AccountId: 011433970860
ContactId: 02268f4d-1041-442c-a24c-2c7d1a717c5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661200 ms
Total Talk Time (AGENT): 272483 ms
Total Talk Time (CUSTOMER): 225004 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/02268f4d-1041-442c-a24c-2c7d1a717c5f_20250625T15:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I was calling to get some um benefits, um, and find a provider and a, and a member ID number for my brother.
[AGENT][NEUTRAL] May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII]. His name is [PII]. It's the [PII].
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnectedshaw.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you, and you don't have the policy number?
[CUSTOMER][NEUTRAL] Uh, on his policy number he has on here, it doesn't.
[CUSTOMER][NEUTRAL] It said 02441311.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Is that for medical and dental?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] One moment, Ms. [PII].
[CUSTOMER][NEUTRAL] Hello? Oh.
[AGENT][NEUTRAL] Yes, um, OK, is Mr. [PII] available?
[CUSTOMER][NEUTRAL] Well, he just left. I can call him online. I mean, on, well he can you you need his permission?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hold on a second.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Mr. [PII], I need to
[CUSTOMER][NEUTRAL] So she won't I don't.
[AGENT][NEUTRAL] Hi, good afternoon. This is [PII]. I'm good, thank you. I need to verify some information from you before I'm able to release any information to your sister. I also need your permission to do that. So, may I have your date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and I need um your mailing address and email address on file.
[CUSTOMER][NEUTRAL] OK, it's uh it's uh [PII].
[CUSTOMER][NEUTRAL] Uh, in my, um.
[CUSTOMER][NEUTRAL] My email address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alright, and you're giving me permission to release benefit information and the policy number of your dental?
[CUSTOMER][NEUTRAL] Well, yeah, and we also need a provider. I mean, what he can find providers that.
[CUSTOMER][NEUTRAL] And what's in work. That's what we need.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Mhm. Yes, I, I can go over that in a minute. OK, thank you. I'll go ahead and give this information out to your sister. Thank you, Mr. [PII]. Have a good day.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK. Yes, Ms. [PII]. OK. Let me go ahead and give you, do you have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hang up, Jojo.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for the providers, this one in particular doesn't have a network. So you can go, he can go to any dentist's office. Um, and it doesn't have a specific network that he needs to follow under.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, so he can choose his own dental if he's been visiting a dental before, he can just continue visiting the same one. for the benefit information, I can go ahead and give you benefits. Do you have a specific questions about the benefits or do you just need a full breakdown of benefits?
[CUSTOMER][NEUTRAL] On it, yeah, what's the procedures 2080, 2080 20 or not how much because he's um he went to the dentist.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Tuesday, he went to the beach this Tuesday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm not for sure how much they were, they're gonna cover and I was trying to see, does he, does he have the right card? is he using the right card with that member number?
[AGENT][NEUTRAL] No, the member number you provided to me is not his dental. That is his medical.
[CUSTOMER][NEUTRAL] Yes, that's what I was trying to explain to him, but he was saying that it is that this card falls on the one. I didn't think so. That's why I told him let me call so I can try to get the correct information.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So yes, if you're ready, I can go ahead and give you the correct policy number so he can call the dentist back and give this information to them for them to submit the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am, I'm ready.
[AGENT][NEUTRAL] OK. All right, um, the policy number is 02441155.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02441155
[AGENT][NEUTRAL] Yes, that is the policy number for the dental.
[AGENT][NEUTRAL] And with this one, and this is not a guarantee of payment, just a verification of coverage, um, there is a maximum of $1500 with the $50 deductible. Deductible does not apply to preventatives. Preventative is cover 100%, which is the regular checkups, regular cleanings, and bite wings. Those are 100%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, then we have the radiograph FMX which is the full mouth X-rays, that one is covered at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Basic expense and basic restorative expense, which is um your fillings and your simple extraction, those are covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you have your major service. Major service includes endodontics, periodontics, surgery, um, anything that is major, um, and that's gonna be covered at 40% after the 12 month waiting period, which it looks like he's already out of the waiting period.
[CUSTOMER][NEUTRAL] You're gonna cover 40%.
[AGENT][NEUTRAL] Yeah, for any major service it's 40% correct.
[CUSTOMER][NEUTRAL] The 4% for you or the 4% for him. Uh, the provider pay.
[AGENT][NEUTRAL] We, we cover 40%.
[CUSTOMER][NEUTRAL] Oh Lord, that's low. OK, uh, cause she's been trying to find um.
[CUSTOMER][NEUTRAL] He's been trying to go to the dentist. So the name of this, the, the dental is American um uh Life, American Public Life. That's the name of it?
[AGENT][NEUTRAL] Yes, it is, it's either under APL or American Public Life.
[CUSTOMER][NEUTRAL] ATL or American Public Life.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][POSITIVE] No, I'm just trying to see how they, when I give it to them, well, I guess they'll know if I just give them the pilot and they just they love our kids. So, um.
[CUSTOMER][NEUTRAL] What's the address for the um how to submit the claims and stuff?
[AGENT][NEUTRAL] OK, the address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] To [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, you said [PII]?
[AGENT][NEUTRAL] Yes, that is correct. If they needed to get in contact with us for any information, they can call the same number that you have called the [PII].
[AGENT][NEUTRAL] And just in case they ask on the payer ID is 60801.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause he was trying to see um
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] He went to the dentist Tuesday, but they want to refer him to get.
[CUSTOMER][NEUTRAL] Mm, something, I think, uh, a tooth extraction done.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I was trying to find.
[CUSTOMER][NEUTRAL] Someone, how can you look up a provider?
[CUSTOMER][NEUTRAL] How, how can you look up providers or it doesn't matter? Well, you did say it don't matter because you said no network, right?
[AGENT][NEUTRAL] Correct. There's no network, so you just go ahead. If you don't know exactly where to go, you just go to Google and put your zip code and find dentist in your area.
[CUSTOMER][NEUTRAL] OK, but, um, we, we, we, we have one, we have one in mind, but I was just trying to make sure, so no, no network, no network. OK, that, that's what I was trying to find out too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you able to see him on another card or they don't have cards?
[AGENT][NEUTRAL] Um, let me see when we send this card because he had this policy since, um, [PII], so more than likely he received that card in back in [PII].
[AGENT][NEUTRAL] Do you need me to send another card?
[CUSTOMER][NEUTRAL] Yeah, because he don't have it. He keeps pulling, the only one he has is, is this one, that that one with the, I guess it's for medical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's like a medical vision.
[CUSTOMER][NEUTRAL] That's the only one he has.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause this, that's the one he took to the uh dentist's office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, this one right here that that he gave me, he, that's one he took to the dentist's office.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I went ahead and ordered the car, so it should be there within 5 to 7 business days, OK?
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am. That'll be all.
[AGENT][POSITIVE] OK, well thank you for calling APO. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.