AccountId: 011433970860
ContactId: 07a94228-1b8d-403e-a91a-55904c0ae871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492019 ms
Total Talk Time (AGENT): 176151 ms
Total Talk Time (CUSTOMER): 165642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/07a94228-1b8d-403e-a91a-55904c0ae871_20250318T15:05_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling you to check the benefits and eligibility status of a patient.
[AGENT][POSITIVE] Sure, I can assist you with that.
[AGENT][NEUTRAL] [PII], can I have a callback number for you and that policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, sure, callback number is [PII], no extension.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is that member's policy number?
[CUSTOMER][NEUTRAL] Policy number for the member.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, sure. Um, it's F for Foxtrot 08466346.
[AGENT][NEUTRAL] OK, so could you give me that again because I didn't catch the beginning.
[CUSTOMER][NEUTRAL] I'm sorry. Yes, yes, sure. It's F for Foxtrot 08466346.
[AGENT][NEUTRAL] I do apologize, [PII], but our policies doesn't start with us a letter.
[AGENT][NEUTRAL] Are you calling, are you sure that you're supposed to be calling American Public Life?
[CUSTOMER][NEUTRAL] Um, uh, actually I was transferred here for this department and this is for a dental plan.
[CUSTOMER][NEUTRAL] Is this correct?
[AGENT][NEUTRAL] Do you have a social? Yeah, this is a dental, this is the insurance company that offered dental policies, however, that's not a policy number unfortunately. Do you have the social of the member?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I don't have that on file.
[AGENT][NEUTRAL] So what policy number did you give the company that transferred you to us?
[CUSTOMER][NEUTRAL] Yes, this is the policy number for the number.
[AGENT][NEUTRAL] No, that's not a policy number here. What is the member's last name to verify for they're in the system?
[CUSTOMER][NEUTRAL] Thank you. Um, last name is [PII], spelled as [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] It's [PII]. Spelled as [PII].
[AGENT][NEUTRAL] And what city and state does this member live in?
[CUSTOMER][NEGATIVE] I don't have that on file unfortunately.
[AGENT][NEUTRAL] But do you have the member's date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] So let me give you the correct policy number because I'm not sure what number that company belonged to, but it's not here at American Public Life.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is 258-4704. It's 258-4704.
[CUSTOMER][NEUTRAL] 258-47004. OK, got it.
[AGENT][NEUTRAL] This policy has been active since [PII] and is currently active. [PII], you're calling to verify dental benefits. He has a maximum benefit amount of $500 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][POSITIVE] Thank you so much. Just to confirm the, uh, this plan is still active.
[AGENT][NEUTRAL] Yes, the policy is currently active.
[CUSTOMER][POSITIVE] Thank you so much. Do you have the insurance group name and the group number on file?
[AGENT][NEUTRAL] I do. Give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] The group name?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] TRC, T as in Tom, R as in Romeo, C as in Charlie, Staffing services.
[AGENT][NEUTRAL] Inc INC.
[CUSTOMER][NEUTRAL] TRC staff and services got it.
[AGENT][NEUTRAL] Yes, that is correct. The group number is 70055.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you so much for that um.
[CUSTOMER][NEUTRAL] Uh, just to confirm, the doctor is in network?
[AGENT][NEUTRAL] So I can't verify that. I can transfer you to [PII] if you would like, however, I can verify the benefits before I transfer you.
[CUSTOMER][NEUTRAL] Oh yeah, sure, can you verify some of the benefits for this plan?
[AGENT][NEUTRAL] So this member's policy has a maximum benefit amount of $500 per calendar year with a $50 deductible that does not apply to us preventative services. This is not a guaranteed benefits, just a disclaimer of the policy's coverage. Preventative is covered at 100% and basic is covered at 80. Joy, this policy unfortunately does not cover major endoperoprosthesis or surgery crowns, bridges, ortho.
[AGENT][NEUTRAL] Endopperio, none of that is covered under the policy. Anything considered as major is not covered. It only covers preventative and basic services.
[CUSTOMER][POSITIVE] Thank you so much. Any missing tooth cloth on file?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[AGENT][NEUTRAL] But there is no waiting period cause nothing major is covered under the policy.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And I can send you a fax back of these benefits if you would like.
[CUSTOMER][NEUTRAL] Yeah, sure, um, do you have the, uh, yeah, um, I have here the fax number.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh thank you. Again, it's [PII].
[AGENT][NEUTRAL] So I have [PII] is the policy is the fax number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, would you like for me to transfer you to [PII] to verify if you're in network with this policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. Let me give you that number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII]. That's [PII] and I'm gonna transfer you.
[AGENT][POSITIVE] Thanks for calling APL and you have a great day, [PII]. You're welcome, hold one moment.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You too. You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assistenen espanol oprima el Nino nue.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up or learn more about our health and lifestyle discount plans, press 2.
[CUSTOMER][NEUTRAL] If you are a member
[CUSTOMER][NEUTRAL] This is the member eligibility and provider search service line.
[CUSTOMER][NEUTRAL] But espanol diga espanol.
[CUSTOMER][NEUTRAL] If you.
[CUSTOMER][NEUTRAL] Sorry, please say either member or provider.
[CUSTOMER][NEUTRAL] Provider.
[CUSTOMER][NEUTRAL] OK, provider, I can help you verify a member's coverage and look up fee and discount information first.