AccountId: 011433970860
ContactId: fa92b182-9dcc-4bca-9e35-163766272620
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454600 ms
Total Talk Time (AGENT): 168492 ms
Total Talk Time (CUSTOMER): 148565 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/fa92b182-9dcc-4bca-9e35-163766272620_20250108T18:25_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning, my name's [PII]. I'm calling from a provider's office, and I am calling because I'm trying to um check benefits for a patient.
[AGENT][POSITIVE] OK, [PII], I can help you with benefits today. Do you mind if I have a good call back number?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your member's policy number?
[CUSTOMER][NEUTRAL] The policy number on this card.
[CUSTOMER][NEUTRAL] It's 02554336.
[AGENT][POSITIVE] Wonderful. Give me just a moment to get that pulled up today.
[AGENT][NEUTRAL] And would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] His name is uh [PII]. Date of birth I have is [PII].
[AGENT][POSITIVE] Perfect, thank you so much. Your patient is current and active, and it looks like they have an effective date of [PII]. Are you wanting me to go ahead and send you a fax back of benefits?
[CUSTOMER][NEUTRAL] Um, is it is it like a complete breakdown or is it like partial stuff on it?
[AGENT][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] No, it's gonna be a fully complete breakdown. So everything that they are covered for will be on there, including all the procedure codes.
[CUSTOMER][POSITIVE] OK perfect yeah that that would work.
[AGENT][POSITIVE] OK awesome let me go ahead and.
[AGENT][POSITIVE] Put that together for you real fast.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Sorry, I opened the wrong one.
[CUSTOMER][NEUTRAL] Is this through his employer or?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then the other question I had was um we're out of network so just you guys pay for out of network providers?
[AGENT][NEUTRAL] OK, yeah, so, um, the policy is in the Carrington PPO network. however, utilization of the Carrington provider is not required, um.
[AGENT][NEUTRAL] It is, but it will follow the Carrington Network fee schedule.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] And then I'm just waiting for the fax box to like open up on my screen.
[AGENT][POSITIVE] Are you going to want that made attention to yourself or attention? OK, perfect.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what's gonna be a good fax number today?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, give me one second to just put that cover sheet together.
[AGENT][NEUTRAL] Oh my gosh, I'm so sorry, like cannot type today.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][POSITIVE] Alright, I just hit send on that. It should be coming through for you anytime between now and the next 15 minutes and then is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, actually.
[CUSTOMER][NEUTRAL] Let me see, I need to, to ask, so the on his card it says there the group name is Group voluntary Dental, is that what it is?
[AGENT][NEUTRAL] Um, the group name is, hold on, let me go back to that screen.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It's gonna be A D E P T HR Inc.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] AD
[AGENT][NEUTRAL] Adapt.
[AGENT][NEUTRAL] A D E P T Adapt.
[AGENT][NEUTRAL] HR Inc.
[CUSTOMER][NEUTRAL] AD or adapt AD.
[CUSTOMER][NEUTRAL] A PPT you said? Or E?
[AGENT][NEUTRAL] E
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, A D E.
[CUSTOMER][NEUTRAL] A as in apple, D as in David.
[AGENT][NEUTRAL] Yep, E as in elephant, P as in Peter, T as in Tom.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] HR
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then ink.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the employer name or the group name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then the group number that's on this card is the 70,050 is that correct as well?
[AGENT][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] OK, and then for mailing out claims, um, there's only an address on here. Are you able to provide me a payer ID because we do electronic claims.
[AGENT][POSITIVE] Oh yes, absolutely. We have an electronic payer ID and that is going to be.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what other question did I have? um.
[CUSTOMER][NEUTRAL] On the facts you're sending me, does it tell me if the amalgams are, I mean if composites are covered or if they're downgraded to amalgam?
[AGENT][NEUTRAL] Um, so we don't do any downgrades.
[AGENT][NEUTRAL] But then as far as, but as far as the fax back goes, every procedure code on that um fax back is covered and if you have a code that's not on it, it's not covered.
[CUSTOMER][NEUTRAL] You don't do any downgrades? Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, perfect, any waiting periods at all?
[AGENT][NEUTRAL] Um, no, not on this plan. This plan is only gonna cover, uh, preventative and basic.
[CUSTOMER][NEUTRAL] Oh, that's all?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Only covers preventative basic no major service.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Major not covered.
[CUSTOMER][NEUTRAL] Do you know if root canals are considered major under this plan?
[AGENT][NEUTRAL] Um, I could look up a procedure number for you.
[CUSTOMER][NEUTRAL] 3331.
[CUSTOMER][NEUTRAL] Or 33:30? Sorry.
[AGENT][POSITIVE] Um, no worries, uh, don't be sorry. I don't have either of them showing us coverage, so I'm willing to bet they are.
[CUSTOMER][NEUTRAL] So they're not covered, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No major coverage.
[CUSTOMER][POSITIVE] OK perfect thank you I'll wait for that fax box to come in then.
[AGENT][POSITIVE] Awesome and then if there's anything else we can do to help you out, Miss [PII], just give us a call and we'd be happy to take care of you.
[CUSTOMER][POSITIVE] Will do thank you so much.
[AGENT][POSITIVE] My pleasure thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.