AccountId: 011433970860
ContactId: fca814c0-2b84-4d63-80af-3101868a4697
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1080130 ms
Total Talk Time (AGENT): 329532 ms
Total Talk Time (CUSTOMER): 258069 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/fca814c0-2b84-4d63-80af-3101868a4697_20250506T21:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from products office checking on the status. Your name is [PII], right?
[AGENT][NEUTRAL] My name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The policy number is 02616198.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And for the eligibility, um, the policy has been active since [PII].
[CUSTOMER][NEUTRAL] [PII] of 25 hours. Can you repeat it again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And could you please check the providers network?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] So this policy is on the Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are still the same. If you would like to see if your provider is in network for Carrington, I can provide you with their phone number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Um, can I have a group name and the group number?
[AGENT][NEUTRAL] The group number is 70083.
[CUSTOMER][NEUTRAL] 83. And the group name?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Lark, LLC.
[CUSTOMER][NEUTRAL] Lock LLC.
[AGENT][NEUTRAL] Doing business as on track staffing.
[CUSTOMER][NEUTRAL] And will maximum for the station.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] I can
[AGENT][NEUTRAL] You said the calendar year maximum. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] The max is $500.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And, and like some use on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] For [PII], none of the benefits have been used, nor has the deductible been met.
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] No used amount?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No use amount, right?
[AGENT][NEGATIVE] Yes, for [PII], nothing has been used.
[CUSTOMER][NEUTRAL] And in individual and family deductible?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And in this form is directable.
[AGENT][NEGATIVE] I I can't understand what you're saying. It sounds muffled. Can you repeat that, please?
[CUSTOMER][NEUTRAL] Uh, deductible, deductible for this patient, individual and family deductible.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's a $50 deductible. This is an individual policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And can you send me this benefits using fax?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Uh sorry?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Should I put it to attention your name?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um, sorry?
[AGENT][NEUTRAL] What should the attention be, what should the attention be for the facts? Attention to
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And now it's fax number [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, so I'll go ahead and send this over for you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does the patient has an out of network benefit?
[AGENT][NEUTRAL] No, as I stated, it's on the PPO network, but if the benefit, if the provider is not a PPO um provider for Carrington, the benefits are still the same.
[AGENT][NEUTRAL] So there's no in or out of network.
[CUSTOMER][NEUTRAL] Mhm. And listening to close on waiting period?
[AGENT][NEUTRAL] There's no waiting period, um, because the policy doesn't cover major expenses and there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] And auto coverage.
[AGENT][NEUTRAL] There is no orthodontic coverage?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, this is the Carrington Insurance site.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, no auto coverage.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Pre-authorization
[AGENT][NEUTRAL] No prior authorization is needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is calendar contract earlier.
[AGENT][NEUTRAL] A calendar year?
[CUSTOMER][NEUTRAL] OK, and can I have a percentage for preventative basic and major?
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] And can I, uh, can I
[CUSTOMER][NEUTRAL] Can I have a free schedule?
[AGENT][NEUTRAL] Preventative is that 100%?
[AGENT][NEUTRAL] Radiographs, FMX, basic and basic restorative expenses are all at 80%.
[AGENT][NEUTRAL] This policy does not cover major, which for us is endogenic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And crowns and orthodontics.
[AGENT][NEUTRAL] There's no orthodontic treatment and crowns are under major. There's no major coverage.
[CUSTOMER][NEUTRAL] OK and uh
[CUSTOMER][NEUTRAL] Can I have a percentage and frequency for 0274?
[AGENT][NEUTRAL] Can you provide your list all at once, please? 0274.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 021 0 0120 1110 12 061351.
[CUSTOMER][NEUTRAL] And 434,143,554,910.
[AGENT][NEUTRAL] Thank you and is it alright if I place you on a brief hold while I go through the codes?
[CUSTOMER][NEUTRAL] This is the only code I have.
[AGENT][NEUTRAL] Is it alright if I place you on a brief hold while I go through your codes?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes I'm here.
[AGENT][POSITIVE] Thank you so much for holding. So 0274.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, it's under, it's bite wings, um, so it's limited to one procedure per 12 months.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It's covered at 100%?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0210 um is under radiograph FMX is at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited to 1 X-ray procedure per five-year period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0120 is limited to two oral evaluation procedures per 12-month period.
[AGENT][NEUTRAL] At 100%.
[CUSTOMER][NEUTRAL] Percentage for that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] 1110.
[AGENT][NEUTRAL] Maximum 1 procedure per 6 months, covered at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1206 is not covered?
[AGENT][NEUTRAL] 131.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months, limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][POSITIVE] And it's covered at 100%?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4341 4355 and 4910 are all major codes and not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm. 4910.
[AGENT][NEUTRAL] It's not covered by this policy. It's a major code.
[CUSTOMER][NEUTRAL] Uh, is it, can I have a history for this patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] History for this patient.
[AGENT][NEUTRAL] History
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] The phone is breaking up, my apologies. Hold on one moment.
[CUSTOMER][NEUTRAL] History for this patient.
[AGENT][NEUTRAL] I understand. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's no history on file for this member?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And can I have a mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Mhm. OK. And I have one more question. Can you move to that?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I'm still here.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am, I'm here. I'm just waiting for the policy number.
[CUSTOMER][NEUTRAL] OK. And the policy number is?
[CUSTOMER][NEUTRAL] C L I
[CUSTOMER][NEUTRAL] 629-411-1.
[AGENT][NEUTRAL] OK, that's not an APL policy number. Um, do you have an APL policy number?
[CUSTOMER][NEUTRAL] No the number I have.
[AGENT][NEUTRAL] OK, I can search the member with their first and last name or their full social.
[CUSTOMER][NEUTRAL] The patient's first name?
[CUSTOMER][NEUTRAL] Uh [PII] and last name is [PII]
[AGENT][NEUTRAL] The first name is [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I'm not showing a member with this name um in our systems and the policy number is not an APL policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] CLI 6294111.
[AGENT][NEUTRAL] I understand what you're saying. That's not an APL policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the name I searched with the first and last name and there's nothing that populated with the first and last name either. Um, we can either search with the full social or um see if the insured has an APL policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a call reference number?
[AGENT][NEUTRAL] So the call reference number for the entire call will be my name and today's date, and that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I think that's all for today now.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.