AccountId: 011433970860
ContactId: 40d8b2cb-d5b0-40ff-b29e-dbeebe45c4ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 891799 ms
Total Talk Time (AGENT): 184165 ms
Total Talk Time (CUSTOMER): 252557 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/40d8b2cb-d5b0-40ff-b29e-dbeebe45c4ca_20250109T17:43_UTC.wav
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[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Miss [PII], how may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, ma'am, this is [PII] at Doctor [PII]'s office, and I would need to help a patient with her insurance, please.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, it looks like it's gonna be.
[CUSTOMER][NEUTRAL] It says individual and then it has a certificate, is that what you want?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] 02464490
[AGENT][NEUTRAL] And that is 02464490?
[CUSTOMER][NEUTRAL] 02464490.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, it is gonna be, uh, [PII].
[AGENT][NEUTRAL] The name please?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. How may I assist you on this member's benefits?
[CUSTOMER][NEUTRAL] 27, can she go to any dentist?
[AGENT][NEUTRAL] Is the provider's discretion.
[CUSTOMER][NEUTRAL] So we're not in network
[AGENT][NEUTRAL] It's still the provider's discretion.
[CUSTOMER][NEUTRAL] OK, well then you'll pay our our claims.
[AGENT][NEUTRAL] Once we receive them in and the member does have benefits available, we will process the claim up to their.
[CUSTOMER][NEUTRAL] [PII] baby. OK, take your time.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so you said that yes it so this policy doesn't matter if you go in or out of the network.
[AGENT][NEUTRAL] No, it's the provider's discretion if they accept the insurance or not.
[CUSTOMER][NEUTRAL] OK and then um go ahead and give me then what is her ID number you'd want me to use? Is it the one I gave you?
[AGENT][NEUTRAL] Yes, that's the certification number and also are you needing a fax back as well?
[CUSTOMER][POSITIVE] Thank you honey.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, I don't know if our fax is gonna work, but what is her [PII]?
[AGENT][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] Because she's she's, you walked in.
[AGENT][NEUTRAL] And if she's also um wanting to check to see if she can find an in-network provider, she will have to contact Carrington to check that provider if need be.
[CUSTOMER][NEGATIVE] I guess she went to somebody and was not happy going in the network.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm pulling that up for you now. I apologize for the wait.
[CUSTOMER][POSITIVE] Sure, thank you honey thank you so much.
[CUSTOMER][POSITIVE] Huh girl, you too, you too, and she's just so cute. You're so blessed. Look at that sweet pea.
[CUSTOMER][POSITIVE] Hopefully y'all just get to go home and.
[CUSTOMER][POSITIVE] Just snuggle, right? Yeah, it's a great day to be home and just snuggle. There's nothing like those days, yeah, and then maybe both y'all take a nap later. Yeah, I mean again great day for a nap on the couch, right?
[CUSTOMER][NEUTRAL] And then what time do the other two couples get home?
[CUSTOMER][POSITIVE] OK, yeah, you still have a little time, yeah.
[CUSTOMER][NEUTRAL] But not a lot I bet it goes by fast doesn't it? Yeah, yeah.
[CUSTOMER][POSITIVE] Well, please be careful and y'all have a wonderful and blessed weekend. Good to see you. Bye, hon.
[AGENT][NEUTRAL] OK, and you were calling in to see what the maximum benefit for this member. Verification coverage does not guarantee the payment of the claim. For this member, they do have up to $500 per calendar year max. They do have a $50 deductible, but that does not apply to any of the preventative services.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, OK, and so I'm gonna put on here $50 deductible $500 max, and then is it $18,050?
[AGENT][NEUTRAL] It's up to $500 for the max, and then they do have a $50 deductible.
[CUSTOMER][NEUTRAL] What do you pay like on a crown?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Is it 50% of 500 or you know what I'm saying?
[AGENT][NEUTRAL] Let me check to see if they have that. What what code?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so code it's gonna be 0140.
[AGENT][POSITIVE] What the cozy.
[CUSTOMER][NEUTRAL] 0220
[CUSTOMER][NEUTRAL] Uh 2750.
[CUSTOMER][NEUTRAL] And 2391.
[AGENT][NEUTRAL] OK, let me check those for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And so for the 0140, that is the limited oral.
[AGENT][NEUTRAL] Evaluation.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Ready, OK, OK, well that was easy, thank you.
[CUSTOMER][POSITIVE] Well thank you [PII] OK so.
[AGENT][NEUTRAL] 2750.
[AGENT][NEUTRAL] So for the code 2750, what is the description for that because I'm not seeing the code listed on here for the crown.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Crown.
[CUSTOMER][NEUTRAL] Shoot.
[CUSTOMER][NEUTRAL] And I'm gonna put you on hold one second honey while you're looking, hold on.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEGATIVE] Ma'am, promise me please don't hang up. It's been such a morning if you hang up, I'm gonna cry, so please don't hang up. I gotta go ask the doctor a question and help a patient, and I'll be right back. Please don't hang up.
[AGENT][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] OK, I'm still here.
[CUSTOMER][NEUTRAL] Because I promise I'll cry. OK, so don't hang up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Honey, thank you so much for not hanging up. You're my hero for the day, my blessing. OK, so what do you think? What would that percentage be covered at?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Are you there? Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm, I'm here.
[CUSTOMER][POSITIVE] Oh thank you [PII]. OK, thank you. So what would it be?
[AGENT][NEUTRAL] So in regards to this policy, verification of coverage for this member, they have the basic, so that will cover up to 80%. Now, for the crown, it is not covered on this policy.
[CUSTOMER][NEUTRAL] Oh wow, OK, what about uh just asking just in case, um, a 70 to 10, an extraction?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] A root canal, like a 3320.
[AGENT][NEUTRAL] Let me check that one.
[AGENT][NEUTRAL] Yes. So this policy is not covering any type of surgical.
[AGENT][NEUTRAL] It's it, so she only have the basic expense.
[CUSTOMER][NEUTRAL] So does that mean like you'll cover what exam, cleanings and fillings?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But no extractions of teeth.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then group number what group number do you want me to use?
[AGENT][NEUTRAL] Let me pull that up for you.
[AGENT][NEUTRAL] The group number is showing 70,03[PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And where do I mail the claims?
[AGENT][NEUTRAL] For the mailing of the claims you will submit that to [PII].
[AGENT][NEUTRAL] 248,950.
[AGENT][NEUTRAL] Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK and and then what is the name of the insurance company? Do I put Carrington?
[AGENT][NEUTRAL] It is American Public Life.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And what is y'all payer ID?
[AGENT][NEUTRAL] The electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you so much for calling American Public Life Care. You have a great day.
[CUSTOMER][NEUTRAL] OK, hey, I guess there's no waiting periods, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, there's 0 waiting period.
[CUSTOMER][NEUTRAL] And then did she no history at all, right?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] No history.
[CUSTOMER][POSITIVE] All right babe, thank you so much and have a great day.
[AGENT][NEUTRAL] Same to you, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.