AccountId: 011433970860
ContactId: fd2e052b-141a-4a89-8ff3-d261d54fa168
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382059 ms
Total Talk Time (AGENT): 184321 ms
Total Talk Time (CUSTOMER): 104449 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/fd2e052b-141a-4a89-8ff3-d261d54fa168_20250109T20:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is the problem. I need eligibility and benefits, please.
[AGENT][POSITIVE] All right, I'll be happy to assist you and I do apologize, the phone was cutting out. What is your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] That's gonna be um hold on.
[CUSTOMER][NEUTRAL] 02113290
[AGENT][NEUTRAL] And the patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] That is for patient [PII] date of birth of [PII].
[AGENT][NEUTRAL] All right, thank you. You're needing benefits for dental coverage?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, I can help you with that. [PII], I am showing that this policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy.
[AGENT][NEUTRAL] It does participate in the Carrington PPO network, but it is not required for benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy does not cover major procedures, only preventive and basic. Are you needing a breakdown?
[CUSTOMER][NEUTRAL] Yes, I do have a specific question. Um, you said that we are in network, right? And if you schedule is Carrington.
[AGENT][NEUTRAL] The fee schedule is Carrington, but network participation is not required.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And then could you provide me the group name and the group number please?
[AGENT][NEUTRAL] I can. The group number is 70055.
[AGENT][NEUTRAL] Group name is T as in Tango, R as in Romeo, C as in Charlie, Staffing Services.
[CUSTOMER][NEUTRAL] And does the policy runs in the calendar year?
[AGENT][NEUTRAL] It is a calendar year policy.
[CUSTOMER][NEUTRAL] OK, and how much is the annual maximum and deductible?
[AGENT][POSITIVE] And also I have a fax back I can send you Divine if you're looking for that as well.
[CUSTOMER][NEUTRAL] Um, this the best backs that is code specific?
[AGENT][NEUTRAL] It is, it's gonna have your effective date, your calendar year max, your deductibles, frequencies, limitations, billing information, it does have.
[CUSTOMER][NEUTRAL] OK, before having the back back, is it possible they could, you could be, you could give me the used amount out of the annual maximum and if the deductible has been met already or not yet?
[AGENT][NEUTRAL] Yes, I can, I can provide that for you as well. Now, any benefits given up, given over the phone is a verification of coverage, not a guarantee of payment?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The calendar year max is $500.
[AGENT][NEUTRAL] There is a $50 deductible up to $150 per family.
[AGENT][NEUTRAL] And for [PII], [PII] has not met his deductible nor used any of his benefits as of yet.
[CUSTOMER][NEUTRAL] OK. And can you check if there will be an ortho coverage as well as missing tooth clos?
[AGENT][NEGATIVE] No ortho coverage. There is a missing tooth clause. In fact, that's covered, that's listed on the facts back as well.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Uh, does the policy have a downgrade, by the way?
[AGENT][NEGATIVE] We do not downgrade.
[AGENT][NEUTRAL] If you wanna give me your fax number, I'll go ahead and get that on the way.
[CUSTOMER][NEUTRAL] There is no downgrade at all? OK.
[CUSTOMER][NEUTRAL] OK. And how about history and file?
[AGENT][NEUTRAL] OK, what is that fax number? I can go ahead and send this for you, [PII].
[CUSTOMER][NEUTRAL] The the history is also stated in the facts.
[AGENT][NEUTRAL] It's not on the facts, but I can provide that for you.
[CUSTOMER][NEUTRAL] OK. Uh, could you provide me this right now, then I'll provide you the fax back number.
[AGENT][NEUTRAL] Sure. And is it for just preventative history?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like for this, uh, for this year's history and like for last year's history that might affect your frequency.
[AGENT][NEUTRAL] Sure, now no claims on file for [PII].
[AGENT][NEUTRAL] On [PII], the patient did have a prophy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By wings and all of the examination.
[AGENT][NEUTRAL] Also, on [PII], a prophy oral evaluation.
[AGENT][NEUTRAL] I do have a panel on file for 66-2023.
[AGENT][NEUTRAL] And it looks like that is his history.
[CUSTOMER][NEUTRAL] OK. For the fax that number, that's gonna be 801.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And just to verify that fax number [PII], I'm sending this to [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, and after that, could you provide me call reference number please?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII].
[AGENT][POSITIVE] And it's been a pleasure to assist you with that breakdown. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that would be all.
[AGENT][POSITIVE] And thank you for calling APL Devine.