AccountId: 011433970860
ContactId: 1d8e67a6-6f65-407c-a9bc-2b2218f80619
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363410 ms
Total Talk Time (AGENT): 167320 ms
Total Talk Time (CUSTOMER): 137632 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/1d8e67a6-6f65-407c-a9bc-2b2218f80619_20250306T17:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I wanted to verify eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, I can definitely help you with the eligibility and benefits, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, my name is [PII] and the number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have, um, the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02579738.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [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] OK.
[AGENT][NEUTRAL] And did you need a copy of the fax back or you have particular questions about it?
[CUSTOMER][NEUTRAL] Um, could I get a fax of the benefits?
[AGENT][NEUTRAL] Sure. So, on the um fax back, you'll see the calendar year max, deductible, all the percentages, waiting periods, frequencies, um, limitations, exclusions, 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 the policy.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] All right, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alrighty, so I'll go ahead and send this over to you now. [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, actually I do have just a couple questions while I'm waiting on that fax. Um, we are out of network. Does this plan have out of network coverage?
[AGENT][NEUTRAL] Sure. OK.
[AGENT][NEUTRAL] So this policy isn't on a network, um, it, it is on like Carrington as a network, but it's not Carrington PPO or so it doesn't have a list of providers.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] I guess we have never filed claims with y'all before, so um.
[CUSTOMER][NEUTRAL] What is um the claims mailing address or can we submit claims electronically?
[AGENT][NEUTRAL] Yes, um, I can give you the payer ID. We also have the fax and the mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, what would be the um the claims mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] that payer ID was 60801.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said you had a fax number available?
[AGENT][NEUTRAL] Yes, um, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, um, and who would we address if, if we needed to mail the claim in who would we address it to?
[AGENT][NEUTRAL] So if you mail it, it's gonna be American Public Life, and then for the facts, the attention would be um claims department.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] What you did today.
[CUSTOMER][NEUTRAL] OK and then um is there a waiting period with this plan?
[AGENT][NEUTRAL] Yes, um, for major expenses, major for us includes endodontic, perontic, prosodontic, and oral surgery. It's covered at 40% and there is a 12-month waiting period. So this policy, um, would be active or would be um eligible for [PII].
[CUSTOMER][NEUTRAL] Want me to
[CUSTOMER][NEUTRAL] OK, so, um, for preventive or diagnostic, so we have them scheduled for an exam and X-rays, um, that would not fall under the waiting period.
[AGENT][NEUTRAL] Right, exams, um, so preventative, so the waiting period is only for major expenses. Preventative and basic don't, don't use the waiting period.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, was, um, Periodonics want uh under the major?
[AGENT][NEUTRAL] Yes, endodontic, periodontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said all of that would be on the fax that we're getting?
[AGENT][NEUTRAL] Yes, um, all of this is on the fax and the, um, just in case you needed the payer ID claims and uh fax, all of that information is on there as well, so you'll have another copy.
[CUSTOMER][NEUTRAL] OK, well I think that is all I need for now.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] So, um, and actually one more so um.
[CUSTOMER][NEUTRAL] Do we need to release the assignment of benefits or will you pay the provider?
[AGENT][NEUTRAL] Um, you don't have to release it. We'll pay, um, you can, but we will pay, you know, if something is owed to the patient, we'll pay the patient. If, if not, it will, it will come to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] To the provider, OK, alright, that is all I needed then thank you.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.