AccountId: 011433970860
ContactId: fa63fe1d-42dd-4277-8933-35ee80c4e56f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476959 ms
Total Talk Time (AGENT): 205620 ms
Total Talk Time (CUSTOMER): 194920 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/fa63fe1d-42dd-4277-8933-35ee80c4e56f_20250213T14:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hello, I was just hoping to get a benefits and eligibility breakdown.
[AGENT][POSITIVE] Yes, ma'am. I will be glad to help you. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and then um.
[CUSTOMER][NEUTRAL] The policy number is 02594432.
[AGENT][NEUTRAL] All right, [PII], thank you for that information. Now, while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] Yes, it is [PII] option two.
[AGENT][POSITIVE] Alright, [PII], thank you so much for that information. Now your patient's name and date of birth for me please, ma'am.
[CUSTOMER][NEUTRAL] Yes, um, patient's name is [PII], yeah. And then, uh, date of birth is [PII].
[AGENT][POSITIVE] Alrighty, thank you so much for that information. Looks like [PII] is the insured.
[AGENT][NEUTRAL] Excuse me, on this dental plan, I do show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim. But [PII], you did say you want to fax back a benefit. Is that correct?
[CUSTOMER][NEUTRAL] Um, yeah, I was hoping to do it over the phone if that's OK.
[AGENT][NEUTRAL] We can do it over the phone, yes, ma'am, but it is very detailed and what's covered and what's not. So the actual backback will give you every co covered and how it is covered, but I can go over the general benefits.
[AGENT][NEUTRAL] Let's see. I don't mind.
[CUSTOMER][NEUTRAL] Yeah, if you don't mind, can we, if you don't mind, uh, can I please have the group name for?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The group name is Innovative Staff Solutions.
[CUSTOMER][POSITIVE] Innovative stuff solution.
[CUSTOMER][NEUTRAL] Alright, APL and then uh what is that claims address?
[AGENT][NEUTRAL] All claims come to APL [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] We're in [PII], [PII].
[AGENT][NEUTRAL] And the zip is [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Alright perfect.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Sorry, trying to like get all this.
[AGENT][NEUTRAL] It's OK. Do you want our payer ID number as well for electronic submission?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, if you don't mind.
[AGENT][NEUTRAL] I don't mind, 60801.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Carrington Carrington.
[AGENT][NEUTRAL] Oh, this patient's PPO network is Carrington.
[CUSTOMER][POSITIVE] Perfect, yeah, alright, thank you so much. um, what is the individual deductible?
[AGENT][NEUTRAL] $50 deductible per calendar year with a $500 max payable per calendar year.
[CUSTOMER][NEUTRAL] $50 deductible and then a $500 maximum individual.
[AGENT][POSITIVE] Yes, ma'am, correct.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] And then um for deductibles is it applied to preventative, basic, or major?
[AGENT][MIXED] OK, they only have preventative and basic, no major covered here at all. Uh, the deductible does not apply to preventative, but it does apply to basic.
[CUSTOMER][NEUTRAL] OK perfect and then is there or coverage?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No oral coverage. All right. And then what is the coverage percentage uh for diagnostic services, basic services and major?
[AGENT][NEUTRAL] There's no major covered at all. Preventative is paid at 100% and no deductible. Basic is paid at 80% after the $50 deductible, up to the $500 max benefit payable per calendar year. There's no major coverage at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. And then uh for endodontics, periodontics, and oral surgery, is that under basic as well or no?
[AGENT][NEUTRAL] No, ma'am, not covered.
[CUSTOMER][NEGATIVE] Not covered. All right.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] And then for payroll maintenance is that not covered? Uh, that's called, um, nope, not covered right and then are what coverage category are simple extractions considered?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] There are a couple that's considered, like I said, this is very coded in what's covered and what's not, but there are a couple of codes covered under the uh basic benefit for simple extraction only.
[CUSTOMER][NEUTRAL] Mm, it doesn't really give me a code. Oh, that's fine. Uh, what is the missing tooth cloth?
[AGENT][NEUTRAL] Uh, there's no missing tooth clause. There's no major coverage. Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, I missing two
[CUSTOMER][NEUTRAL] OK, um, and, uh.
[AGENT][POSITIVE] But I'll be glad to get you the facts back that will tell you all that just so you'll have it.
[CUSTOMER][NEUTRAL] Yeah, if you want, but that'll be fine.
[AGENT][NEUTRAL] Sure, sure, go ahead and give me a good fax number that way you'll have it in writing, in writing, [PII].
[CUSTOMER][NEUTRAL] Uh, fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna get it faxed over to you, huh.
[CUSTOMER][NEUTRAL] And then how long do fax backs?
[CUSTOMER][NEUTRAL] Yeah, how long do they usually take?
[AGENT][NEUTRAL] About 3 minutes.
[CUSTOMER][NEUTRAL] Oh yeah, that's fine and that was I guess that was my biggest concern just if it took too long.
[AGENT][POSITIVE] Oh no, ma'am, you have it in just a couple of minutes. Is that all that I can help answer for you today?
[CUSTOMER][NEUTRAL] Um, I, I do have, uh, two more questions. Are crown and bridge restorations on motors downgraded to cash payment only based materials?
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] There's no major coverage.
[CUSTOMER][NEUTRAL] Nope, OK, and then, um, do you accept assignment of benefits to non participating providers?
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, OK, and then if benefits are exhausted participating provider discounts apply?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, oh, OK, we'll do more questions then, um, and then for non-covered services do participating provider discounts apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Nope, um, and if the patient is not eligible for services, do you participating provider discounts applying?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Nope, all right, thank you so much. Can I please have a reference number?
[AGENT][NEUTRAL] We do not give reference numbers, [PII], but you can use my name and today's date and my name is [PII], spelled [PII]
[CUSTOMER][POSITIVE] Why? OK, thank you so much, [PII]. I really appreciate your time and help with me.
[AGENT][POSITIVE] Yes, ma'am. Yes, ma'am. No problem, and [PII], thanks for calling APO and you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye bye.