AccountId: 011433970860
ContactId: 41edef44-ee48-4171-bba4-683b29ec7072
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449070 ms
Total Talk Time (AGENT): 138248 ms
Total Talk Time (CUSTOMER): 227064 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/41edef44-ee48-4171-bba4-683b29ec7072_20250326T13:32_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, my name's [PII], and I'm calling from Aspen Dental here in [PII], and I am looking to get some benefits and eligibility on a patient.
[AGENT][POSITIVE] Sure, [PII], I can assist you with that. I have a callback number for you and that policy number.
[CUSTOMER][NEUTRAL] For sure the callback number is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII] number [PII] and the policy number is 025.
[CUSTOMER][NEUTRAL] 947887.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you [PII]. This policy has been active since [PII] and it's currently active.
[AGENT][NEUTRAL] Major has a maximum benefit amount?
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] Of $500 per calendar year.
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] OK, one second, 500, perfect. And could I bother you really quickly, um, for the, the member ID and I'm bear with me, I'm a little new with the insurance, so is this member ID gonna be the same as the policy number?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Oh perfect, I say thank you so much yeah, bear with me because she said [PII] girl, you're gonna do it today.
[CUSTOMER][NEUTRAL] I said, OK, I'm gonna try.
[CUSTOMER][NEUTRAL] I'm gonna try um and what is the group name?
[AGENT][NEUTRAL] The group name is Manage.
[AGENT][NEUTRAL] Analyst and utilization Inc.
[CUSTOMER][NEUTRAL] And you said management?
[AGENT][NEUTRAL] Mhm, analyst and utilization Inc.
[CUSTOMER][POSITIVE] Wow, utilization Inc.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the group number is 70056.
[CUSTOMER][POSITIVE] Perfect. OK, oh.
[CUSTOMER][NEUTRAL] And this is single next, OK, and then I just want to verify with you.
[CUSTOMER][NEUTRAL] Um, the insurance name because I'm not familiar with this insurance. What was the name again? I'm so sorry.
[AGENT][NEUTRAL] This is American Public Life.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And there we go.
[CUSTOMER][NEUTRAL] And then what's a good address for you guys, the [PII]?
[AGENT][NEUTRAL] It's [PII] [PII].
[CUSTOMER][NEUTRAL] Thank you so much. OK, and then I just have um a couple questions if that's OK if I could bother you, the deductibles, does that apply to preventative, basic or major?
[AGENT][NEUTRAL] The there's no major coverage on the policy. The deductible does not apply to preventative, so it goes towards basic. So the policy basically only covers preventative and basic services, and preventative is at 100% and basic is at 80%.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, let me write that down just in case.
[CUSTOMER][NEUTRAL] Basics at 80%. OK, wonderful. OK, so this one is just basic, so there's no ortho and then you did say the maximum amount was 500.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And this is not a guaranteed benefits, just a disclaimer of the policy coverage, yes.
[CUSTOMER][NEUTRAL] Mm per calendar year.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, let me see here.
[CUSTOMER][NEGATIVE] And in Datics would be no.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Endoyal
[AGENT][NEUTRAL] Prosthesis or surgery or none of that is covered.
[CUSTOMER][NEUTRAL] Mhm, that
[CUSTOMER][NEUTRAL] Yeah, so that would all be no.
[CUSTOMER][NEUTRAL] OK, so we can, but no, no, no.
[CUSTOMER][POSITIVE] So then there's OK, so just basic, perfect.
[CUSTOMER][NEUTRAL] And then for the basic for the exams, is it one per calendar year?
[AGENT][NEUTRAL] Um, so, exams are 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm. What about cleanings?
[AGENT][NEUTRAL] Um, once every 6 months.
[AGENT][NEUTRAL] And bite wings once per 12 months.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Full mouth X-rays and panoramics is once every 5 years.
[CUSTOMER][NEUTRAL] Once every that'd be 60 months.
[CUSTOMER][NEUTRAL] 1060 who who who.
[CUSTOMER][NEUTRAL] Um, fluoride.
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months, limited to dependent children aged [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Got you. OK, and any per maintenance?
[AGENT][NEGATIVE] No, that's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Not covered. Well, I just wanna make sure I'm gonna double check with you what coverage category are simple extractions considered?
[AGENT][NEUTRAL] Basic at 80%, 7140.
[CUSTOMER][NEUTRAL] Heard OK.
[CUSTOMER][NEUTRAL] Um, missing tooth claws, would that be a no?
[AGENT][NEUTRAL] There is one, [PII], however, I'm not sure why there's one because no major services are covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's goofy. OK, well, I believe it is.
[AGENT][NEUTRAL] But I guess they just gotta cover their self, make sure it's in the exclusion.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about um Perio SRPs?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, that's what I figured, oh.
[CUSTOMER][NEUTRAL] Oral oral screening, the oral cancer screening not covered.
[AGENT][NEGATIVE] Not covered.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, dentures not covered as well.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and um that would be the same for bridges and crowns because I know we went over that just a minute ago too.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect, so I just wanna make sure, um, our crowns and bridges restorations are downgraded.
[AGENT][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] What? OK, are, um, fillings downgraded?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] I can never pronounce that word.
[CUSTOMER][NEUTRAL] Um, and is a predetermination mandatory?
[AGENT][NEUTRAL] It's not mandatory, but if you would like to verify what would be covered under the under the policy and what won't be covered and what we will pay towards the services, I suggest you put one in, but it's not mandatory.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] But it's not mandatory? OK, perfect.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK perfect and then can I just bother you for a reference number?
[AGENT][NEUTRAL] We don't provide those [PII], however, you can use my name and today's date as a reference. It's [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you and today's day is [PII]. I really appreciate your help. You've been super helpful. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] 25.