AccountId: 011433970860
ContactId: 10f7859e-b595-4ef4-88ea-37eac8114c5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466640 ms
Total Talk Time (AGENT): 172859 ms
Total Talk Time (CUSTOMER): 147486 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/10f7859e-b595-4ef4-88ea-37eac8114c5a_20250324T16:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi I was calling to get a breakdown of dental benefits for a patient.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and uh my callback number is [PII] option 2.
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] I don't have it. Would you be able to take his social as identification?
[AGENT][NEUTRAL] May I have the social please?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] May I have the member's name?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][POSITIVE] And thank you so much, [PII] for verifying the member. Would you like the member's policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. The policy is 02.
[AGENT][NEUTRAL] 594629.
[CUSTOMER][NEUTRAL] And the group name and number?
[AGENT][NEUTRAL] The group number is 70056.
[AGENT][NEUTRAL] And it is showing management, analysis, and utilization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And American.
[CUSTOMER][NEUTRAL] Public life
[AGENT][NEUTRAL] And would you like for me to send, go ahead.
[CUSTOMER][NEUTRAL] And what is what net?
[CUSTOMER][POSITIVE] I'm sorry
[CUSTOMER][NEUTRAL] Um, what network do you use? Do we use for, um.
[CUSTOMER][NEUTRAL] For benefit information to get in network discounts for patients.
[AGENT][NEUTRAL] OK, so this policy does participate in the Carrington PPO network. So if you would like to contact them to see if you're in that network, you can check with that as well.
[CUSTOMER][POSITIVE] We are perfect.
[AGENT][NEUTRAL] OK, so we do utilize that.
[CUSTOMER][NEUTRAL] And what is the claims address?
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] That we'll use.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also would you like for me to submit a fax back to you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I would say yes, but I kind of need to get the information like ASAP. Um, is there a can is it OK if I just ask you specific questions?
[AGENT][NEUTRAL] Yes, because we do have a limit of how many codes we can verify.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well that's OK uh I can pretty much get I most of it's just general and um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let's see here, what's the maximum and deductible?
[AGENT][NEUTRAL] OK, so for this member benefits verification of coverage does not guarantee the payment of the claim. They have up to $500 per calendar year max, and then for the calendar year deductible they do have a $50 deductible, but their deductible does not apply to the preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and our preventative services covered at 100%?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What about basic and major?
[AGENT][NEGATIVE] For the basic, it only shows basic only, they do not have the major benefits, so the basic is showing at 80% of liable.
[CUSTOMER][NEUTRAL] They don't, OK.
[CUSTOMER][NEUTRAL] OK. And does that include endoperio and oral surgery?
[AGENT][NEUTRAL] May I have those codes?
[CUSTOMER][NEUTRAL] Or the
[CUSTOMER][NEUTRAL] Uh, like, uh, 4341.
[CUSTOMER][NEUTRAL] Uh, 70 to 10.
[CUSTOMER][NEUTRAL] And oh I don't know the endodonic code uh for root canals um.
[CUSTOMER][NEUTRAL] Maybe 3331?
[CUSTOMER][NEUTRAL] Possibly
[CUSTOMER][NEUTRAL] Hold on, I could actually.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Now, that is showing a treatment for root canal obstruction.
[CUSTOMER][NEUTRAL] Oh wait, wait, wait, I'm sorry I gave you the wrong one. It is hold on it was 3310.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The endogenic therapy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check those codes for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Y'all got
[AGENT][NEUTRAL] So the 4341, I'm not seeing that code listed on the on the benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 7210 is also not listed?
[AGENT][NEUTRAL] And the 3310 is not listed either, so that is considered not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK, what what about 49, 10 and 7140?
[AGENT][NEUTRAL] 41,910 is not listed and you said 7140?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the 7140, it is showing as an extraction, and that is listed up under the basic expenses, which is the 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And what is the frequency for basic uh cleanings and exams?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] So for the prophylactic cleaning, the member does have once every 6 months.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And for the full mouth X-ray and panoramic, is that what you're needing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It is showing once every 5 years.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alrighty, and that that is all I needed thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today? and did you want me to go ahead and submit that fax back as well?
[CUSTOMER][POSITIVE] Actually, yeah, that would be great if you could um our fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, I will get that submitted over to you and I do wanna thank you so much for calling American Public Life [PII], you have a great day.
[CUSTOMER][NEUTRAL] here
[CUSTOMER][POSITIVE] Thank you ma'am you too bye bye.
[AGENT][POSITIVE] Thank you, bye.