AccountId: 011433970860
ContactId: 215cf261-7d05-4e3d-936b-795b1cb3d7fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354970 ms
Total Talk Time (AGENT): 163065 ms
Total Talk Time (CUSTOMER): 119996 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/215cf261-7d05-4e3d-936b-795b1cb3d7fd_20250127T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII].
[CUSTOMER][NEUTRAL] I'm a dental provider. Could you please help me with the member's benefits?
[AGENT][POSITIVE] Yeah, I can check benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, it's 02.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 492 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, yes, I'm gonna, um, look for two dependents. The first would be [PII].
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh yeah.
[AGENT][NEUTRAL] OK, did you say that there was another number we needed to check as well?
[CUSTOMER][NEUTRAL] Yeah, it's um the order number is his, her spouse, [PII].
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you for verifying all of that, [PII]. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Uh, can you help me with the benefits through phone? I have a question too. Are we network? Can you verify that?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So this plan participates in the Carrington PPO, uh, but utilization of a provider in the Carrington network is not required. It just participates in the Carrington PPO.
[CUSTOMER][NEUTRAL] So it would cover with us?
[AGENT][NEUTRAL] Are you a part of Carrington, the Carrington PPO?
[CUSTOMER][NEUTRAL] Uh, well, we're part of the American.
[CUSTOMER][NEUTRAL] I'm sorry, let me just check. American Public Life Insurance PPO?
[AGENT][NEUTRAL] OK, yeah, yeah.
[CUSTOMER][NEUTRAL] So we're in network?
[AGENT][NEUTRAL] So this plan, yeah, it participates in the Carrington PPO network but the provider does not have to be in the Carrington network that's just what it follows, so yes.
[CUSTOMER][NEUTRAL] OK. All right, and you, uh, can you check with the tax ID or?
[CUSTOMER][NEUTRAL] Is there any way you can check where you work?
[AGENT][NEUTRAL] Um, I can, I can't see if you're a part of the Carrington PPO network, um, but I can give you their phone number.
[AGENT][NEUTRAL] If you'd like.
[CUSTOMER][NEUTRAL] Um, OK, yes, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, uh let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. And can you help me with the benefits for now?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, of course. Alright, um, let's see, of course I will let you know, Marcella, verification of coverage is not a guarantee of payment for claims. Uh, so this the benefits are, uh, $500 max per calendar year. There is a $50 deductible and that does not apply to preventative services.
[AGENT][NEUTRAL] And in short this plan offers preventative and basic expenses. There is no major coverage on this plan though.
[CUSTOMER][NEUTRAL] OK, I'm sorry, max is 500 and deductible is 50 and nothing has been used.
[AGENT][NEUTRAL] Correct per calendar year, uh, I can see if any of that has been used. We will definitely check. Give me just a moment.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, none of that has been used so far.
[CUSTOMER][NEUTRAL] Thank you and can you, I'm sorry, you said the coverage for preventative and basic?
[AGENT][NEUTRAL] Mhm.
[AGENT][MIXED] Yes, this offers preventative. It's at 100%, um, basic and radiographs are gonna be at 80%, but it does not offer any major coverage.
[CUSTOMER][NEUTRAL] OK, so basic it's 80.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you also provide me the frequency for exam and by lans?
[AGENT][NEUTRAL] Yes, so let's see, exams going to be 2 per 12 month period.
[AGENT][NEUTRAL] Bite wings are going to be once per 12 month period.
[CUSTOMER][NEUTRAL] OK, thank you. And are there any waiting periods or copays?
[AGENT][NEGATIVE] No, not for this plan, no waiting periods and no copays.
[CUSTOMER][NEUTRAL] OK. And these benefits are for both? Are they both the same?
[AGENT][NEUTRAL] Yes, yes, they are the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh you also have the group name?
[AGENT][NEUTRAL] Uh yes, give me just a moment, let me get that.
[AGENT][NEUTRAL] So the group name is partners.
[AGENT][NEUTRAL] Personnel
[AGENT][NEUTRAL] Management
[AGENT][NEUTRAL] Services.
[CUSTOMER][POSITIVE] OK, all right, thank you, that would be it.
[AGENT][NEUTRAL] OK, uh, did you want me to go ahead and send you the snacks back, Marcella, or did you get everything you needed?
[CUSTOMER][POSITIVE] No, I, I got everything I need thank you.
[AGENT][POSITIVE] OK, alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too bye bye thank you.
[AGENT][POSITIVE] Thank you bye bye.