AccountId: 011433970860
ContactId: f63927dc-9cf2-4cc4-9587-35b88a5a2ba9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235100 ms
Total Talk Time (AGENT): 146703 ms
Total Talk Time (CUSTOMER): 71981 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/f63927dc-9cf2-4cc4-9587-35b88a5a2ba9_20250225T15:54_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning Ms. [PII]. I was calling to verify patients benefits.
[AGENT][NEUTRAL] I can help with benefits. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number that we're looking at, please?
[CUSTOMER][NEUTRAL] Her policy number is 02564042.
[AGENT][POSITIVE] 42. Great. Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Miss [PII] [PII].
[AGENT][NEUTRAL] Thank you. I just need to call back number while I'm looking at this the policy.
[CUSTOMER][NEUTRAL] 803.
[CUSTOMER][NEUTRAL] 234-232-0 [PII].
[AGENT][NEUTRAL] Thank you. Now the policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Um, this is a, uh, limited benefit dental policy. It has $500 per calendar year as a maximum. Um, it, uh, covers basic.
[AGENT][NEUTRAL] They took restorative and preventative services only.
[AGENT][NEUTRAL] Uh, it's, uh, we don't have a, um, any sort of, uh, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Network for who, who they can see because the policy does just pay that $500. Uh, we do follow the Carrington PPO fee schedule, um, but you don't need to be a member of Carrington in order for those policies to, to work. Now I've got a fact stack that I can send to you um if you would be interested, or is there anything in particular I could tell you about the policy?
[CUSTOMER][NEUTRAL] Yes ma'am, could you provide me with that um fax back?
[AGENT][NEUTRAL] Yes, of course. And what is your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, and I'm just gonna look here and see what, let's see it's [PII] what.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I I that right because.
[AGENT][NEUTRAL] It doesn't look like [PII] has used her benefits at all. So when you get this fax, um, uh,
[CUSTOMER][NEUTRAL] but for now.
[AGENT][NEUTRAL] all of the preventative services will be available because it doesn't look like she has used any of it at all, at all. Um, you will see that there is a $50 deductible that does not apply to the preventative services. Um, so all of this stuff will be available. Now, is there anything else that I can uh tell you about the policy before I send off this fax back?
[CUSTOMER][NEUTRAL] That'll require
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um, OK, are there any downgrades on her plan?
[AGENT][NEUTRAL] It doesn't downgrade to amalgam, no. Um, now that, it doesn't cover dentures or, or, um, or bite wings, I mean, excuse me, not bite wings, uh, dentures or partials. Uh, so, um, the only thing that would be covered would be the fillings, and those are not downgraded.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But, but you'll see that on the, on the fax back as well, so that, that will be something that will be noticeable on there. It, it will tell you that it doesn't downgrade. Um, it'll also tell you where to send the the claim um we we have uh an online service center, a fax or you can mail it to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, ma'am. And does she have endoperio and oral surgery coverage? Does that fall under the basic?
[AGENT][NEUTRAL] Uh, no. No, that, that is all major services that are not, uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for
[CUSTOMER][NEGATIVE] Oh, never mind, she won't have coverage for SRP that's it.
[AGENT][NEUTRAL] OK, I'll have this for you in just a moment. Um, once you get the facts, if you have any questions, just let us know.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes ma'am, for uh for simple extractions, are they covered under basic?
[AGENT][NEUTRAL] Yes, yes, they are.
[CUSTOMER][POSITIVE] OK, thank you so much for that, and I'll wait for the face for everything else.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thanks for contacting API have a good day.