AccountId: 011433970860
ContactId: fee3c758-9817-48a7-9771-44b34b23d87f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298920 ms
Total Talk Time (AGENT): 132059 ms
Total Talk Time (CUSTOMER): 78650 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/fee3c758-9817-48a7-9771-44b34b23d87f_20250213T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I would just like to get a whole breakdown of benefits for a patient that I have here and also to see if this patient is in network with us.
[AGENT][POSITIVE] OK, [PII], I'm happy to take a look. Do we have the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number, let me see, yes, it's 02465237.
[AGENT][NEUTRAL] Let me pull this up here. Give me one sec.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, um, patient's name is [PII]. Date of birth is, let me see.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you so much, [PII]. So the patient is active. Uh, the effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And this plan pays it looks like by UCR no network is required for usage. It's just gonna pay off usual customary fee.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you need I can send you a fax back with a breakdown also.
[CUSTOMER][NEUTRAL] Um, yes. Do you know how long would that take?
[AGENT][POSITIVE] Um, it should just take about 5 minutes to get over to you, but if you need anything verbally, I'm happy to confirm that for you also.
[CUSTOMER][NEUTRAL] OK, and is this uh like a PPO plan?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it looks like it does participate in the Carrington PPO network, yes.
[CUSTOMER][NEUTRAL] OK, alright, and what would be the fee schedule?
[AGENT][NEUTRAL] So this one it looks like preventative pays at 100% of UCR basic is 80% and major is 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would be the yearly max?
[AGENT][NEUTRAL] Uh, yearly max is $1500 per covered insured, and there is a $50 deductible per insured up to $150 for the family.
[CUSTOMER][NEUTRAL] Mhm. What does that apply to?
[AGENT][NEUTRAL] Um, so that is for everything except for preventive. Preventative does not apply towards, yeah, the deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and what would be the parent ID and the mailing address?
[AGENT][NEUTRAL] Uh, payer ID is going to be 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and for this patient, is there any history?
[AGENT][NEUTRAL] Uh, let me check.
[AGENT][NEGATIVE] No history on file.
[CUSTOMER][NEUTRAL] OK, and for that, um, breakdown of benefits, would that provide me the frequency?
[AGENT][POSITIVE] It does. Uh-huh. Absolutely. And also the waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right, then I'll get that fax back.
[AGENT][NEUTRAL] OK [PII], what is the fax number you want me to send this to?
[CUSTOMER][NEUTRAL] OK, it will be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, that is on its way right now. That should be there momentarily. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, that was just everything.
[AGENT][POSITIVE] Alright, thanks for calling APL have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Uh, bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.