of payment basic outline of the policy. It looks like actually got.
[CUSTOMER][NEUTRAL] based on like actually.
[AGENT][NEUTRAL] 69
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It actually looks like they have used, I don't know why it didn't report it. OK, they have used this here.
[CUSTOMER][NEUTRAL] Actually looks like they have you here.
[AGENT][NEUTRAL] 20,480.
[CUSTOMER][NEUTRAL] 20,480.
[AGENT][NEUTRAL] And they've had a bite wing on [PII].
[CUSTOMER][NEUTRAL] It might be 59225.
[AGENT][NEUTRAL] They had cleaning an exam on [PII].
[CUSTOMER][NEUTRAL] Uh cleaning
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would be all in the history.
[CUSTOMER][POSITIVE] Um, OK, thank you so much for that, [PII]. So in that case, I'll be all for this patient.
[CUSTOMER][NEUTRAL] And uh would you mind helping me with one more patient if that's OK with you?
[AGENT][NEUTRAL] OK. Uh let me get the.
[AGENT][NEUTRAL] Get the notes put in, one moment.
[CUSTOMER][NEUTRAL] Uh sure.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, that will be 02033644.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. The uh the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Can you show this policy is active and effective [PII]?
[CUSTOMER][NEUTRAL] OK. Thank you, [PII], for that. And also for this one, can I get the group name and number?
[AGENT][NEUTRAL] My group name is.
[AGENT][NEUTRAL] Oxford or Oxford Global Resources.
[CUSTOMER][NEUTRAL] Oxford or Oxford.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And group number is 70052.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And under this one, will there be any missing too lo or waiting period?
[AGENT][NEUTRAL] Um, there is a missing two claws. There's no waiting period.
[CUSTOMER][NEUTRAL] There is a missing
[CUSTOMER][NEUTRAL] OK. Uh, she will be tight.
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] Standard. Any downgrades for the fillings?
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][POSITIVE] The downgrades. OK. Thank you.
[CUSTOMER][NEUTRAL] And just to confirm, the major services and also they are not covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Um, anything you sort of the annual max or the deductible for this calendar year?
[AGENT][NEUTRAL] And anything quoted is not a guarantee of payment basic outline of the policy, um, looks like.
[CUSTOMER][NEUTRAL] hang on.
[CUSTOMER][NEUTRAL] Uh, my.
[AGENT][NEUTRAL] They've not used anything this year.
[CUSTOMER][NEUTRAL] Not use anything here. That's used. And uh what about history on file that may affect frequency?
[AGENT][NEUTRAL] History.
[AGENT][NEUTRAL] Uh they had a bite wing on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] We had a cleaning on the same date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They had a full mouth on the same date.
[CUSTOMER][NEUTRAL] Have a full amount.
[AGENT][NEUTRAL] Looks like that's it.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[CUSTOMER][NEUTRAL] Um, yeah, that'll be it for this patient.
[CUSTOMER][NEUTRAL] Uh, can I have the reference number of our call, [PII]?
[AGENT][NEUTRAL] That's my name is [PII]. First [PII], and then today's date.
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much again. I really appreciate it. And that will be all from my end. So you have a great rest of your day ahead, [PII], and take care.
[AGENT][POSITIVE] OK. Thank you for calling APL. I hope you have a great day too. Bye-bye.
[CUSTOMER][POSITIVE] Mhm. Thank you. Bye-bye.