AccountId: 011433970860
ContactId: e0f284c5-60ee-4916-83a3-f8c5554dbc25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 242899 ms
Total Talk Time (AGENT): 113073 ms
Total Talk Time (CUSTOMER): 97174 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/e0f284c5-60ee-4916-83a3-f8c5554dbc25_20250512T19:31_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] Uh, hi [PII], my name is [PII]. I'm calling from a dental office. I was, I need a breakdown of benefits for a patient, please.
[AGENT][NEUTRAL] OK, well, I can help you with the dental breakdown, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, it's [PII] and the ID number is [PII].
[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] Uh, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. And did you need a copy of the fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] I, I've never, um, had, I've never worked with you guys before, so I don't know what you have on your fast pack. I need like a group name and number and I'm and I need a payer ID and a mailing address for claims and then I need, um, like frequencies for.
[CUSTOMER][NEUTRAL] Preventative stuff.
[AGENT][NEUTRAL] OK, so on the
[CUSTOMER][NEUTRAL] Do you have that is all of that on your fax bag?
[AGENT][NEUTRAL] Yes, everything except the um group name and number and I can give that to you. Let me see if there's any history on file. Hold on one second.
[CUSTOMER][NEUTRAL] OK,
[AGENT][NEUTRAL] All right, so there's no history on file.
[CUSTOMER][POSITIVE] Yeah and history on file, yeah, OK, very good.
[AGENT][NEUTRAL] And the group, group number is 70,030.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is Creative Circle LLC.
[CUSTOMER][NEUTRAL] Got it. Do you, can you tell me are posterior composites downgraded?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] Or are they covered?
[CUSTOMER][POSITIVE] No downgrades, so that's great. Can you also tell me for out of network providers, is the plan pay based off of UCR or is it based off of your loud amounts?
[AGENT][NEUTRAL] So the policy, um,
[AGENT][NEUTRAL] It's on the Carrington PPO network, but the benefits are the same whether you're [PII] or not. Um, so we are off of allowable for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Allowed them out.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and take the um the um fax back and then if I have any additional questions I can always call back.
[CUSTOMER][NEUTRAL] Do you need my fax number?
[AGENT][NEUTRAL] OK, what's it, mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And that's attention, [PII].
[CUSTOMER][POSITIVE] That's fine yeah thank you.
[AGENT][NEUTRAL] And it was [PII], you're welcome, [PII]?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Alright, well, I'll go ahead and send this over to you now, so you'll see the calendar year maximum deductible, all the percentages, frequencies, exclusions, all the ways to file a claim, and then there's a list of covered codes. If the code you're looking for is not on this list, it wouldn't be covered by the policy.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, if I give you one code and our charge our fee for it, are you able to tell me if we are above or within the loud amount?
[AGENT][NEUTRAL] Um, it doesn't really work like that. I can tell you if if the code you tell me is on this list to be covered, but the, the, um,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, but you don't let, OK, that's fine, no problem. I will look forward to the facts.
[AGENT][NEUTRAL] You want to do that?
[AGENT][NEUTRAL] OK. Well, I'm gonna go ahead and fax it over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's all thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.