AccountId: 011433970860
ContactId: 2a8a3f8f-69c2-434d-8c1e-b6e27a085b3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1457979 ms
Total Talk Time (AGENT): 365693 ms
Total Talk Time (CUSTOMER): 749676 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/2025/01/08/2a8a3f8f-69c2-434d-8c1e-b6e27a085b3e_20250108T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi [PII], good morning. My name is [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][NEUTRAL] I'm good too, thank you. I am calling because I have a couple of questions regarding my uh dental benefits. I wasn't sure if I was supposed to speak with you first or to be transferred to the Carrington team.
[AGENT][NEUTRAL] OK, what specific information are you needing?
[CUSTOMER][NEUTRAL] Um, so, a couple of things. I was on the phone with the dentist that I usually go to do my yearly cleaning and checkup, and they actually told me that it is, um, if I do X-rays, it's only covered at 80% with this insurance which I wasn't aware of originally.
[CUSTOMER][NEUTRAL] Um, and if that's the case, I would like to find another dental provider that's in network with this insurance.
[AGENT][NEUTRAL] OK. May I have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, it is 02.
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] 09.
[AGENT][NEUTRAL] And may I have a callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And could you please verify your date of birth and the mailing address listed on file please?
[CUSTOMER][NEUTRAL] Date of birth is [PII], and the mailing address is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And we do have an email address on file. Could you verify that to make sure it's correct?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy and you were trying to see if you can find an in network provider?
[CUSTOMER][NEUTRAL] Yes, and also to confirm what the benefits are for.
[CUSTOMER][NEUTRAL] I guess like dental visits because I know that there's a limit of $500 for the year.
[CUSTOMER][NEUTRAL] Um, and I was told that because if I do X-rays, it's only 80%, and then I have the 20% co-payment.
[CUSTOMER][NEUTRAL] Um, that's not something I was aware of in the past few years that I've been on this insurance. So I wasn't sure if it's a new policy or if it's always been the case, and the dentist just waived the fee.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so in regards to your policy, it does show that this policy effective date is [PII]. So this is an old policy, so nothing has changed since the [PII] since [PII].
[CUSTOMER][NEUTRAL] OK, um, but that when it comes to, I guess, dental X-rays.
[CUSTOMER][NEUTRAL] Is that only covered at 80%? I thought that if you do like um.
[CUSTOMER][NEUTRAL] You know, a routine dental checkup once a year, usually everything is covered.
[AGENT][NEUTRAL] Support for the preventative expenses, verification of coverage does not guarantee the payment of the claim. You do have up to 100% for the preventative expenses. Now according to how the providers submits that bill in to us, if we receive something that is not listed under the preventative, then it does cover up to the 80%.
[CUSTOMER][NEUTRAL] OK, um, so is it possible that this dentist was just looking for like a larger payout and, and build it that way? I, I guess my assumption was when you do X-rays once a year.
[CUSTOMER][NEUTRAL] That's technically considered preventative.
[AGENT][NEUTRAL] If it was due to the preventative visit, but it like I said, it's according to how we received the bill if if the provider submits it in that way, we can only go off of how the provider submits it in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I understand so it's, it just depends on how they actually go.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, OK, cause I, it seemed a little weird to me because in all the years I've been to dental visits.
[CUSTOMER][NEUTRAL] It's just uh the first time I was hearing it and they told me I have an unpaid balance from last year which.
[CUSTOMER][NEUTRAL] Nobody told me about.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'd like to avoid that this time if possible, um, which is why I'm trying to find a new dentist that will not
[CUSTOMER][NEUTRAL] Make up things, I guess, a year later.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there a, I don't know if there's a PDF that you're able to like send to my email that lists all, uh, in-network dentists?
[CUSTOMER][NEUTRAL] And also if there's.
[AGENT][NEUTRAL] So in order to
[AGENT][NEUTRAL] In order to find that the providers you will have to contact Carrington in regards to the providers to see if they're in network with Carrington.
[CUSTOMER][NEUTRAL] OK, so it's not and so when I'm looking it wouldn't be under APL, it would have to be like Carrington as the.
[CUSTOMER][NEUTRAL] Insurance that they're billing?
[AGENT][NEUTRAL] You the Carrington will handle if they're in or out of network up on their PPO so that's why you would contact Carrington and they may have a website that you would be able to go into to pull up that provider that's in or out of network or they can give you that information over the phone.
[AGENT][NEUTRAL] We only have the benefits.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, um, would you be able to point me to maybe a benefits document? I don't know if that's on the APL website.
[AGENT][NEUTRAL] No, you will get that from Carrington when you contact them.
[CUSTOMER][NEUTRAL] Just so I can take another look at it.
[AGENT][NEUTRAL] We don't have that information.
[CUSTOMER][NEUTRAL] OK, so Carrington or.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so Carrington will provide me with the providers and they'll provide me with.
[CUSTOMER][NEUTRAL] Um, the benefits breakdown and is my member ID number with Carrington the same as it is with APL?
[AGENT][NEUTRAL] Yes, now for the benefits we have the benefit breakdown but we don't have the providers.
[AGENT][NEUTRAL] So the benefits is what I gave you when I stated that the preventative is at 100% but it's based off of how the provider submits the bill in once they submit that bill in, then we can review it and we will have to go off of how the fax back is listed.
[CUSTOMER][NEUTRAL] OK, I mean that's.
[CUSTOMER][NEUTRAL] OK, is there an area that explains what is considered preventative or like the code that they would have to use to mark it as preventative?
[AGENT][NEUTRAL] It's according to what procedure that they, that they provide to you for that day, that will show if it is preventative or if it is considered under a different percentage.
[CUSTOMER][NEUTRAL] Right, but I'm asking who determines what's considered preventative? Is it APL slash Carrington, or is that up to the provider who interprets it as preventative or not preventative?
[AGENT][NEUTRAL] Once the provider submits the claim in, it's based off of how they bill it. When we receive it, if the coding is not preventative, then it's processed under the different bracket.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and does it literally say in coding preventative or is there like a number? Because I know in medical they have like certain codes for types of visits that you go to.
[AGENT][NEUTRAL] It's based off of the code.
[CUSTOMER][NEUTRAL] That's what I'm trying to understand.
[CUSTOMER][NEUTRAL] OK. And is there a way for me to see a list of codes that's accepted by the insurance company?
[AGENT][NEUTRAL] There's not a list of code that is accepted. Once we receive the codes in, if it indicates that it is a preventative procedure, then it will go up on the preventative.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I think I may be going in circles. So just again to verify, I go in to see a dentist for a preventative visit once a year. I go for my cleaning, I go for X-rays, the regular X-rays, just the regular teeth that they take a look at.
[CUSTOMER][NEUTRAL] They have to build each X-ray under a certain code, right? It's either preventative or it's not preventative.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] They have the code that determines whether or not it's preventative, right? Like it's either preventative, it's like one code, if it's not preventative, it's another code. How can I make sure
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] A regular X-ray for a preventative visit will be built under that.
[CUSTOMER][NEUTRAL] Code. I'm just concerned that they may bill it not preventative.
[CUSTOMER][NEUTRAL] Just so they can get more money from people. It's it's happened before.
[AGENT][NEUTRAL] OK, so say for instance, right, so if you go to the provider and the dentist state that they're going to do preventative services, but if they render that services and find out that they have to do something else other than the preventative services, then that is what they be.
[AGENT][NEUTRAL] Now the only thing that I can tell you, they can tell you that they're billing preventative, but if that services is not completely rendered at that time, they will submit a different bill. So if they tell you a different code by the time they submit that claim in, it could be another different code.
[AGENT][NEUTRAL] It's just based off of what is rendered.
[AGENT][NEUTRAL] When they provider sends the bill in.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, but if I'm only going in for like one visit for like 30 minutes and they're just expecting my mouth and they're doing the cleaning and X-rays.
[CUSTOMER][NEUTRAL] And it's the bare minimum X-rays.
[CUSTOMER][NEUTRAL] My understanding is that's technically covered under preventative. I just want to understand the interpretation of the, the term preventative between your group and then like what the dentists use it as.
[AGENT][NEUTRAL] Yes, whatever COVID, when it's billed as preventative, it's going to indicate preventative services.
[AGENT][NEUTRAL] Whatever code that they submit in, if it's for preventative, it's gonna stay preventative.
[CUSTOMER][NEUTRAL] It is. OK. And
[CUSTOMER][NEUTRAL] OK. And I guess I just have to find a, a different dentist that will.
[CUSTOMER][NEUTRAL] Market as preventative.
[AGENT][NEUTRAL] It's just according to how to since we can't tell the provider how to submit the bill, we can only just go off what they submit into us because that would be the services that they rendered.
[CUSTOMER][NEUTRAL] Right, I understand. I guess because uh just to go back to this example from last January.
[CUSTOMER][NEUTRAL] They did not explain to me that there's a difference between
[CUSTOMER][NEUTRAL] The X-ray is preventative and not.
[CUSTOMER][NEGATIVE] Um, they've been covering a portion of it without telling me, and now they're saying we actually are going to bill you for it from a year ago. I don't even know if that's still.
[CUSTOMER][NEGATIVE] Like an active bill, like that should have been their responsibility last year to bill me.
[CUSTOMER][NEUTRAL] So to prevent that from happening again.
[CUSTOMER][NEUTRAL] I just wanted to get more information, so when I'm in the chair, I would instruct them like, no, only know what is preventative. I don't need the other X-rays.
[CUSTOMER][NEUTRAL] If that makes sense.
[AGENT][NEUTRAL] OK, so which procedure are you stating that they submitted in?
[AGENT][NEUTRAL] Is this for, you said for January?
[CUSTOMER][NEUTRAL] Uh, correct, so I went last January.
[CUSTOMER][NEUTRAL] Uh, to the dental group, um, and they, you know, did my preventative visit, they did my teeth cleaning, they did X-rays.
[CUSTOMER][NEUTRAL] Um, I only do X-rays with them once a year because.
[CUSTOMER][NEUTRAL] There's because my plan only covers up to $500 a year, they usually bill so high that it goes over $500.
[CUSTOMER][NEGATIVE] And then I actually have to go to a different dentist for like a second cleaning in a year and I just pay out of pocket. It's not feasible for me to keep doing that.
[CUSTOMER][NEUTRAL] So, when I called this dental office today to confirm my appointment next week,
[CUSTOMER][NEUTRAL] I asked, are you still accepting this insurance? And when they looked in the system, they said, well, last time you were here, your X-rays were only covered at 80% and you have a 20% deductible, and they said that we covered a portion of it but you still owe $45 from your January visit.
[CUSTOMER][NEGATIVE] Which is the first time I'm hearing about it, and they said, when I come this time it's $85 because they're not gonna cover.
[CUSTOMER][NEUTRAL] You know, 50% of that deductible.
[CUSTOMER][NEUTRAL] That's news to me.
[CUSTOMER][POSITIVE] I would like to not be surprised like that again, which is why I'm calling your team to make sure I understand properly what my benefits actually are.
[CUSTOMER][NEUTRAL] I don't think it should have to be this like stressful or confusing for people who have insurance.
[CUSTOMER][NEUTRAL] Like it should be simple, like you go in, you do your appointment, it's done.
[AGENT][NEUTRAL] OK, so looking at your.
[AGENT][NEUTRAL] You do have a calendar year deductible which is the $50.
[AGENT][NEUTRAL] Even though that does not apply upon the preventative, it looks like looking at this bill that there was a $50 deductible that was used and let me see which code this was for.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So this is an X-ray.
[AGENT][NEUTRAL] So with the X-ray that they render services for, that's not listed up under the preventative category. So that is the reason why that deductible was applied to that code.
[AGENT][NEUTRAL] So when they did that,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] X-ray, the first film that's not listed under preventative.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I wish that they had explained that to me, but as usual.
[CUSTOMER][NEUTRAL] That's not always the case in most places. All right, um.
[CUSTOMER][NEUTRAL] I, I'll just see if I can find another vendor that's closer to me and who will just be upfront with what they're gonna be billing specifically.
[AGENT][NEUTRAL] OK. And did you have that contact number for Carrington?
[CUSTOMER][NEUTRAL] Um, I have
[CUSTOMER][NEUTRAL] No, I was actually gonna ask if you can please transfer me, but before we do, could you just explain to me the $50 deductible again? Is that something that I do have to pay out of pocket or do I have to meet the minimum of $50 like for the.
[CUSTOMER][NEUTRAL] I guess services to kick in.
[AGENT][NEUTRAL] OK, so for your calendar year, do you do have up to that $50 that you will have to pay out of pocket.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we will pay up to that maximum of 500 once your deductible had been met.
[CUSTOMER][NEUTRAL] OK, to the
[CUSTOMER][NEUTRAL] OK, and then that $50 deductible I just pay to the dental office.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's something you have to remember to do too.
[CUSTOMER][NEUTRAL] Regardless if it's preventative or not, or does preventative not count under the deductible information.
[AGENT][NEUTRAL] The preventative services does not apply upon the $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So maybe that's what they meant with the deductible information and why they were covering a certain percentage.
[AGENT][NEUTRAL] Yes, because what they build like the services that I did just review, it doesn't show that that code is listed on the preventative, so that is one reason why that $50 was applied for that service as well.
[CUSTOMER][NEUTRAL] Mhm. OK, that makes sense to me.
[CUSTOMER][NEUTRAL] So then again, if I go to a dentist for my yearly cleaning and checkup.
[CUSTOMER][NEUTRAL] That's all considered technically preventative, so as long as they
[CUSTOMER][NEGATIVE] Bill it as preventative. There shouldn't be a $50 charge deductible, and there should not be.
[CUSTOMER][NEUTRAL] Additional like
[CUSTOMER][NEGATIVE] Charges that I have to pay out of pocket because it's all considered preventative.
[AGENT][NEUTRAL] As long as
[CUSTOMER][NEUTRAL] Am I correct in understanding it that way?
[AGENT][NEUTRAL] As long as they're renting in their services up on the preventative, then that is considered at the 100% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that makes sense to me. um, thank you for explaining that. So if you could please transfer me to [PII], then I can ask them for.
[CUSTOMER][NEUTRAL] Um, I guess a list of the providers that are currently in network with them.
[AGENT][NEUTRAL] OK, and let me get you that number as well just in case if that call is disconnected. Are you ready for that number?
[CUSTOMER][NEUTRAL] I am, yes.
[AGENT][NEUTRAL] It is 1800.
[AGENT][NEUTRAL] 298.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0523 and could you hold for the transfer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] OK, you're welcome and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's everything. I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you so much for calling American Public Life hold for the transfer please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assisten espanol oprima elummino Nueve.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
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[CUSTOMER][POSITIVE] Your call is important to us and we appreciate your patience. Please continue to hold for the next available representative.
[CUSTOMER][NEUTRAL] Thank you for calling. My name is [PII]. May I please have the member ID?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] and my um policy number is 02211.
[CUSTOMER][NEUTRAL] 009.
[CUSTOMER][NEUTRAL] Thank you. Let me check for [PII].
[CUSTOMER][NEUTRAL] Your policy number is 02211009.
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] It shows no records found, sir. What is your phone number that connected to your account?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I think I found your account sir [PII]. Just to verify the account, sir, what is your last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[CUSTOMER][POSITIVE] Thank you sir and yes I think I found, let me double check here. I have your dental PPO plan. How can I help you, sir?
[CUSTOMER][NEUTRAL] Yes, OK, um, actually, could I have the policy number cause I, I have Carrington through APL, so I, I guess it's a different policy number for, for each group. So would you be able to share what that number is, please?
[CUSTOMER][NEUTRAL] Mhm, yes, I have your policy number, sir, the one that you gave me, but there's a 0 before 221. So instead of 10, we have 500, so 00000221.
[CUSTOMER][NEUTRAL] 1009.
[CUSTOMER][NEUTRAL] Oh, that's very odd number. Anything else? 500 got it thank you.
[CUSTOMER][NEUTRAL] OK, perfect. So now my question is I am looking to find providers in my area um that accept this insurance.
[CUSTOMER][NEUTRAL] And I have your zip code the provider.
[CUSTOMER][NEUTRAL] Yes, um, because the provider that I went to.
[CUSTOMER][NEUTRAL] Yeah, I, I'd like to switch providers, so.
[CUSTOMER][NEUTRAL] Um, I'm trying to see what is a more doable option for me here.
[CUSTOMER][NEUTRAL] OK, so I have your zip code [PII].
[CUSTOMER][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, so I have a list here of dental PPO plan that only network.