AccountId: 011433970860
ContactId: 1e1eb19e-a639-48de-84ef-4262ba5f17d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 756580 ms
Total Talk Time (AGENT): 290971 ms
Total Talk Time (CUSTOMER): 424604 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/1e1eb19e-a639-48de-84ef-4262ba5f17d7_20250227T13:41_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, um, I just have a couple of questions about my, um, dental benefits.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with your dental benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]. However, that's not my phone number. I'm borrowing my mom's phone because my phone crashed and I don't have a new one yet, so please don't put it in my profile or anything.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, OK, no worries. And may I have your policy number, I'm sorry.
[CUSTOMER][NEUTRAL] OK, is um.
[CUSTOMER][NEUTRAL] Alright, the policy number is 02596151.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And [PII], I just need you to verify your last name, your date of birth, your mailing and email address.
[CUSTOMER][NEUTRAL] OK, last name is [PII] Date of birth is [PII]. Mailing address is [PII], and then my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And what benefit questions did you have today?
[CUSTOMER][NEUTRAL] Um, on my dental, um,
[CUSTOMER][NEUTRAL] I know that it, like I called yesterday. I just got this, so I'm like trying to figure out how it works and everything. Um, they, she told me yesterday I have a 500 for like preventative for like like cleaning at the dental, I have 500.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, dollars max, and then a $50 deductible. But my question was, are there any rules on like, like if I want to get two cleanings within a calendar year, do they have to be so far apart in time? Like some dental that I've had in the past, it's like, you have to do it 6 months and a day apart, but I was not sure if there was any rule like that here so that I know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for cleanings, they're once every 6 months, so twice a year.
[CUSTOMER][NEUTRAL] OK, so it's and it's strict on that like it couldn't be like a month early or anything?
[AGENT][NEUTRAL] Right, it has to be exactly 6 months from that, whatever that, you know, first date is.
[CUSTOMER][NEUTRAL] OK, OK, OK, and then um.
[CUSTOMER][NEUTRAL] I think that might have been my only question, um.
[AGENT][NEUTRAL] Now, I just want to make sure the $500 is not just for preventative, the $500 is for, so your policy covers preventative and basic, so the $500 is for the whole calendar year, any dental, um, basic or or um preventative that you use, you have $500 for the year for your dental.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so if I get two cleanings and there it that.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] The thing is, like, I don't know how much a cavity is, but if I had a cavity, then.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] That's probably not
[CUSTOMER][NEUTRAL] Because two cleanings will probably be almost $500 so then like I would just have to pay it out of pocket for anything else after that, right?
[AGENT][NEUTRAL] Right, if, if this is the only dental coverage you have, then yes, if you do exhaust the 500, it will be denied saying that the max has been used or met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is my calendar year or is my year like my effective date on my card says [PII], so is it up till like [PII]? Is that the date, the year of the [PII]?
[AGENT][NEUTRAL] Well, no, so, so that would be a plan year. Yours, it just starts [PII] of each year.
[CUSTOMER][NEUTRAL] OK, so I have till the end of the calendar year for the $500.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm. Now, if you have passed, um, like let's say next year, if you have something that you need to file for for for [PII], if you still have benefits and your policy was active, you can file, you know, that claim for at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got you and then um.
[CUSTOMER][NEUTRAL] OK, and then in with the cleaning if I need the bite wings, um.
[CUSTOMER][NEUTRAL] Like once a year you get the bite wing X-rays.
[CUSTOMER][NEUTRAL] Like those are covered like within the uh the $500 but do I have to pay anything extra for those like
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Or is that considered preventive part of the preventative?
[AGENT][NEUTRAL] So the bite wings are covered at 80%, um, like you said, it's once per 12 month period. So if you were to have used the full 500, um, then yes, it it could come back, that is your the patient responsibility, um, but I mean it depends.
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEGATIVE] The bite wings are not.
[CUSTOMER][NEUTRAL] Like, if I go to the dentist.
[CUSTOMER][NEUTRAL] And I need bite wings in addition to the cleaning. Like the cleaning, like after I pay the $50 deductible, the cleaning is totally covered if it's under $500. I don't have to pay any part of that, but what you're saying is I'll have to pay 20% of the cost of the bite wings.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or is that after it
[AGENT][NEUTRAL] No, no, no, no, no. Well, yeah, 80, 20, 100. OK, I see what you did there, yes.
[AGENT][NEUTRAL] So we will cover it at 80% and then that 20% if there's something, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would be patient responsibility.
[CUSTOMER][NEUTRAL] OK, just, just so I'm clear, when I go to the dentist for my appointment, like coming up because I made an appointment already and I need the bite wings cause I haven't been to the dentist in over a year. So like,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think the, the cost of the um cleaning is gonna be something like $180 or I don't know, something like that, $150 so.
[CUSTOMER][NEUTRAL] I'll pay the $50 and then the $150 let's say the cleaning is, that will be covered because I haven't spent any of the $500 yet. And then.
[CUSTOMER][NEUTRAL] And then I'll have to, whatever the bite wings are, let's say the bite wings are $100 more, that's still within the $500 but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 500, right.
[CUSTOMER][NEGATIVE] But I have to pay 20% of that?
[AGENT][NEUTRAL] Right, you, right, because we only cover 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I thought yesterday she told me that those are covered, like those are part of the preventative care.
[AGENT][NEUTRAL] Bite wings, let me double check. They could be, hold on, because some some policies they're under basic, some they're preventative. I can double check for you.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I, I, I wrote down that the pano one that you get every 5 years that she's, I wrote down that I would have to pay 20% of that, but thankfully I'm not like due for that for a while. But I didn't write that down on the bite wings. I, so I thought she
[AGENT][NEUTRAL] Let me double check for you. Hold on one second now.
[AGENT][NEUTRAL] Yeah, um,
[AGENT][NEUTRAL] FMX and panels, like you said, yes, those are under um 80%, but then, yes, when I looked at the bite wings, those are under preventative, so that's at 100% as well.
[CUSTOMER][MIXED] OK, good. And then, um, the $500 OK. So the, the $50 doesn't like
[CUSTOMER][NEUTRAL] That's just what I have to pay for the deductible that doesn't like affect like the amount of $500 that you can.
[CUSTOMER][NEUTRAL] OK, sorry, I'm just talking out loud.
[AGENT][NEUTRAL] No, you're fine, and the $50 deductible, it doesn't apply to your preventative services. So,
[CUSTOMER][NEUTRAL] Alright, I think, I think that.
[AGENT][NEUTRAL] Once you pay that $50 and your deductible is met for the year, that's that'll, um,
[AGENT][NEUTRAL] Help you with like your, your basic, um, what is an example of something basic like your evaluations or um your FMX and panels, uh, fillings.
[CUSTOMER][NEUTRAL] A cavity.
[CUSTOMER][NEUTRAL] OK, so like when I go to the, like when I go to the dentist, I, even for the preventative appointment, I still have to pay the $50 though, right? Like I still have to pay that? or are you saying I don't even have to do that? That's only for the other stuff.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, like if you're going and and you're only getting um preventative services, then you wouldn't be charged a deductible. Deductibles don't apply to preventative services. Um, but now if you do like, you know, like you said, the cleaning and then the bite wing, then for that cleaning part, of course, the deductible wouldn't apply, but you would probably have that $50 deductible for, well, even the bite wings are preventative, so that still wouldn't.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Affect that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good, OK, this is getting better and better for me.
[CUSTOMER][NEUTRAL] Oh, now, like, you probably don't know the answer to this question, but I'll ask it anyways. Like, I don't even, I, it's hard for me to tell in my paycheck how much I'm paying every week for this, but like you wouldn't be able to that question, right? Like I have to go.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, your premium is 3.
[CUSTOMER][NEUTRAL] I'm trying to figure out how much.
[AGENT][NEUTRAL] Your premium is $3.30. Let me see how.
[AGENT][NEUTRAL] Frequently is it on payroll.
[CUSTOMER][NEUTRAL] Well it's weekly but.
[AGENT][NEUTRAL] Yeah, it's weekly.
[CUSTOMER][NEUTRAL] It must be, is that bundled into some other type like with vision or something because like it's showing something, it says medical 125 $5.63 but then, see, I signed up for several different things through my company, so there's a like I signed up for other medical stuff.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But they've like lumped it together so I can't tell how much I'm paying for the dental but you said $3 and.
[CUSTOMER][NEUTRAL] 30 times? Oh OK.
[AGENT][NEUTRAL] Mhm. For, yes, for dental by itself it's $3.30.
[CUSTOMER][NEUTRAL] OK, and um
[CUSTOMER][NEUTRAL] Can you tell, like, can you tell if it's bundled with anything?
[AGENT][NEUTRAL] Well, so here's the thing, so you have payroll deductions, so when they take it out of your paycheck, after they take it out, they being your employer, after they take it out of your your payroll deduction, then they pay us. So I can tell you like your policies that you have here with us, I can tell you what the total of that premium is and see if maybe that's what's being taken out, but I'm not sure if they're bundling.
[CUSTOMER][NEUTRAL] Does it say that?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Like if they just take all your benefits out of your check at once or I'm not sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. What, what else do I have through American Public Life?
[AGENT][NEUTRAL] Oh, so you have your hospital indemnity policy, so that's medical. You have accident and you have a group term life policy, and then you have the dental.
[CUSTOMER][NEUTRAL] OK, how much is the life one?
[AGENT][NEUTRAL] Life is $1.92.
[CUSTOMER][NEUTRAL] So like
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] Maybe that's the one that's bundled with the dental 330 and 192 is.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, maybe that is and it's like somehow there's like tax on it or something because that comes out to 522 alright and then what, how much is the, you said there was a third one?
[AGENT][NEUTRAL] Mhm, you have 4 altogether. Um, you, you want me to tell you all of them?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah and tell me the price of each I'll write it down.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for your um medical policy.
[AGENT][NEUTRAL] It's $9.19.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Accident is $1.82.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Life is $1.92.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the dental is $3.30.
[CUSTOMER][NEUTRAL] OK, alright, that's helpful so I must, I have one other thing from a different company I think because I got.
[CUSTOMER][POSITIVE] Maybe it's the vision and something, but all right well uh I appreciate your help thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Alrighty. Well, thank you for calling APL A and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.