AccountId: 011433970860
ContactId: df29f22e-76c2-4839-a51e-43aa235f9700
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 590580 ms
Total Talk Time (AGENT): 291296 ms
Total Talk Time (CUSTOMER): 136789 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/df29f22e-76c2-4839-a51e-43aa235f9700_20250519T14:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi um my name is [PII]. I am calling from a dental office and I had a patient give me a call, um, and I have never dealt with this insurance so we wanted to see if I could get some information.
[AGENT][NEUTRAL] Sure, [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much. And what is the policy number?
[CUSTOMER][NEUTRAL] Um, so she gave me an ID and a group number.
[CUSTOMER][NEUTRAL] Um, the ID she gave me was 6.
[AGENT][NEUTRAL] Does anything say a policy search? Oh, go ahead, let's try that.
[CUSTOMER][NEUTRAL] Um, OK, uh, 60801.
[AGENT][NEUTRAL] That's a group number, OK.
[CUSTOMER][NEUTRAL] OK, and then she, well, let's see, maybe she switched them um.
[AGENT][NEGATIVE] Yeah, it's too short. Um.
[AGENT][NEUTRAL] Is there a policy er number?
[CUSTOMER][NEUTRAL] This one is 7.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] You know what she just read it over the phone, so the only other number she gave me was 70035.
[AGENT][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] Do you have a name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]. Last name is [PII]
[CUSTOMER][NEGATIVE] Oh sorry, I just lost my screen. uh [PII]
[AGENT][NEUTRAL] OK, that is
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, that is not the correct person I have, so that is not the right number. Let me do something just real quick, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me look them up by their last name. Can you spell that for me one more time?
[CUSTOMER][NEUTRAL] Of course, yeah, it's [PII]
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh good.
[AGENT][POSITIVE] And you, and can you do the birthday for me one more time? I'm so sorry.
[CUSTOMER][NEUTRAL] No, you're fine, uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Would you like that policy number?
[CUSTOMER][NEUTRAL] Um, yes, I will take that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 02.
[AGENT][NEUTRAL] 62.
[AGENT][NEUTRAL] 1118.
[CUSTOMER][NEUTRAL] Alright, so is that the actual ID number then that would go in?
[AGENT][NEUTRAL] Right, so when she comes in and gives you her dental card if she has one, it'll it'll show on there I believe as policy certification number or policy certificate number and that's probably why she didn't think or he um didn't think that it was the right number so um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But this is the correct number and it is a dental policy and it is effective or it is active with an effective date of [PII].
[AGENT][NEUTRAL] Um, if you would like, if you have a good fax number, I can give you a fax back so that it has all of, uh, what their policy covers before they get seen. Would that be helpful?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be wonderful I guess my biggest question before that though is are they able to go anywhere or do they have to stick like to a network?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They should be able to um let me see what.
[AGENT][NEUTRAL] Um, they get a discounted rate if they go through the Carrington network, which I don't know if you all are in.
[AGENT][NEUTRAL] That group that network or not? OK, um, we are able to so if it ends up being where you um you can.
[CUSTOMER][NEGATIVE] We are not.
[CUSTOMER][NEGATIVE] Yeah, no, we're not.
[AGENT][NEUTRAL] Bill us for it, um.
[AGENT][NEUTRAL] And if we deny the claim then they would be able to if it's for something that is covered under their policy and uh we'll still be able to.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We should be able to yeah reimburse the patient if if the claim gets denied from you guys because you're not within the network.
[CUSTOMER][NEUTRAL] Reimburse the patient or would it?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But we will honor their policy whichever they have, they just get an extra discount if you're through the Carrington network but we are APL um and we don't use the PPO.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] See real quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][POSITIVE] Mhm, not a problem.
[AGENT][POSITIVE] I can probably give you a little bit more information.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, yeah, it looks like with this policy they'll have a $50 deductible.
[AGENT][NEUTRAL] They haven't used any other benefits yet. They have a calendar year maximum of $500.
[AGENT][NEUTRAL] And let me check.
[AGENT][NEUTRAL] Yeah, it looks like we do buy allowable, so preventative services are 100% of allowable, uh, FMX expenses, radiographs are 80%, basic expenses and basic restorative uh expenses are at 80% of allowable as well.
[AGENT][NEUTRAL] With the cleaning once every 6 months?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] There's not a missing tooth clause in this policy, um, but like I said, if you file the claim and it gets denied because it's not covered or you, you don't use us, then they can always file the claim as well, and we will um honor whatever they got done as long as it's within their policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And where did the claims actually go to?
[AGENT][NEUTRAL] OK, uh, you can either fax them.
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or you can mail it to us or upload it through [PII].
[AGENT][POSITIVE] And it will and all of this information um I'm going to give you in the fax back as well so hopefully that helps as well yeah yeah it should be in there as long as I get uh a good fax number and it gets to you all of that information should be there.
[CUSTOMER][POSITIVE] Oh, OK, perfect, yes, that will.
[AGENT][NEUTRAL] It does go through the Carrington PPO network but like I said it's not necessarily required um if you guys deny it they can always file the claim through us.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is there any other um.
[AGENT][NEUTRAL] Questions?
[CUSTOMER][NEUTRAL] Um, mm, I think that I think too close, um, no, I think like you said most of the stuff's on the fax that should be good so I can give you the fax whenever you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what's a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm gonna read it back to you [PII].
[AGENT][NEUTRAL] [PII] correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, well [PII], I will get this sent over to you, um, give it 5 to 10 minutes if that's all right, and if you don't get it, uh, feel free to call us back.
[CUSTOMER][POSITIVE] OK all right wonderful thank you so much.
[AGENT][POSITIVE] Alright, thank you so much and if there's nothing else I can help you with, I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Mm thank you mm bye.
[AGENT][NEUTRAL] Bye.