AccountId: 011433970860
ContactId: 1cdf9e0b-a556-4cbb-9bb4-b7ab05306aff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1838390 ms
Total Talk Time (AGENT): 460054 ms
Total Talk Time (CUSTOMER): 469086 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/1cdf9e0b-a556-4cbb-9bb4-b7ab05306aff_20250409T19:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling from a dental office and I'd like to get some eligibility for a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 1065324
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] And what is the name of the insurance company?
[AGENT][NEUTRAL] The insurance company is American Public Life.
[CUSTOMER][NEUTRAL] And would the provider be in network?
[AGENT][NEUTRAL] So this is on the Carrington network. Um, let me double check for this particular policy to see if they have a particular network. Hold on one moment.
[AGENT][NEUTRAL] Sorry about that. I clicked on the wrong thing here we go.
[AGENT][NEUTRAL] Um, so, no, this policy isn't on, um, we use Carrington as the product, is Carrington, but this, um, Carrington product is not on like a PPO network or anything. So the benefits um are the same no matter where they go.
[CUSTOMER][NEUTRAL] So should still use the Carrington fee schedule.
[AGENT][NEUTRAL] Yes, it's a it's Carrington.
[CUSTOMER][NEUTRAL] And there's no network?
[AGENT][NEUTRAL] So sometimes there's like a Carrington PPO or Carrington HMO. There's no, there's no network for this policy. This one goes off of um usual and customary charges. So I can give you the percentages for like preventative, basic and major, but there's no like, it's just the standard fee schedule for this product.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is preventative, basic and major covered?
[AGENT][NEUTRAL] So preventative is at 100%?
[AGENT][NEUTRAL] Radio graphs and FMX basic and basic restorative are all at 80%.
[AGENT][NEUTRAL] Major, uh, which for us major includes um all endoonic codes, periodontic, prosodontic, or oral surgery codes.
[AGENT][NEUTRAL] They're all covered at 40% with the 12 month.
[AGENT][POSITIVE] Um, waiting period, which that has been satisfied.
[CUSTOMER][NEUTRAL] OK, I'm still going through cases. I'm not done because they just dropped some more. Give me a minute.
[CUSTOMER][NEUTRAL] Is there a maximum and deductible?
[AGENT][NEUTRAL] Yes, the calendar year max is $1500 per person. The deductible is $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] Any waiting period or missing tooth cloths?
[AGENT][NEUTRAL] There is a waiting period for Major, but it has been um
[AGENT][NEGATIVE] But it's, it's already been met. It was uh [PII] and there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Was the replacement rule for Crowns Bridges, dentures?
[AGENT][NEUTRAL] Crowns and bridges are once every 7 years per tooth, partials and dentures are once every 5 years.
[CUSTOMER][NEUTRAL] Does it go by calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what's the mailing address and payer ID?
[CUSTOMER][NEUTRAL] you'll be able to see that.
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] um, I'm sorry, and the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's free and you get.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] What's the timely filing for claims?
[AGENT][NEGATIVE] There's no timely filing as long as the policy is active on the data service.
[CUSTOMER][NEUTRAL] Is there any portal to get eligibility?
[AGENT][NEUTRAL] Um, not for the provider there, um, you can check claim status on the portal.
[CUSTOMER][NEUTRAL] And what's the portal?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And once the page populates, you'll um look to the top right corner for sign in.
[AGENT][NEUTRAL] And you'll be using the option that you're a provider.
[CUSTOMER][NEUTRAL] Is there any email address or fax number for claims?
[AGENT][NEUTRAL] Um, we don't accept claims via email. Our fax number is 877.
[CUSTOMER][POSITIVE] Yeah, I love.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And would you be able to tell me each procedure that's on preventative and the frequency.
[AGENT][NEUTRAL] What do you mean by that? Like all the codes that are under preventative?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you need a copy of the fax back?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can fax you a copy of the fax back. So on the fax back, it has all the information we just went over calendar year, percentage, frequencies, all the ways to file a claim, and then there's a list of covered codes. If the code you're looking for is not on this list, it wouldn't be covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, what's a good fax number for you, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And would that be attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm faxing the fax back over to you now. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Could I know all history that's on file?
[AGENT][NEUTRAL] History, OK, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment, the box of effects, it just came up. Let me send this first.
[CUSTOMER][NEUTRAL] Uh, we don't have that many of them. Let me see what I have.
[AGENT][NEUTRAL] All right, so the fax has been sent and let me go back to the history. Hold on one moment.
[CUSTOMER][NEUTRAL] I haven't ordered any lately.
[CUSTOMER][NEUTRAL] Let me get it over here baby.
[CUSTOMER][NEUTRAL] OK then I may have to order some.
[CUSTOMER][NEUTRAL] Say that I just have them.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] here
[AGENT][NEUTRAL] Alright, do you have any particular codes that you want to go over with history because I will have to go through each claim since [PII] to see what the codes are on these claims.
[CUSTOMER][NEUTRAL] Mhm I'm gonna have to order some. It's gonna be a few.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, like crowns, bridges, cleaning, X-rays.
[AGENT][NEUTRAL] Do you have a list of codes that you'd like me to go over? I can't search it, but I will have to put the code in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh 2740.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 6740.
[CUSTOMER][NEUTRAL] 624 5.
[CUSTOMER][NEUTRAL] 4341.
[CUSTOMER][NEUTRAL] 4342.
[CUSTOMER][NEUTRAL] 11:10.
[CUSTOMER][NEUTRAL] 4910.
[CUSTOMER][NEUTRAL] 4346.
[CUSTOMER][NEUTRAL] 4355.
[CUSTOMER][NEUTRAL] 1208.
[CUSTOMER][NEUTRAL] 0210.
[CUSTOMER][NEUTRAL] 0330027401200140.
[CUSTOMER][NEUTRAL] 2920.
[CUSTOMER][NEUTRAL] 5225.
[CUSTOMER][NEUTRAL] 5226.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 5110.
[CUSTOMER][NEUTRAL] 5120.
[CUSTOMER][NEUTRAL] 2950.
[CUSTOMER][NEUTRAL] 333 0.
[CUSTOMER][NEUTRAL] 3320.
[CUSTOMER][NEUTRAL] 2954 7953.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 721071402393.
[CUSTOMER][NEUTRAL] 2335.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] 6058.
[CUSTOMER][NEUTRAL] 6057.
[CUSTOMER][NEUTRAL] 2960.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2962.
[CUSTOMER][NEUTRAL] That's all.
[AGENT][NEUTRAL] Thank you. Um, do you mind if I place you on just a brief hold while I go through the codes?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII] right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I'm going to give you the last date of service for each of the codes that you provided.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] orthodontist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] So for um 2740, [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] So then she's smart and say she make good grades and say that's good.
[AGENT][NEUTRAL] 6740, no history, 6245, no history.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 4341, no history.
[AGENT][NEUTRAL] 4342, no history?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You shouldn't have been on.
[AGENT][NEUTRAL] 11:10, [PII].
[AGENT][NEUTRAL] 4910 [PII].
[AGENT][NEUTRAL] 43, 46, no history.
[CUSTOMER][NEGATIVE] What don't care for, huh.
[AGENT][NEUTRAL] 4355, no history?
[AGENT][NEUTRAL] 12:08 is [PII].
[AGENT][NEUTRAL] 0210, no history.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 0330 [PII].
[CUSTOMER][NEUTRAL] And they did.
[AGENT][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 0120, [PII].
[CUSTOMER][NEUTRAL] s.
[AGENT][NEUTRAL] 0140 [PII].
[CUSTOMER][NEGATIVE] you're gone.
[AGENT][NEUTRAL] 0292920 is [PII].
[CUSTOMER][NEUTRAL] Did.
[CUSTOMER][NEUTRAL] But I know.
[AGENT][NEUTRAL] 5225, no history. 5226, no history.
[CUSTOMER][NEUTRAL] What it says he's gone.
[CUSTOMER][NEUTRAL] OK man do you have the share baby?
[AGENT][NEUTRAL] 5110, no history?
[AGENT][NEUTRAL] 5120, no history.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] 2950, [PII].
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] 3330, no history. 3320, no history. 2954, no history.
[CUSTOMER][NEUTRAL] If I put 3 in the bus, I get the bus.
[AGENT][NEUTRAL] 7953, no history?
[AGENT][NEUTRAL] 7210, [PII].
[AGENT][NEUTRAL] 7140, no history.
[AGENT][NEUTRAL] 2393 [PII].
[AGENT][NEUTRAL] 2335, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6010, no history?
[AGENT][NEUTRAL] 6058, no history.
[AGENT][NEUTRAL] 6057, no history.
[CUSTOMER][NEUTRAL] Um, stuff.
[AGENT][NEUTRAL] 2960 and 2962, no history.
[CUSTOMER][NEUTRAL] OK, let me look at my phone right now and that way I can.
[CUSTOMER][NEUTRAL] Do all the exams share frequency?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Of
[AGENT][NEUTRAL] The only exams that share frequency are 120, 40, 50, 60, and 80, 2 for 12 month period.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Does 49, 10 and 1110 share frequency?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh yeah, you can just you can.
[AGENT][NEUTRAL] 4910 and
[CUSTOMER][NEUTRAL] How much does she get?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] She can always have it. I don't see it so far, ma'am, your ID and insurance card.
[AGENT][NEUTRAL] No, they don't share frequency. I mean, it's.
[CUSTOMER][POSITIVE] Thank you as soon as they send it I'll let you know that I.
[AGENT][NEGATIVE] No, they're they're not, they don't, they're not paired, they don't share.
[CUSTOMER][NEUTRAL] Could it 4910 and 1110 be alternated?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] They're not shared as in it's two different um categories, but they're both maximum 1 procedure per 6 months.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] That way we can uh verify and I can tell you about it OK?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Get 1 49 10 and then next visit get 11:10 and then again 4910.
[AGENT][NEUTRAL] You can as long as it's a it's just a maximum of 1 procedure per 6 months. So how you switch it up is up to
[AGENT][NEUTRAL] The office and the patient as long as it's once per 6 months.
[CUSTOMER][NEUTRAL] Yeah, I could
[CUSTOMER][NEUTRAL] OK, is there any healing period after SRP?
[CUSTOMER][NEUTRAL] So it's always important to have the front and the back.
[AGENT][NEGATIVE] No, the fax back doesn't specify that.
[CUSTOMER][NEUTRAL] For SRP are all 4 quads allowed on the same day?
[AGENT][NEUTRAL] Um, that's up to your discretion. It's not specified on the facts back.
[CUSTOMER][NEGATIVE] No, no, no, no,
[CUSTOMER][NEUTRAL] Is there an age limit for fluoride?
[CUSTOMER][NEUTRAL] all that I'm seeing, I need the front and the back so I know how to.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] Fluoride.
[CUSTOMER][NEUTRAL] Yes ma'am, but uh, I will give you a call a little later just as soon as I know if I got it because I got a lady I need to work with with.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] If it's an adult, it's limited to dependent children aged [PII]. If it's a child, limited to dependent children under age [PII].
[CUSTOMER][NEUTRAL] Is there any?
[CUSTOMER][NEUTRAL] Uh, ortho coverage.
[AGENT][NEUTRAL] Um, there's no orthodontic treatment on this policy.
[CUSTOMER][NEUTRAL] A group name and group number?
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The group number is 13611.
[CUSTOMER][NEUTRAL] er
[CUSTOMER][NEUTRAL] Is pre-authorization required?
[AGENT][NEUTRAL] No, prior authorization is not required for any APL policy.
[CUSTOMER][NEUTRAL] Any downgrading?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] Does the plan pay on prep or seat date?
[AGENT][NEUTRAL] Either or there's no specification.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you say your name is [PII]?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Does it have two Ns?
[AGENT][NEUTRAL] And the first initial.
[AGENT][NEUTRAL] Yes, [PII], the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Could I have a reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] And the member ID provided that's the correct member ID?
[AGENT][NEUTRAL] Um, the 1065324, yes, that's their policy number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And this is the good number to call for eligibility?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And [PII], he will be the policy holder?
[AGENT][NEUTRAL] Yes, he's the policyholder.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] All right, well, thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.