AccountId: 011433970860
ContactId: ecb01c07-a165-4f56-b69f-d09ea038a37c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444450 ms
Total Talk Time (AGENT): 189442 ms
Total Talk Time (CUSTOMER): 76380 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/ecb01c07-a165-4f56-b69f-d09ea038a37c_20250514T12:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Yes, I called yesterday to get a fax back regarding a member that has an appointment this morning and it never came.
[AGENT][NEUTRAL] OK, so you called yesterday you said and requested a fax back this on the dental policy, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] But you didn't receive it.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you and [PII], what's a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02616954
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] OK, then the information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. Is your fax number [PII]?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, well then that is why you did not receive it because that is what we are showing as the fax number so give me just a second, [PII], and I'll be happy to send that to you again, but he is the subscriber, the policy is active as a 4-12025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your correct fax number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so just one moment.
[AGENT][NEUTRAL] It takes a moment to load the facts back [PII], just one second, but I can't tell you while I'm waiting that there is no history on file for this member.
[CUSTOMER][NEUTRAL] OK, um, I do have a few questions just in the meantime before the fax that comes because his appointment is this morning.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, does it show what month his plan renews?
[AGENT][NEUTRAL] I'm sorry, what month, what?
[CUSTOMER][NEUTRAL] His plan renews like is it a calendar year plan?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] Is there a deductible?
[AGENT][NEUTRAL] There is a $50 deductible on basic. Yes, Preventative is covered at 100%. Radiographs basic and basic restorative are 80% of UCL I'm sorry, 80% of allowable and they are subject to the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] OK, is there a maximum?
[AGENT][NEUTRAL] $500 per calendar year for covered outpatient services and again any information that I'm providing for you Destiny as a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Will the um payer ID be on the fax back?
[AGENT][NEUTRAL] It is, and the mailing address and fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And all the covered codes are on the fax back again there is no history and then that's the fax back has been sent to you, Destiny. Um, if you will end up filing a claim for Mr. [PII] with us once it has been processed, we do have a portal also that you should be able to check claim status in excuse me.
[AGENT][NEUTRAL] And that website for our.
[AGENT][NEUTRAL] Um, portal is located at [PII].
[CUSTOMER][NEUTRAL] OK and then does it show whether we are in network or out of network?
[AGENT][NEUTRAL] Now this plan participates with the Carrington PPO network. however, they are not required to use a network provider, but to find out if your provider if you don't know if they parti you participate with [PII], I can, I'll be happy to give you their phone number also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no, we do, um, OK, that was all I needed then thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you're certainly very welcome. So hopefully, I'm sorry, I don't know about, are you familiar with that number at all that I called off to you as the fax? [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's, that's our, that's our other location.
[AGENT][NEUTRAL] OK, so it looks like somebody probably called from there and gave that number to our representative.
[CUSTOMER][NEUTRAL] But I gave them this.
[AGENT][NEUTRAL] It wasn't you.
[CUSTOMER][NEUTRAL] OK, yeah, because I called yesterday and I gave them the correct fax number. It was around [PII], um.
[AGENT][NEUTRAL] Do you know who you spoke with us because we gave, we give our names as reference numbers.
[CUSTOMER][NEGATIVE] And it never came.
[CUSTOMER][NEUTRAL] I honestly have no idea because it was a brand new policy and I was just rushing to try to get it into the system so I didn't take the name down.
[AGENT][NEUTRAL] Oh, OK. All right. Well, is there anything else that I could help you with this morning, [PII]?
[CUSTOMER][POSITIVE] That's all I appreciate it thank you.
[AGENT][POSITIVE] OK, well, you're very welcome and again thank you for calling APO and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.