AccountId: 011433970860
ContactId: e793a7f8-c3cb-4107-beb7-607e4ef6252a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668969 ms
Total Talk Time (AGENT): 214407 ms
Total Talk Time (CUSTOMER): 213609 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/e793a7f8-c3cb-4107-beb7-607e4ef6252a_20250407T12:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling AP Angel. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. This is [PII] in customers.
[CUSTOMER][NEUTRAL] Yes I have um provider's office call with Asia on the line.
[CUSTOMER][NEUTRAL] Um, requesting benefits for
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] For policy 26.
[CUSTOMER][NEUTRAL] 04676.
[AGENT][NEUTRAL] OK, and what is the provider's name? I'm sorry.
[CUSTOMER][NEUTRAL] Um, Asia.
[AGENT][NEUTRAL] Asia, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and she's requesting the benefits on the, um, it.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] She already verified the name and date of birth. Thank you.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Could you please provide the benefits?
[AGENT][NEUTRAL] I sure can, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Is [PII] direct line?
[AGENT][NEUTRAL] OK, I'm sorry, one moment please.
[AGENT][NEUTRAL] And if you could repeat that number for me again please?
[CUSTOMER][NEUTRAL] I you
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you, and you're calling for benefits for dental, is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] OK, thank you. I can assist you with that. And before we get started, um, please spell your first name for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And again, my name is [PII], that's [PII] And let me get those benefits for you for the dependent. One moment, please.
[AGENT][NEUTRAL] OK, uh, this policy shows effective as of [PII], it shows that it is active for the member.
[AGENT][NEUTRAL] And once I am done with the verbal breakdown, I can also send over a fax back to you as well. Please note verification of benefits provided does not guarantee payment. The member has a $500 calendar year max.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a $50 deductible.
[AGENT][NEUTRAL] This plan does not cover any major services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And the member has no history at all on file.
[CUSTOMER][NEUTRAL] No history. OK. And um
[CUSTOMER][NEUTRAL] Uh, what is the coordination of benefit rule?
[AGENT][NEUTRAL] We do not coordinate benefits.
[CUSTOMER][NEUTRAL] No. OK. And what is the claiming address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. And what is your direct call number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, what is, uh, direct call number for the Carrington?
[CUSTOMER][NEUTRAL] For dependents.
[AGENT][NEGATIVE] I don't understand the question sorry.
[CUSTOMER][NEUTRAL] As uh the previous two representatives.
[CUSTOMER][NEUTRAL] As the previous two representatives uh referred me to, to you. So I need the direct call number.
[AGENT][NEUTRAL] OK, our number is [PII].
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. OK. And um,
[CUSTOMER][NEUTRAL] Uh, what is timely filing limit?
[AGENT][NEUTRAL] There's no time filing limit.
[CUSTOMER][NEUTRAL] And uh it is clear your plan or the fiscal year plan.
[AGENT][NEUTRAL] This is a calendar year policy.
[CUSTOMER][NEUTRAL] Is there any out of network benefits?
[AGENT][NEUTRAL] The plan participates in the Carrington PPO network and if the provider does not participate, it will follow UCR.
[CUSTOMER][NEUTRAL] Mhm. And uh is there any used amount for the maximum and deductibles?
[AGENT][NEGATIVE] No, nothing has been used from that.
[CUSTOMER][NEUTRAL] OK. And maximum are applying on um a preventative.
[AGENT][NEUTRAL] It applies to all covered benefits, the maximum of 500.
[CUSTOMER][NEUTRAL] And uh deductible?
[AGENT][NEUTRAL] The deductible only applies to
[AGENT][NEUTRAL] Basic services.
[CUSTOMER][NEUTRAL] Is there any family deductibles?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is there any missing tooth cloth in the waiting period?
[AGENT][NEGATIVE] There is a missing tooth clause.
[AGENT][NEUTRAL] There is no waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what are the coverage percentage for perman the basic?
[AGENT][NEUTRAL] Preventative
[CUSTOMER][NEUTRAL] And major.
[AGENT][NEUTRAL] Preventative is covered at 100%, basic at 80, there is no major coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK. And um I have some courses to know the frequency and coverages may provide all at once or one by one.
[AGENT][NEUTRAL] I'm so sorry, [PII], can you repeat that? You were going too fast. If you could repeat what you need.
[CUSTOMER][NEUTRAL] Uh, I need the uh
[CUSTOMER][POSITIVE] Coverage percentage and the frequency for some goods. They provide all ones or one by one.
[AGENT][NEUTRAL] Percentages and frequent.
[AGENT][NEUTRAL] Uh, I'm sorry, you need percentages and frequencies, is that correct? OK, yes, one by one, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. Uh, postcode is [PII].
[AGENT][NEUTRAL] OK, 100%. That's once every 6 months.
[CUSTOMER][NEUTRAL] And it is uh showing the frequency with the 4910.
[AGENT][NEGATIVE] 4910 is not covered, that is considered major. There's no major coverage.
[CUSTOMER][NEUTRAL] Mhm. All right. And uh 2391?
[AGENT][NEUTRAL] OK, 2391 that is covered at 80%, 1 for 24 months, no downgrades.
[CUSTOMER][NEUTRAL] OK. And uh 3330.
[AGENT][NEUTRAL] Not covered, that is considered major.
[CUSTOMER][NEUTRAL] OK. And uh 4341.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that is covered at 100% and that is 2 for 12 month period.
[CUSTOMER][POSITIVE] No problem. It is the frequency with any procedure?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] 0274
[AGENT][NEUTRAL] OK, 100%, 1 for 12 month period.
[CUSTOMER][NEUTRAL] 100%. And it is the frequency with any procedure?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And 0210.
[AGENT][NEUTRAL] OK, [PII] and 0330 they share frequency, those are 1 per 5 year period at 80%.
[CUSTOMER][NEUTRAL] 80, 20% 1.5 and 0220?
[AGENT][NEUTRAL] OK. [PII]. There are no frequencies for PAs. Those are covered at 80%.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 0180, 1 moment, just to make sure that it is not covered.
[AGENT][NEUTRAL] OK, not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh 9110?
[AGENT][NEUTRAL] OK, covered at 80%, no frequency.
[CUSTOMER][NEUTRAL] 424 9
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 994 4
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] [PII] automatic.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh 0120 and 0140. It is shared that we see with each other?
[AGENT][NEUTRAL] They share frequency, yes, those are 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm. OK. Just 2 minutes.
[AGENT][NEUTRAL] Now 0140 that's covered 80% though.
[CUSTOMER][NEUTRAL] And there is no history on the fund.
[CUSTOMER][NEUTRAL] So they are not sharing the frequency. Uh 0120 and 0142.
[AGENT][NEUTRAL] They share frequency
[AGENT][NEUTRAL] I'm sorry, they share frequency but 0140 is covered at 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] OK. And uh what is the reference number for this call?
[AGENT][NEUTRAL] We do not provide reference numbers [PII]. You can use my name [PII] last initial is [PII], and today's date. Anything else I can help you with, please?
[CUSTOMER][POSITIVE] No, thank you so much. Have a nice day. Bye for now.
[AGENT][POSITIVE] Mm thank you for calling APL. Take care. Bye bye.