AccountId: 011433970860
ContactId: e751e927-e730-4e05-82bf-7e33dc1cd3eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263320 ms
Total Talk Time (AGENT): 156052 ms
Total Talk Time (CUSTOMER): 91281 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/e751e927-e730-4e05-82bf-7e33dc1cd3eb_20250214T19:39_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I just need to get a breakdown for a patient's benefits.
[AGENT][NEUTRAL] I can help with benefits. With whom am I speaking to?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII], thank you. What's that policy number, please?
[CUSTOMER][NEUTRAL] Um, 02580467.
[AGENT][NEUTRAL] Again, the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] is a subscriber, but I need his daughter's information. Let me [PII].
[AGENT][NEUTRAL] OK, and the daughter's
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I do appreciate that, thank you. Uh, so first of all, the policy went into effect on [PII]. It is active. Now, the policies have $500 per calendar years and maximum. That's just the verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And they um will pay the basic, basic restorative and preventative services only. Now, I, I do have a uh fax back that I can send to you if you would be interested, um, it, uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] It doesn't look like any of the uh family have used their benefits, so it, it doesn't look like we have any history on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like a fax back, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Yes, that would be great just to see it. Will it have the max and deductible on it?
[AGENT][NEUTRAL] Yes, the maximum is $500 per calendar year and that's just a verification, not a guarantee of payment. The deductible is $50 per calendar year per individual with a family deductible of $150 and that doesn't include the preventative services.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is that fax number that I can send this to, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK. So what I'm gonna do is I'm gonna go ahead and send this.
[CUSTOMER][NEUTRAL] [PII] sorry uh it's been a long day.
[AGENT][NEUTRAL] 89887.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, great. So what I'll do is I'll go ahead.
[CUSTOMER][NEUTRAL] I was reading off
[AGENT][NEUTRAL] OK. Um, so what I'm gonna do is I'll just go ahead and send that and then um you should be getting it just, uh, any, anytime. Now, is there anything else that I can tell you about the policy before I send off this uh fax?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] So you said it was just preventative and diagnostic.
[AGENT][NEUTRAL] That's correct, yes. There's no major services. There's no endo, uh, Pero or anything like that.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So basic is just covered at 50 you said?
[AGENT][NEUTRAL] Uh, no, the, um, preventative services are covered at 100%.
[AGENT][NEUTRAL] The uh basic and basic and restorative are covered at 80% and what we do is you'll you'll see on here that we use the Carrington PPO fee schedule. Now you don't need to be a member of Carrington.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, in order for that policy to pay out, so we don't have a network. There is no network with this. Uh, it's just that we, we just happen to use their fee schedule and that's it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it basically goes off of the fee schedule then.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And that fee schedule will be attached to the breakdown?
[AGENT][NEUTRAL] Um, no, it is online now.
[AGENT][NEUTRAL] We found that the fire was too.
[CUSTOMER][NEUTRAL] Would you be able to send me a copy of it?
[AGENT][NEUTRAL] Uh, I can see if I can get a copy of it and send it to you by that same fax.
[CUSTOMER][POSITIVE] Yes, that would be great.
[AGENT][NEUTRAL] Is there anything else at all I can help with? Oh.
[CUSTOMER][NEUTRAL] It's just it's a.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's just like a new plan that I have to put in the system completely like so that's just why I was asking for it on paper.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Of course, yeah, let me see if I can't get that and then um I'll I'll send that off to you if I, if I can get it, if I can pull it up in my system.
[CUSTOMER][POSITIVE] OK, cool. Thank you so much.
[AGENT][POSITIVE] OK well thank you for contacting.
[CUSTOMER][NEUTRAL] If I have any other questions I'll call back.
[AGENT][NEUTRAL] Yes, please, yeah, do, um, any of us will be able to help you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Mhm thanks for contacting AP have a good