AccountId: 011433970860
ContactId: df023ba8-1538-4144-8d4b-6cd372278bfc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364179 ms
Total Talk Time (AGENT): 161515 ms
Total Talk Time (CUSTOMER): 177918 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/df023ba8-1538-4144-8d4b-6cd372278bfc_20250314T15:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, good, good morning. This is [PII] from provider's office. I would like to check the patient's eligibility, please.
[AGENT][NEUTRAL] Sure, I can check eligibility for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, that is 02502130.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that lien. So this policy is active. Effective date was [PII], and if you'd like I can send you the fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Can you just uh provide me uh verbally please if if it's OK.
[AGENT][NEUTRAL] Oh, you just needed to check some things over the phone?
[CUSTOMER][NEUTRAL] You can't provide the benefits over the phone?
[AGENT][POSITIVE] Oh yes I can absolutely.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, just a verbal please. uh I don't need to send it fax.
[AGENT][NEUTRAL] OK, that's perfectly fine. OK, what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Um, is it, uh, this American Public, uh, insurance, is it, um, PPO or a discount plan?
[AGENT][NEUTRAL] So this policy participates in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Oh, OK, PPO got it. And then, um, is there an annual maximum deductible for this patient?
[AGENT][NEUTRAL] Yes, yes, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so their calendar year maximum is $500 that calendar year deductible is $50 which does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the only annual max participation is only 500.
[AGENT][NEUTRAL] Yes, this policy only has coverage for preventative and basic expenses. There is no major coverage under this policy.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Oh, got it, got it. There's no uh basic restorative as well, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] There is basic and restorative, uh, no major coverage.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Just major, OK, got it.
[AGENT][NEUTRAL] Right, right. So like oral surgery, uh, periodontic, things like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm OK OK OK and then the fees that we're going to follow is for Carrington, right?
[AGENT][NEUTRAL] Correct Carrington PPO Network.
[CUSTOMER][NEUTRAL] Mhm and uh can you uh provide me the group name of the patient insurance?
[AGENT][NEUTRAL] Of course give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the group number as well?
[CUSTOMER][NEUTRAL] Uh, I already have the group number. The patient already provided here just to verify, is it, is that uh 705270052? OK, great. Alright, and group group name please?
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Yes, that is Oxford.
[AGENT][NEUTRAL] So OX FORD Global.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Resources
[CUSTOMER][NEUTRAL] Global OK.
[CUSTOMER][POSITIVE] Resources got it.
[AGENT][NEUTRAL] LLC, yes.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh, so the coverage for uh basic and uh basic restorative and the preventive diagnostic, is it both 100%, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, so preventative expenses is at 100%. Uh, radiographs, basic and restorative are all at 80%.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 80. OK, so there will be 20% for this patient then. OK, and then um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One more thing, uh, can you, uh, verify with me if our office is in network actually our provider has 3 offices with different tax ID. I can provide you with the different tax ID for the different office. There are 3 offices all in all, and um if you could check that uh in case the patient would uh you know uh come into other office, I would like to double check with you if uh these 3 offices are in, uh, are all in network or out of network.
[AGENT][NEUTRAL] Sure, so I'm not able to see that information lien that would be through Carrington, um, and if you'd like I can give you their information and transfer you to them.
[CUSTOMER][NEUTRAL] Carry, OK.
[CUSTOMER][NEUTRAL] OK, maybe later I can get the phone number for the Carrington, uh, department, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so can you just provide me the mailing address and the uh payer ID for this insurance?
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK got it got it alright thank you so much um can I get the reference before you transfer me to the other department?
[AGENT][NEUTRAL] Oh, of course, yeah, reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last [PII] and then was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That would be all, [PII], thank you so much.
[AGENT][NEUTRAL] OK, sure, did you want that phone number for Carrington before I transfer you?
[CUSTOMER][POSITIVE] Yes, yes, can I have it?
[AGENT][NEUTRAL] OK, yes, that phone number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a good day.
[AGENT][POSITIVE] Of course, yes, I'm just gonna put you on a hold while I get them on the line for you. I hope you have a great day too bye bye.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Thank you for