AccountId: 011433970860
ContactId: 35e642f6-38a0-4aa5-83c6-ad2a19d1cf82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 955299 ms
Total Talk Time (AGENT): 224320 ms
Total Talk Time (CUSTOMER): 491109 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/35e642f6-38a0-4aa5-83c6-ad2a19d1cf82_20250320T13:41_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, ma'am. Can you hear me?
[CUSTOMER][NEUTRAL] Hi, ma'am. Very good morning. My name is [PII] from today's Dental.
[AGENT][POSITIVE] Hello, how are you doing today, [PII]? How can I assist you?
[CUSTOMER][NEUTRAL] Ma'am, actually, I'm here for checking for the dental eligibility and benefits. Can you please help me with it, ma'am?
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you and that policy number of the member that you're inquiring eligibility for today?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII]. Uh, and the member ID is 02584703.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is uh
[CUSTOMER][NEUTRAL] The patient's uh first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're calling to verify benefits and eligibility. This member's policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK, is, is this for dental, right?
[AGENT][NEUTRAL] Yes, that is correct. She has a maximum benefit amount of $500 per calendar year with a $50 deductible per insured up to $150 per family. It does not apply to preventative services, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, ma'am, can you please share me the group name or the group number?
[AGENT][NEUTRAL] The group number is 70055. The group name is T as in Tom, R as in Romeo, C as in Charlie, staffing services.
[CUSTOMER][NEUTRAL] I was.
[CUSTOMER][NEUTRAL] That's definitely more than.
[CUSTOMER][POSITIVE] No no. All the best.
[CUSTOMER][POSITIVE] It was yeah it was good.
[CUSTOMER][NEUTRAL] I yeah.
[AGENT][NEUTRAL] Preventative is covered at 100% and basic is covered at 80%. The policy does not cover major endopperoprosthesis or surgery crowns, bridges ortho.
[CUSTOMER][NEUTRAL] I, I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] OK, ma'am. So, what is the annual remaining, uh,
[AGENT][NEUTRAL] The yearly max is $500. The member has not utilized any of their benefits for [PII] or met their deductible. This is not a guaranteed benefit, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the
[CUSTOMER][NEUTRAL] Can I get the client mailing address and the payer ID?
[AGENT][NEUTRAL] The payer ID is 60801. The mailing address will be addressed to American Public Life.
[AGENT][NEUTRAL] Claims department, [PII]. That's [PII] and I can send you a face back of these benefits if you would like.
[CUSTOMER][NEUTRAL] See, that's yeah.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I got yeah.
[CUSTOMER][NEUTRAL] A the.
[CUSTOMER][NEUTRAL] What thing?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A type that to my.
[CUSTOMER][NEUTRAL] I that
[CUSTOMER][NEUTRAL] OK, um, ma'am, can, is there any machine to class and waiting period?
[AGENT][MIXED] There is a missing tooth cloth. However, there is no waiting period because there is no major services.
[CUSTOMER][NEUTRAL] OK, can I get the frequency for biking?
[AGENT][NEUTRAL] Once every 12 months.
[CUSTOMER][NEUTRAL] 0120
[AGENT][NEUTRAL] It's once every 12 months for the bite wings. 0120 files on a preventative at 100%.
[AGENT][NEUTRAL] Limitations are as followed.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] Yeah, what, what is the frequency for 0120?
[AGENT][NEUTRAL] Limited to 2 or evaluation procedures in any combination of D0120 D0140 D0150 D0160 per 12 month period.
[CUSTOMER][NEUTRAL] 015 0330.
[AGENT][NEUTRAL] Limited to one X-ray procedure of B0210 D0277 and D0330 per 25 year period.
[CUSTOMER][NEUTRAL] 1110.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] I could barely hear you.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] Is that with varnish or without?
[CUSTOMER][NEUTRAL] What, ma'am I couldn't get you?
[AGENT][NEUTRAL] Is that with varnish or without varnish?
[CUSTOMER][NEUTRAL] Fluoride.
[AGENT][NEUTRAL] With varnish or without varnish?
[CUSTOMER][NEUTRAL] With one.
[AGENT][NEUTRAL] Varnish is not covered. However, without the maximum of one procedure for 12 months, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] 1351
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months, limited to dependent children aged [PII].
[AGENT][NEUTRAL] Application made to permanent Matee only.
[CUSTOMER][NEUTRAL] 2740 Crowns.
[AGENT][NEUTRAL] Not covered. Crowns, bridges, ortho, major services.
[CUSTOMER][NEUTRAL] OK. Uh,
[AGENT][NEUTRAL] None of that is covered under the policy. The policy only covers preventative and basic service and basic consists of simple extractions of the 7140 and fillings. There is no downgrade.
[CUSTOMER][NEUTRAL] OK, what is the frequency for 2391?
[AGENT][NEUTRAL] Maximum of 1 each 2 for 24 months.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 2330.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] He buys it.
[AGENT][NEUTRAL] Maximum of one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] Each 2 for 24 months.
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEGATIVE] It's not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, but can you please share me the history for this patient?
[AGENT][NEUTRAL] What was your name?
[AGENT][NEUTRAL] Could you provide me with your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And what did you ask me?
[CUSTOMER][NEUTRAL] But can you please tell me the history for this patient?
[AGENT][NEUTRAL] Repeat your question.
[CUSTOMER][NEUTRAL] Can you please share me the history?
[AGENT][NEGATIVE] There is no history on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, ma'am, if you don't mind, can you please, uh, can you check with you whether the doctor is, uh, in network or out of network with this insurance?
[AGENT][NEUTRAL] I can't verify if you're in network. I can transfer you to [PII] and to verify if you're in network.
[AGENT][NEUTRAL] Would you like for me to transfer you to [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] I can barely hear you. Your background is very loud.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I get the caller reference number?
[AGENT][NEUTRAL] We don't provide reference numbers, however, you can use my name in today's date as a reference. It's [PII] and today's date.
[AGENT][NEUTRAL] Would you like for me to transfer you to [PII] to verify if you're in network?
[CUSTOMER][NEUTRAL] Can you please uh send me the benefit through fax if you don't mind?
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 08.
[AGENT][NEUTRAL] So I have [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Can you please transfer the call to the [PII] to check the patient's eligibility and benefits?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][POSITIVE] Yeah, just take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services. Ara assisten espanol oprima elumino Nve to better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up or learn more about our health and lifestyle discount plans, press 2.
[CUSTOMER][NEUTRAL] If you are a member calling about your current products, press 3. All other callers, please press 4. To hear these options again, press 5. For faster service, you can access your account information 24/7 by visiting our website at [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Once there, click on Create an Account at the top of the page. Use your carry number or policy ID found on your membership card to sign in and make changes to your membership, add or delete dependents, requests new membership cards, find participating healthcare providers, or view billing information and payment history. Don't forget to also check out Carrington Mall, our members only online shop for special deals. Thank you for your call.
[CUSTOMER][NEUTRAL] No response was detected. Please select an option from the following menu or your call will be disconnected.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assistencia espanol oprima elummino Nuebe.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up or learn more about our health and lifestyle discount plans, press 2.
[CUSTOMER][NEUTRAL] If you are a member calling about your current products, press 3. All other callers, please press 4. To hear these options again, press 5. For faster service, you can access your account information 24/7 by visiting our website at [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Once there, click on Create an Account at the top of the page. Use your Carrington member or policy ID found on your membership card to sign in and make changes to your membership, add or delete dependents, request new membership cards, find participating healthcare providers, or view billing information and payment history. Don't forget to also check out Carrington Mall, our members only online shop for special deals. Thank you for your call.
[CUSTOMER][NEUTRAL] No response was detected. Please select an option from the following menu or your call will be disconnected.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assistencia espanol oprima el Nino uve.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up or learn more about our health and lifestyle discount plans, press 2.
[CUSTOMER][NEUTRAL] If you are a member calling about your current products, press 3. All other callers, please press 4. To hear these options again, press 5. For faster service, you can access your account information 24/7 by visiting our website at [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Once there, click on Create an Account at the top of the page. Use your Carrington member or policy ID found on your membership card to sign in and make changes to your membership, add or delete dependents, request new membership cards, find participating healthcare providers, or view billing information and payment history. Don't forget to also check out Carrington Mall, our members only online shop for special deals. Thank you for your call.
[CUSTOMER][NEUTRAL] No response was detected. Please select an option from the following menu or your call will be disconnected.
[CUSTOMER][NEUTRAL] Thank you for calling member services Para assistencia espanol oprima el Nino Nve.
[CUSTOMER][NEUTRAL] To better assist you, please have your membership or policy ID number available.
[CUSTOMER][NEUTRAL] If you are a healthcare provider, press 1. If you would like to sign up or learn more about our health and lifestyle discount plans, press 2.
[CUSTOMER][NEUTRAL] If you are a member calling about your current products, press 3. All other callers, please press 4. To hear these options again, press 5. For faster service, you can access your account information 24/7 by visiting our website at [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Once there, click on Create an Account at the top of the page. Use your Carrington member or policy ID found on your membership card to sign in and make changes to your membership, add or delete dependents, request new membership cards, find participating healthcare providers, or view billing information and payment history. Don't forget to also check out Carrington Mall, our members only online shop for special deals. Thank you for your call.
[CUSTOMER][NEUTRAL] Your call will now be disconnected. Goodbye.