AccountId: 011433970860
ContactId: e77f5688-d80c-4976-9564-f0a2d2143364
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851140 ms
Total Talk Time (AGENT): 344350 ms
Total Talk Time (CUSTOMER): 297626 ms
Interruptions: 11
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/e77f5688-d80c-4976-9564-f0a2d2143364_20250326T18:49_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII]. My name spells [PII] And I'm calling directly from the provider's office. I'm just here to get a full breakdown of a dental benefit plan. Can you help me out today?
[AGENT][NEUTRAL] OK, [PII], you're needing a breakdown of dental benefits on a member, is that correct?
[CUSTOMER][NEUTRAL] That is correct. How do you spell your name, ma'am?
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] [PII]. I can help you with this, [PII]. We have, you're very welcome. We have facts facts of the benefits that I will send to you for the member. Um, first off.
[CUSTOMER][POSITIVE] [PII], thank you so much, [PII].
[CUSTOMER][NEUTRAL] Would you, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is your callback number?
[CUSTOMER][NEUTRAL] Yeah, um, that's gonna be a moment. [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Yes, we have 0258551.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member up please.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, so let's just one moment. You said 0258551?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, that is missing a number somewhere in there.
[CUSTOMER][NEUTRAL] Let me just check here for you. Hold on a moment. Just just give me one quick moment. It's 02585551. That's gonna be 35.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] That's OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The date of, I'm sorry, the name of the patient is [PII] and he was born on [PII].
[AGENT][NEUTRAL] [PII], are there anything that you said?
[CUSTOMER][NEUTRAL] I'm sorry, that is [PII].
[AGENT][NEUTRAL] What was the gentleman's
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Mhm. Would you like me to spell it out for you? Yeah, he was born on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. I don't need that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So yes, I do show that he subscribers from policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Alright, does it work on the calendar year? Does it?
[AGENT][NEUTRAL] And there is no history on file for him?
[AGENT][NEUTRAL] It does, and all of that information will be on the fax back. Mhm.
[CUSTOMER][NEUTRAL] All right. Does it
[CUSTOMER][NEUTRAL] Uh, would you mind if, is it OK if I can speak to you instead?
[AGENT][NEUTRAL] OK, what information do you?
[AGENT][NEUTRAL] Do you need?
[CUSTOMER][NEUTRAL] Can you start with the group name? Can you start with the group name and the group number, please?
[AGENT][NEUTRAL] The group name is Creative Circle LLC.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Group number 7000.
[CUSTOMER][NEUTRAL] How about the group number?
[CUSTOMER][POSITIVE] Thank you so much. And the pair ID please?
[AGENT][NEUTRAL] Mhm. 7
[AGENT][NEUTRAL] 0030.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] How about the
[CUSTOMER][POSITIVE] Thank you so much. And well, how much is the maximum amount allowed for this policy?
[AGENT][NEUTRAL] $500 per covered person per calendar year.
[CUSTOMER][POSITIVE] Thank you so much. Um, is it used or not?
[AGENT][NEGATIVE] No benefits have been used.
[CUSTOMER][NEUTRAL] How much is used for this amount?
[CUSTOMER][NEUTRAL] From this amount, I'm sorry?
[AGENT][NEGATIVE] There has not been any benefits used on this policy for this calendar year as of now.
[CUSTOMER][POSITIVE] Oh, I'm sorry. Thank you so much.
[CUSTOMER][POSITIVE] Thank you so much for that. Can you also tell me, [PII], um,
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] How much is the deductible amount, um,
[AGENT][NEUTRAL] $50 per covered insured per.
[CUSTOMER][NEUTRAL] Available for this plan?
[AGENT][NEUTRAL] Under a year.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is it Matt?
[AGENT][NEUTRAL] No, it is not, but there have not.
[AGENT][NEGATIVE] Not been any there is no history on file and none of it have been used for this calendar year.
[AGENT][NEGATIVE] And none of the deductible has been met. There is no history on file.
[CUSTOMER][NEUTRAL] Is there any waiting period?
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] Is there any waiting period? All right. How about missing too?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, got it, thank you. Can you verify to me um.
[CUSTOMER][NEUTRAL] The co-insurance coverage for class preventive, class basic, and class major, please?
[AGENT][NEUTRAL] There is no coverage for major services at all. Preventative is 100% of allowable and basic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And they ready
[AGENT][NEUTRAL] Graphs FMX and basic restorative are 80% of allowable with no waiting period.
[CUSTOMER][NEUTRAL] All right, got it. Thank you so much for that. Since major is not covered, I'll just place here that there's no coverage for this procedure. Yeah, got it. Thank you. I have here like um less than 20 codes to provide to you. Would you like me to give you
[AGENT][NEUTRAL] It is not
[AGENT][NEUTRAL] No, ma'am, I can. Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am, I can send you a fax back that has everything that is covered on this policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That's listed on the fax back. And if the code is not on the fax back, that means it would not be covered.
[CUSTOMER][NEUTRAL] All right. Can you please, um, I, I actually need to ask as well for the guidelines and some, I have follow-up questions. That's why I called. So it would be better if I can speak to you instead. I promise it won't take much time from you for you uh.
[AGENT][NEUTRAL] But you, you said that you had 20 codes, so I'll be happy to, um, I can connect you with, yes, ma'am. If, if you already have the facts back.
[CUSTOMER][NEUTRAL] Less than.
[AGENT][NEUTRAL] Do you already have that?
[CUSTOMER][NEGATIVE] No, I haven't yet. We don't, we haven't received it yet.
[AGENT][NEUTRAL] OK. Have you already requested it to be sent?
[CUSTOMER][NEUTRAL] Not yet.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] What type of information are you needing? I mean, all of the codes that are covered on this member's plan are listed on our fax back.
[AGENT][NEUTRAL] And if it is not on there, that means that it is not covered at all.
[CUSTOMER][NEUTRAL] Alright, I understand that.
[CUSTOMER][NEUTRAL] Um, just wanna ask as well, does the maximum applies to preventive or not?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] How about the?
[CUSTOMER][NEUTRAL] How about the deductible? Does it apply to prevent?
[AGENT][POSITIVE] It applies to everything else.
[CUSTOMER][POSITIVE] Alright, got it, thank you.
[AGENT][NEUTRAL] The deductible to the preventative, it applies to the basic and the and the radiographs.
[CUSTOMER][NEUTRAL] Can you help me in getting the frequency limit and the coverage? Because I won't be able to get the fax today.
[AGENT][NEUTRAL] Trophies are once every 6 months, oral evaluations are 2 for 12 months, bite wings are once per 12 months, and full mouth X-rays and pan.
[AGENT][NEUTRAL] Or once every 5 years.
[CUSTOMER][NEUTRAL] I'm sorry, the line is cutting in and out. [PII] the.
[AGENT][NEUTRAL] And that is all of the free information on this policy.
[CUSTOMER][NEGATIVE] The light is cutting in and out and I wasn't able to catch everything. If you
[AGENT][NEUTRAL] Right, I know there's some phone issues. Yes, that's why I was wanting to fax it to you so that you would be able to have all of the information at hand.
[CUSTOMER][NEUTRAL] It's the fax number. Can you send it to me?
[AGENT][POSITIVE] I can, absolutely. What is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Does it need to be put to your attention?
[CUSTOMER][NEUTRAL] Can you repeat that for me, please?
[AGENT][POSITIVE] Yes, ma'am. I will be happy to. Just one moment. Does it need to have
[CUSTOMER][NEUTRAL] Yes. Can you
[AGENT][NEUTRAL] Just the fax need to have your name on it, [PII]?
[AGENT][NEUTRAL] Does it need to be put to your attention?
[CUSTOMER][NEUTRAL] You can just put my name if you'd like.
[CUSTOMER][POSITIVE] It's OK, yes, you can do that.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm. Before you go, can you at least tell me if you guys are covering out of network or benefits?
[AGENT][NEUTRAL] This this plan provides it participates in the Carrington PPO network, however, they are not required to use a network provider.
[CUSTOMER][NEUTRAL] Are you covering out of network or benefits?
[AGENT][NEUTRAL] There is no ortho coverage. I gave you the categories of coverage. This is preventative and basic only. No major services or orthos is covered under this plan.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Does this plan renew every cal um every [PII]?
[AGENT][NEUTRAL] It is, it is a calendar year policy, yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much. What is the fee schedule that we're following here? Is it Carrington?
[AGENT][POSITIVE] Carrington. That is correct.
[CUSTOMER][POSITIVE] Thank you. Sorry about that.
[AGENT][NEUTRAL] That is also on the back pack.
[CUSTOMER][NEUTRAL] What is your claim filing limit? How many days a month?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] How many days a month are you allowed?
[CUSTOMER][NEUTRAL] All right. And your mailing address, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, the line is cutting in and out.
[AGENT][NEUTRAL] [PII]. Yes, ma'am. That is why it's going to be better for me to send you this fax back that has this information on here.
[CUSTOMER][NEUTRAL] Can you repeat the mailing address, please? [PII]. What's the next word after that?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] The [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, got it, thank you so much for that information.
[AGENT][NEUTRAL] You're welcome. And you said that your fax number is [PII].
[CUSTOMER][NEUTRAL] Uh, does this, uh, policy has a future termination date?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. That is what I have.
[CUSTOMER][NEUTRAL] What is your what is your reference number? Thank you so much, [PII]. Can you tell me the reference number, please?
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[AGENT][NEUTRAL] And if you all do file a claim on this policy, [PII], with APO once the claim has been processed, we have a portal that you can also check claim status in by going to [PII].
[AGENT][NEUTRAL] And is there anything else?
[CUSTOMER][NEGATIVE] Once again, the out of network benefits is not covered, right?
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] There are no orthodontic benefits at all on this policy.
[CUSTOMER][POSITIVE] Thank you so much. All right, that's it. Thank you. Have a great day. Bye for now.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, I