AccountId: 011433970860
ContactId: f13f4acf-d2a9-432b-a539-b5c7d63d71c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431850 ms
Total Talk Time (AGENT): 202519 ms
Total Talk Time (CUSTOMER): 128881 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/f13f4acf-d2a9-432b-a539-b5c7d63d71c6_20250319T12:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with Great Expressions Dental, and I need to verify the eligibility and benefits for patients.
[AGENT][POSITIVE] OK, [PII], well, I'll be more than happy to help you with the eligibility and the benefits. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02536226.
[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] Um, [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][POSITIVE] Funny, funny.
[AGENT][NEUTRAL] And did you need a copy of the fax back or you have particular questions about it?
[CUSTOMER][NEUTRAL] Um, uh, a copy would be nice as well, but can I get the um.
[CUSTOMER][NEUTRAL] Can I get the group name, group number, all that kind of stuff.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. Hold on, let me get it for you.
[AGENT][NEUTRAL] So the group number is 192.
[AGENT][NEUTRAL] 05
[AGENT][NEUTRAL] The group name is Universal.
[AGENT][NEUTRAL] Trucking
[AGENT][NEUTRAL] P like Paul.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] S like Sam,
[AGENT][NEUTRAL] And I'm assuming this is transportation, it's cut off, but it's mostly transportation, so.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, what, so what's the like the, the name of the insurance that it's under?
[AGENT][NEUTRAL] So the insurance is under Carrington. Um, it's not like this, this particular policy is not like Carrington PPO or HMO. It doesn't, it's, it's um.
[AGENT][NEUTRAL] It's just the standard, uh, what am I trying to say, the, the standard fee schedule, I'm sorry, and um it has a calendar year max and deductible.
[CUSTOMER][NEUTRAL] OK, what's that?
[AGENT][NEUTRAL] So the calendar year max is $1500 per cover insured?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Calendar year deductible is $50 per person up to $150 per insured.
[AGENT][NEUTRAL] Or per family, sorry.
[CUSTOMER][POSITIVE] Perfume, OK, um.
[CUSTOMER][NEUTRAL] What would be the percentage breakdown for.
[AGENT][NEUTRAL] Preventive basic and major.
[CUSTOMER][NEUTRAL] Basic, yeah, mhm.
[AGENT][NEUTRAL] So, preventative is at 100%?
[AGENT][NEUTRAL] Radiographs and FMX is in its own category, which is 80%.
[AGENT][NEUTRAL] Basic expenses. I'm sorry.
[CUSTOMER][NEUTRAL] For X-rays, sorry, so X-rays you said?
[CUSTOMER][NEUTRAL] Or 80%.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, basic expenses and basic restorative are 80%.
[AGENT][NEUTRAL] And then major expenses, which major for us is endodontic, periodontic, prosodontic, and oral surgery, um, that's at 40% and there's a 12-month waiting period.
[AGENT][NEUTRAL] So they'll be eligible to use those expenses [PII].
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And what uh what's her effective date?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] So I will put this under Carrington.
[AGENT][NEUTRAL] Yes, the the dental product is under Carrington. The insurance company is APL.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I'm just trying to see how I should. What's the um the billing um address and um and the the code.
[AGENT][NEUTRAL] Billing address and the like the payer ID?
[CUSTOMER][NEUTRAL] Yeah, yeah, sorry.
[AGENT][NEUTRAL] OK, no, it's OK. Um, so our, our claims mailing address is [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And then our um payer ID.
[AGENT][NEUTRAL] It's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] All right and um.
[CUSTOMER][NEUTRAL] The renewal is this a calendar year or?
[AGENT][NEUTRAL] Yes, this is the calendar year.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So when I build this policy into our system.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I'm putting this under Carrington or you just use the Carrington fee schedule but I should be putting this under a different name.
[AGENT][NEUTRAL] Right, APL, right, so we, the the fee schedule is Carrington, but the claims are coming to APL.
[AGENT][NEUTRAL] Which is the claim's mailing address and payer ID I just gave you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We have a fax number too if you need it. I don't know.
[CUSTOMER][NEUTRAL] Um, yes, let me get that fax number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so it's 877.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] 925.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Hold on one moment. I just went completely blank and I don't know why. One moment.
[CUSTOMER][NEUTRAL] It's OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. So it's um [PII]. My apologies.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Um, OK, and then were you able to fax over?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I need to pay attention, [PII]?
[CUSTOMER][POSITIVE] Uh yes please that'll work.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I will go ahead and send the copy of the fax back over to you now. And was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That is all thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Thanks for calling [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] You as well thanks bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.