AccountId: 011433970860
ContactId: 0f13f25d-f08c-4377-99e8-ac288e8774b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376459 ms
Total Talk Time (AGENT): 197634 ms
Total Talk Time (CUSTOMER): 173408 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/0f13f25d-f08c-4377-99e8-ac288e8774b5_20250127T22:32_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yes, my name is [PII]. I will call to check my coverage.
[AGENT][POSITIVE] OK, sure, I can assist you with your benefits, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Number [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK, the policy, is it the caller ID number? OK, the policy number I see it. I see the policy is is 02558116.
[AGENT][NEUTRAL] I can try that policy number. Mhm.
[AGENT][NEUTRAL] OK. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] And my mailing address is [PII].
[AGENT][NEUTRAL] All right. And this is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have a specific question about your dental benefits or how may I assist you?
[CUSTOMER][NEUTRAL] So right now I'm at the uh I'm, I'm going to to dentist.
[CUSTOMER][NEUTRAL] I just left the dentist and I'm, and I, and they said I had 3 cavities or something and I'm trying to figure out.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Do what they cover my insurance cover that or do they accept it?
[AGENT][NEUTRAL] OK. Are they gonna be doing like some fillings?
[CUSTOMER][NEUTRAL] Yes, I don't know yet. I'm trying to figure it out. Do I, can I use my insurance or, or, or I have to pay out of pocket?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, Mr. [PII], it really depends on exactly what they're doing. Um, but if they found some cavities and what they want to do is fillings, um, yeah, fillings are uh basic, so you don't have to wait that 12-month waiting period for basic. Um, so that will be paid under basic, um, from your policy, you have 1500 calendar year maximum.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let you know that
[CUSTOMER][NEUTRAL] Yeah, but you don't cost.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. Go ahead.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] They still like 150 or 2 or something like that.
[CUSTOMER][NEUTRAL] Yeah, I don't.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Did they call us to get benefit information or you gave them the card or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, now I have a.
[CUSTOMER][NEUTRAL] Yeah, I gave him the card.
[AGENT][NEUTRAL] You gave him the card. OK, um.
[AGENT][NEUTRAL] So I'm not really sure what why they're charging you, um, but we pay 80% for fillings. I'm not sure if that amount that they're paying, they're asking you is um probably the 20%, um, but you can ask them to see if they already ran the.
[AGENT][NEUTRAL] The benefits of the policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So I have to pay out of pocket?
[AGENT][NEUTRAL] You have to pay the 20%, correct, because we pay $80 and then you have a $50 deductible.
[CUSTOMER][NEUTRAL] Oh, OK, that looks like I.
[AGENT][NEUTRAL] So you will have to pay some. I'm not sure how much they can give you that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I got another question. um, how, how would I know if they accept my the insurance I have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, can you repeat your question?
[CUSTOMER][NEUTRAL] Like, like, could, could you look it up, so I'm at this place called Hollywood Perfect Smile in [PII].
[CUSTOMER][NEUTRAL] And how would I know if they accept my insurance or not?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Oh, you have to call them. We don't have a network. We don't work with any networks. Uh, we work with every provider, basically. So every dentist, uh, they can send in a claim for
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] That will be.
[AGENT][NEUTRAL] To be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So you don't have any specific dental office that you need to go to. We don't have a network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and, and, and, and the name of the the um.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's called American Public Life.
[AGENT][NEUTRAL] Correct. The name of the insurance is American Public Life. Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I think I I emailed him the information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they should, I guess they should try to claim whatever.
[AGENT][NEUTRAL] Yeah, usually what they do is they'll go ahead and call us and get the benefit information, um, either fax or by phone and then we can let them know how much we pay for the um service they're providing and from there they will go ahead and let you know how much you have to come out of pocket.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright. So what happened to the, OK, OK, alright.
[AGENT][NEUTRAL] Mhm. Do you have any other questions?
[CUSTOMER][NEUTRAL] That's my mom.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Yeah. Yeah, you said something about the $1500 or something. How did that work?
[AGENT][NEUTRAL] Yeah, that is your maximum benefit. You have a calendar year maximum of $1500. That is your maximum benefit. And then you have a $50 deductible and that's a one time per year.
[CUSTOMER][NEUTRAL] Mhm. OK, alright.
[AGENT][NEUTRAL] So for fillings, for fillings, they're gonna add, you know, they're gonna charge that $50 deductible and then um we pay 80% of fillings, so you end up paying the 20% less and then the $50 deductible.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK then, thank.
[AGENT][NEUTRAL] Mm OK. I, uh, do you have any other questions, any other concerns?
[CUSTOMER][NEUTRAL] Oh, no more questions.
[AGENT][NEUTRAL] OK. Well, if you think about anything else, just give us a call back and we can go ahead and assist you. Yeah, if you want to know exactly how much you will have to come out of pocket, you need to call them and see if they already got the benefits and how much you will have to pay after they run the insurance, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, well, thank you for calling ATL. You have a good afternoon, Mr. [PII].
[CUSTOMER][NEUTRAL] Alright, so
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] We do.