AccountId: 011433970860
ContactId: 20155104-d485-455e-b32a-9dfc79002d66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 659450 ms
Total Talk Time (AGENT): 325577 ms
Total Talk Time (CUSTOMER): 178575 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/20155104-d485-455e-b32a-9dfc79002d66_20250210T20:47_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII].
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And I'm trying to find out what kind of.
[CUSTOMER][POSITIVE] Benefits I have.
[CUSTOMER][NEGATIVE] I just got this insurance and I, I only, they only sent me.
[CUSTOMER][NEUTRAL] A, uh, general card. I don't have the medical card.
[CUSTOMER][NEUTRAL] And I'm just trying to see
[CUSTOMER][NEUTRAL] If I can get that car that you have a policy number or something.
[AGENT][NEUTRAL] I can help you with that, Mr. [PII]. What is the policy number for your dental coverage?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK for you just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number 025.
[CUSTOMER][NEUTRAL] 66
[CUSTOMER][NEUTRAL] 098.
[AGENT][NEUTRAL] All right, thank you, sir. And what is your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And my address is [PII].
[CUSTOMER][NEUTRAL] Berg Meadow Lane.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then finally, what is that email address for you, sir?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we actually have a Gmail address. Do you want us to change that for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, you can believe the same. It's uh [PII].
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Yes, you, yeah, use that email, yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. Now, we do have medical coverage for you.
[AGENT][NEUTRAL] Um, that is active.
[AGENT][NEUTRAL] And what I'm gonna do is.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get that pulled up, bear with me just one second, seeing if I, if we have a card on file for you.
[CUSTOMER][NEUTRAL] Uh, my daughter's on there also, isn't it?
[AGENT][NEUTRAL] Uh, is her name [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] She is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what I can do is I can email you a copy of your ID card as well as your policy certificate that way you, you can view the benefits on there as well. Would you like for me to email you a copy of both?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yes ma'am, that'll be fine.
[AGENT][POSITIVE] I'm gonna take care of that right now for you.
[AGENT][NEUTRAL] Let me just
[AGENT][NEUTRAL] It'll just take me just a minute.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And my daughter just went to try the other doctor today and she got.
[CUSTOMER][NEUTRAL] They're saying that uh
[CUSTOMER][NEUTRAL] That they don't have any uh
[CUSTOMER][NEUTRAL] Coverage, I mean, doesn't have a provider in the area of uh [PII] or [PII] area.
[CUSTOMER][NEUTRAL] I know
[AGENT][NEUTRAL] Now, I'm not sure of that. um, now I do know that this policy is handled, your medical, is handled by our third party administrator.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] There's a phone number on this card that I'm sending you and you would need to contact them to find out, you know, who is in your area.
[AGENT][NEUTRAL] Did she contact do you know if she contacted with TPA for that information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know. I, I just got off the phone with her and uh she told me that they was going to schedule an appointment but they didn't, they couldn't find a provider.
[CUSTOMER][NEUTRAL] Uh, uh, in the area, but that's all she would told me, so yeah, I'm gonna have to, I guess I have to do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Call the number that you're gonna send me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah and I'm also gonna put that in the email hang on.
[AGENT][NEUTRAL] So that for your medical you're going to contact web TPA and I'll put that in the email it's also going to be on your card.
[CUSTOMER][NEUTRAL] Alright, and I just forward that information to her.
[AGENT][POSITIVE] OK. Yeah, and hopefully they can get someone in that area for her.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for your dental, you can go anywhere. There's no network for that.
[CUSTOMER][NEUTRAL] You know the percentage that's covered.
[AGENT][NEUTRAL] Sure. So, on your dental policy,
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the preventive is covered at 100% of the usual customary rate in your area. There's no network and a lot of times they'll ask if if this is a PPO plan, just tell them it's not a PPO plan. It is a UCR UCR stands for usual customary rate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um you can go to any dental provider. Now, I will tell you there is a 12 month waiting period for major procedures. That's like oral surgery, your crowns or bridges, um, the extensive.
[AGENT][NEUTRAL] Gum this treatment, the endoimperial treatment, periodontal treatment. This policy does have a 12-month waiting period for those major procedures to be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] sort of preventing stuff.
[CUSTOMER][POSITIVE] It's covered 100%.
[AGENT][NEUTRAL] 100%, yes, sir. And then your basic is covered at 80%.
[AGENT][NEUTRAL] And then once you meet that 12 month waiting period, your major is covered at 40%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And I've just about got this email ready for you putting in that web TPA information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I just sent it it's gonna be from the care team or where are you where you can check it?
[CUSTOMER][NEUTRAL] Yeah, I can take it hold on a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just wanna make sure you can open both of those attachments.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I haven't got it yet.
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] OK. And also on the back of the card?
[AGENT][NEUTRAL] There's for the PPO provider network there's the multi plan number and how to search for providers in that area.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I can, I mean, they can operate everything from the uh website uh.
[AGENT][POSITIVE] Absolutely there's a portal.
[AGENT][NEUTRAL] Now it won't give you the um and that's on that email as well. That won't give you, yeah, your provider network for that medical policy, but it would for your dental policy which.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just got
[AGENT][NEUTRAL] But your dental policy has no network, but you can click on the policy numbers and view your policy certificate as well with an active online account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So let me see what oh you sent me the.
[AGENT][NEUTRAL] And it went to your Gmail address.
[CUSTOMER][NEUTRAL] OK, I get it.
[CUSTOMER][NEUTRAL] So this the whole policy or?
[AGENT][NEUTRAL] You have your whole policy for your medical as well as your ID card.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And if you need any further assistance for, you know, for your medical, you would contact the web TPA or look for a multi-plan provider.
[CUSTOMER][NEUTRAL] OK, this first page that's the that's the policy number sir.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The first page, the policy number, do you see that 02566174?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, that's your policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You said the web GPA is.
[AGENT][NEUTRAL] It's Web TPA T as in Tango.
[CUSTOMER][NEUTRAL] We have TPA OK.
[AGENT][NEUTRAL] Yes, sir. I can understand how you would understand here G.
[AGENT][NEGATIVE] This phones make it hard sometimes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, alright.
[CUSTOMER][NEUTRAL] OK, so and that.
[CUSTOMER][NEUTRAL] That will, so I can search that search that and that.
[CUSTOMER][NEUTRAL] Find me a provider.
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] It should, yes, sir.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be all. I think that'll work for now.
[AGENT][NEUTRAL] OK. And if you want to, um, within the policy, it's
[AGENT][NEUTRAL] Closer to the end there's a page called the schedule of benefits page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then that kind of outlines your benefits.
[AGENT][NEUTRAL] And it looks like you have the high option.
[AGENT][NEUTRAL] So you would look for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That benefit amount for the services that are covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's fine. OK, I got that. I see that. Alright.
[AGENT][POSITIVE] But you know, if you need anything else, you never hesitate to give us a call, OK? Because we're here.
[CUSTOMER][POSITIVE] Yes ma'am thank you.
[AGENT][NEUTRAL] For you.
[AGENT][POSITIVE] My pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That'll be all that you're gonna do it. I appreciate it.
[AGENT][POSITIVE] It was my pleasure and thank you, Mr. [PII], for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Alright you do the same thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Mhm.