AccountId: 011433970860
ContactId: 467ada45-959d-46a7-a0b9-ffcdeaa58233
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 804909 ms
Total Talk Time (AGENT): 331218 ms
Total Talk Time (CUSTOMER): 330345 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/467ada45-959d-46a7-a0b9-ffcdeaa58233_20250425T16:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi [PII]. Uh, I just had a question about a dental plan. I thought it was through this company called Carrington, but when I called them, they said it's like there's supplemental or something and that the actual insurance for the dental is through you guys.
[CUSTOMER][NEUTRAL] Um, I didn't understand that completely, but, um, I guess the question I had was I was comparing things on the marketplace versus you keeping this plan, and I wanted to know with this dental plan, like for still, I know all the preventative stuff is covered like cleanings and stuff like that, but if I get a filling or something like that, the lady on the other line said you get a 20% discount.
[CUSTOMER][NEUTRAL] So I asked her that a 20% discount of whatever the dentist is charging for the filling or 20% off like a negotiated rate?
[CUSTOMER][NEUTRAL] And she was like, oh, that's a question that you have to call this phone number for. So would you by any chance know that?
[AGENT][NEUTRAL] Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Answer
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Do you currently do have dental with us?
[CUSTOMER][NEUTRAL] It's 456.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 04190
[CUSTOMER][NEUTRAL] Yeah, 456-041-90.
[AGENT][NEUTRAL] OK. Uh, I'm not pulling anything up under that. What's your last name?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] What was that?
[AGENT][NEUTRAL] Your first name?
[CUSTOMER][NEUTRAL] Oh, [PII]
[AGENT][NEUTRAL] OK. Last name?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Did you ask for, I, that was the last name, the first name was [PII]
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, it's pulling it up. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, let me pull up your policy.
[AGENT][NEUTRAL] OK, so [PII], so they're a PPO network, um, for dental. So what that means is if you use someone in network with them, um, they, they'll be a discount involved, um, off of.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whatever the, whatever the uh dentist charges. So, um let me look at your policy. Um, I just need to verify a few pieces of information too. What is your birth date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, birthday is [PII].
[AGENT][NEUTRAL] And the address?
[CUSTOMER][NEUTRAL] That I'm not sure.
[AGENT][NEUTRAL] Are you with the dental provider or is this?
[CUSTOMER][NEUTRAL] No, that's, it's my partner and we're just deciding whether or not to switch to the um Obamacare dental plan or this one. So it's not my personal plan, but it's his.
[AGENT][NEUTRAL] Is this
[AGENT][NEUTRAL] OK, and you don't know his address?
[CUSTOMER][NEUTRAL] Well, he's a traveling nurse, so I don't know if he left the one in [PII] on his, or if it's so, if you tell me if it's the [PII] one, I could tell you.
[AGENT][NEUTRAL] And it looks like.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, doesn't have that one.
[AGENT][NEUTRAL] Um, let me
[AGENT][NEUTRAL] Um, let me pull up the policy and see what.
[AGENT][NEUTRAL] Hold on just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so the policy that this is, like I said, Carrington is the PPO network, so whatever provider is in network with Carrington, there'll be a discount involved on the bill charges and then, um, whatever their negotiated discount is, so I mean depends on the provider what charges are, um, you know what that discount will be um I I don't know what Carrington's discounts are I just know that that's the PPO network.
[AGENT][NEUTRAL] And then you had a question about filling.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well, that it's sort of I just don't understand the discount but so I have right now through work where it's like say the doctor charges for my filling $500 then Blue Cross Blue Shield has a negotiated rate which is like $150 and then you know I have to pay the negotiated rate sometimes there's a discount like maybe they'll do 20% off that and then I pay like $100 right? So I guess my question is, is Carrington said they have a 20% discount.
[CUSTOMER][NEUTRAL] So is that 20% off whatever the dentist feels like charging $500 1000 dollars, or is it whatever the negotiated rate which you guys have with them is, you know, like the $150.
[AGENT][NEUTRAL] Uh, it would be off whatever the dentist is charging.
[AGENT][NEUTRAL] So if it
[CUSTOMER][POSITIVE] Oh, so it's almost like a coupon. It's not a negotiated rate, it's like a like a discount coupon almost.
[AGENT][NEUTRAL] Right, it would be a discount off of the bill charges, right, and then this policy, um, which is not a guarantee of payment, a basic outline, this policy for, uh, let me see what it pays for.
[CUSTOMER][NEUTRAL] Would that be your first?
[AGENT][NEUTRAL] For um billings will pay 80% after a $50 deductible and the max it will pay out for all services in a calendar year is $500.
[CUSTOMER][NEUTRAL] Oh, so it pays 8, so if there's a filling, it would, it would pay 80.
[CUSTOMER][NEGATIVE] This is so confusing because they said it's a 20% discount, but then you're saying you guys pay 80%.
[AGENT][NEUTRAL] Right, so if
[CUSTOMER][NEUTRAL] 20% so maybe she said I paid 20%.
[AGENT][NEUTRAL] So if, if the filling, if, if Carrington's discount is 20% off of the charges and say the filling is $500.
[AGENT][NEUTRAL] Then 20% off that takes down to 400, we're gonna pay 80% of $400.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so then the responsibility would be, so that's $320 the responsibility would be $80.
[AGENT][NEUTRAL] Now, there's also
[CUSTOMER][NEUTRAL] Oh, it's such a.
[AGENT][NEUTRAL] Yeah, and so that 320 would be deducted from the total of 500, that's the maximum payout per calendar year.
[CUSTOMER][NEUTRAL] I, I see.
[AGENT][NEUTRAL] So that's all that's covered per calendar year and then this policy too doesn't have any major services, so there's nothing covered for Edo Pero, um, like root canals.
[CUSTOMER][NEUTRAL] What about like a crown or something?
[AGENT][NEGATIVE] No coverage for that.
[CUSTOMER][NEUTRAL] Oh, and, but OK, so that was the other question, but is there a negotiated rate? Oh, I guess there wouldn't be, right? There's no negotiated because that's the other thing. One time I got a crown, the guy told me it was $4000 but then the negotiated rate with insurance was $1500. So would he have the same benefit with you guys, or would he have to pay whatever the dentist says, like the $5000 for it?
[AGENT][NEUTRAL] Well, I, so it it's, there's a lot of factors involved, which there's Carrington, there's the PPO network, and then
[AGENT][NEUTRAL] The we will pay off of what's reasonable and customary. So for example, it's not reasonable for a dentist to charge $10,000 for a crown. What is reasonable would then this is, this is just a hypothetical example. What is reasonable and for a dentist to charge would be say $2500. So if that dentist charged $10,000.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're not we're only gonna consider that 2500 to pay off of.
[AGENT][NEGATIVE] Because essentially it's like they are they're they're way over billing what's reasonable for that service. Does that make sense?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, that makes sense, but when you say there's no benefit for him under this plan, what would you guys do? Like you guys, would you just say, OK, you have to pay the full negotiated rate or we're not even, you're just on your own here with this crown.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] We would deny.
[AGENT][NEUTRAL] Yes, we would deny a crown cause it's not, there's no coverage for it under the policy, correct.
[CUSTOMER][NEUTRAL] OK, so the crowns denied. So then, OK, he's like, OK, so then what would he have to, would you guys still fight for him and say, oh no, that's too expensive, just charge him 2500 and go to bat for him, or would you say, oh.
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] Yeah, no, we wouldn't, we, it's just, it's not even considered under this policy, so from our standpoint it's just not considered, and that's where it ends with us is that we would say this isn't covered and then it would be up to you and to, um, you know, discuss with your dentist, you know, what, yeah, how will I pay this, etc.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The dentist, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that answers my question. It seems like Obamacare might be a better deal then. um, and then my other question was, do you do medical questions also or only dental?
[AGENT][NEUTRAL] Um, is this on another, another one of the policies?
[CUSTOMER][NEUTRAL] I don't know if it's, it's through this other thing called Benes in a card like 90 degree Benefits. I don't know if that's the same phone number I'm calling you at.
[CUSTOMER][NEUTRAL] Maybe it's different.
[AGENT][NEUTRAL] Um, yeah, the 90 degree benefits, let me give you that number.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, I have their phone number. I just wasn't sure if this was part of it, you know, or if like the dental and health were together or this is because it doesn't say your company on the card. It's, that's why it's so confusing. Like it says all these other companies' names on the cards, you know, like it doesn't say American public life, you know.
[AGENT][NEUTRAL] Yeah, so we, so this, it is kind of confusing because we administer some policies for benefits in a card and then others are through 90 Degree. I believe 90 Degree has like a limited uh medical policy, um, and then we do like the dental, we do like a extremely like limited hospital indemnity, you know, like for example, it'll pay $50 for a visit, so, um, nothing with us.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what he has. That's what he.
[CUSTOMER][NEUTRAL] So maybe I can ask you a question then because that's what he has this thing called neck, MEC and it's the same thing like for the hospitals, it just pays $50 a day, right? Um, so my question to him, and he's so clueless, was, do you get a negotiated rate? So for example, like just say you need an ultrasound of your gallbladder and you're in the emergency room, and usually, you know, the hospital charge you $1000 for the ultrasound. But like when I have Blue Cross, I just pay the negotiated rate which is like $150.
[CUSTOMER][NEUTRAL] So I said fine, you have this Mac, it doesn't cover your ER visit, but you, will you at least get the benefit of getting just to pay the 150 or would you have to pay the full $1000 that the hospital's gonna ask you for? Do you know what happens in that type of situation?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] In that situation, if it was a policy through us like a hospital indemnity, it's not a major medical policy like Blue Cross Blue Shield. So there is no network that's applicable for medical services, and if that was what someone presented to the hospital, I have this hospital indemnity policy through American Public Life, um, they're not going to write off any amount, they're not going to charge a negotiated rate. They would probably balance bill the full.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So, it's major medical, like Blue Cross Blue Shield, United Healthcare, those policies have like deep negotiated discounts off of services.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All of our medical policies don't, don't have any type of negotiated rates or discounts.
[CUSTOMER][NEUTRAL] Oh, so there's $50 a day for a hospital visit. It's like nothing, right? Like if you're in the hospital for 2 days, you say each day is like $10,000 20,000 dollars bill, you would get $100 back.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Essentially, yeah, in theory.
[CUSTOMER][NEUTRAL] Oh God. All right.
[CUSTOMER][POSITIVE] All right, well, think that's been very informative because, you know, I just didn't know much about these, but.
[CUSTOMER][POSITIVE] That's good information. Thank you for your help.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.