AccountId: 011433970860
ContactId: 094aecb6-0d29-4abd-9651-ec992442d35f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407029 ms
Total Talk Time (AGENT): 219349 ms
Total Talk Time (CUSTOMER): 111160 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/094aecb6-0d29-4abd-9651-ec992442d35f_20250124T21:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Um, I'm calling to see if my insurance will cover going to the endodontist. Um, it's a referral from my dentist.
[AGENT][NEUTRAL] OK, so you're wanting to see if your dental coverage covers endedonic visits?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell your last name for me?
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][POSITIVE] OK, thank you. And Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Um, OK, the policy number is 02576908.
[AGENT][NEUTRAL] Thank you. Alright, so give me a couple of moments to get your information pulled up. Then I will need to verify several things with you first, Ms. [PII], for security purposes, and then any information that is provided today would be a verification of benefits and not a guarantee of payment. So just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. And lastly your email address, please.
[CUSTOMER][NEUTRAL] Um, it's my first name. last um my middle initial is just [PII].
[AGENT][NEUTRAL] OK, thank you very much. OK, so on this dental policy that you have, it does not cover endodontics.
[AGENT][NEUTRAL] This plan only has benefits for preventative and basic expenses.
[CUSTOMER][NEUTRAL] OK. Um, so, um, I do wanna ask, so if I do need a filling.
[CUSTOMER][NEUTRAL] Or a cap fixed.
[CUSTOMER][NEUTRAL] Is that covered?
[AGENT][NEUTRAL] It would be dependent upon the code that is used um by your dental provider.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] There is no coverage under your policy for, again, anything other than preventative or basic restorative.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yeah, so what would be restorative then?
[AGENT][NEUTRAL] Again, it's going to be dependent upon the codes that they use.
[AGENT][NEUTRAL] Um, you do have, that would fall, any, any fillings that would fall under, well, fillings would fall under basic restorative as far as to be able to tell you specifically the code that could, you know, whether it's covered under your policy. I mean, we would have to have that. Without the code, I can't give you very detailed information.
[CUSTOMER][NEUTRAL] OK, and then what about fixing it like if there's an issue with the cap?
[AGENT][NEUTRAL] Let me pull up some different information because again without the codes um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't say specifically, so give me just a moment. Have you, has your provider, have you spoken with your provider?
[CUSTOMER][NEUTRAL] Yeah, that's why I'm going to an endodantist. That's why I have a referral.
[AGENT][POSITIVE] OK, again, more well.
[AGENT][NEUTRAL] What I would recommend, [PII] is to provide our phone number to the provider to have them call. If any of the procedures that they're doing fall under endodontics, it would not be covered under this plan.
[CUSTOMER][NEUTRAL] So they want me just to do an eval over there and then go back to the dentist. The dentist would be doing the work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, now if they can provide and you can put place me on hold, I'll, I'll be happy to do that if you can try and see if they can tell you what the code that they would be using.
[AGENT][NEUTRAL] For your procedure would be.
[CUSTOMER][NEUTRAL] OK. I, I think I'll probably just ask them when I like
[AGENT][NEUTRAL] I'll I'll be
[CUSTOMER][NEUTRAL] After I make this other appointment because
[CUSTOMER][NEUTRAL] Uh, to be honest, I have no idea if they'll be able to answer and whatnot, but I can see if I can try to get the codes.
[AGENT][NEUTRAL] So what I would do is I would just make sure that you provide them with our, your policy information for this coverage because most providers will call to verify that you are, you know, that your policy is active and.
[AGENT][NEUTRAL] Get your benefit information for the type of services that they're gonna be rendering to you and check any history that we may have on file pertaining to, you know, what your procedure is gonna be that they're gonna be doing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we can provide them that information then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][POSITIVE] OK. All right. Well, you are certainly very welcome. So is there anything else at the moment that I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, no, that honest[PII] just needed to know if my endodontics for sure would be covered or not.
[AGENT][NEUTRAL] Yes, and that is not covered under this particular plan. No, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] OK. You are certainly welcome and thank you again for calling APL if that's all I can help you with. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.