AccountId: 011433970860
ContactId: 4bf2dcd3-7db8-496f-9526-afd10e7dad21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 935020 ms
Total Talk Time (AGENT): 454624 ms
Total Talk Time (CUSTOMER): 323787 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/4bf2dcd3-7db8-496f-9526-afd10e7dad21_20250212T20:19_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey, good afternoon. Um, my name is [PII]. I'm giving you a call from a dental provider's office. I'm just calling to see if, uh, two mutual patients are eligible for dental benefits through APO.
[AGENT][POSITIVE] OK, be glad to help you, [PII]. Go ahead and give me your policy number.
[CUSTOMER][NEUTRAL] Yes ma'am, um, would it be the policy certificate number?
[AGENT][POSITIVE] Yes, ma'am, correct.
[CUSTOMER][NEUTRAL] That's 02538511.
[AGENT][POSITIVE] Alright, [PII], thank you so much for that information. Now while I'm pulling this up for you, go ahead and give me a good return telephone call number please.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And that's [PII].
[AGENT][POSITIVE] Alright, just in case we get disconnected, we are having bad weather here, so if we get disconnected, [PII], I'll call you back, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All righty. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I'm starting off with the first patient, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what's the other patient name?
[CUSTOMER][NEUTRAL] [PII] [PII] is the date of birth.
[AGENT][NEUTRAL] All right, looks like both of those dependent children are covered under this dental plan. I do show the original effective date is [PII], but I must advise that verification of coverage is not a guarantee of payment on a claim. But are you needing that back back a benefit today, [PII], or just eligibility?
[CUSTOMER][NEUTRAL] Um, if you could send me the eligibility and benefits, that'd be greatly appreciated, um, and then I, yes ma'am, that's [PII].
[AGENT][POSITIVE] Sure, yes, ma'am. Good fax number.
[AGENT][NEUTRAL] All right, I got that. And what was your other question?
[CUSTOMER][NEUTRAL] Um, I do, I, I'm also needing like a verbal breakdown of benefits, um, so I do have additional procedure codes to provide to you. I just need to know the co-insurance for those codes.
[AGENT][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK, because this back back a benefit is gonna tell you every code covered and how it is covered and frequencies, it has everything on it, but hang on just a second, let me.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am, um.
[AGENT][NEUTRAL] Get that pulled up.
[CUSTOMER][NEUTRAL] Is there any way I could verify if the provider is in network with this policy?
[AGENT][NEUTRAL] They're not in the network, they can go to any dentist they choose to go to.
[CUSTOMER][NEUTRAL] OK, so they're in and out of they have in and out of uh benefits.
[AGENT][NEUTRAL] No ma'am, they just have a set of benefits. Uh, it's gonna tell you every code covered and how it is covered on the schedule of benefit page when you get your fax back, um, but they're not in the network. It's gonna be paid on UCR and your zip code.
[CUSTOMER][NEUTRAL] Oh, OK, is this a is this a PPO policy?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] What type of policy is this?
[AGENT][NEUTRAL] It's a, it's a regular dental plan. They have a $1500 max benefit payable per calendar year. What that includes, and I would just go over the the the little basics while your fax is trying to go through. Your preventative paid at 100% of UCR, no deductible.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Class B basic is paid at 80% after a $50 deductible has been met.
[AGENT][NEUTRAL] W UCR.
[AGENT][NEUTRAL] They do have a 12 month waiting period for major services which would be 10-120 25. There won't be no major coverage until then, but it will pay after that date at 40% of UCR and of course that is up to the $1500 max benefit payable per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You said at 40% right after [PII] of this year.
[AGENT][POSITIVE] Correct. 12 month waiting period for major, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm getting that back since, so.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So you can, do you want me, um, you want me to send one on each child or just one?
[CUSTOMER][NEUTRAL] Uh, please, if you don't mind, yes, ma'am, please.
[AGENT][NEUTRAL] I don't mind at all. No, ma'am.
[CUSTOMER][NEUTRAL] Um, what's the group number of this policy?
[AGENT][NEUTRAL] Let's see the group number.
[AGENT][NEUTRAL] Um, group number is 16358.
[AGENT][NEUTRAL] Group name Universal Trucking Company.
[CUSTOMER][NEUTRAL] Universalt.
[AGENT][NEUTRAL] Trucking company. Mhm.
[CUSTOMER][NEUTRAL] Oh trucking trucking company, OK.
[AGENT][NEUTRAL] Yes, ma'am. Trucking.
[CUSTOMER][NEUTRAL] And what's the name of the insurance? It's APO?
[AGENT][NEUTRAL] This is APL or if you want to spell it out, American Public Life, either way.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else I can help? Go ahead.
[CUSTOMER][NEUTRAL] So they can go to any.
[CUSTOMER][NEUTRAL] And so they, they can go to any, any, any dental office.
[AGENT][NEUTRAL] Any dentists anywhere, any state, yes, ma'am.
[CUSTOMER][NEUTRAL] Alrighty, um, um, now in regards to those procedure codes, um, I understand you're sending the facts you know it may be on there, um, it's just a few, um.
[AGENT][NEUTRAL] Mhm. Yeah, all the codes that are covered are gonna be on the facts, but it list every single code that's covered and if your procedure code is not on the facts, it's not covered at all, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you, um, can I just, uh, provide you just just a few?
[AGENT][NEUTRAL] And it
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, um, the first one is gonna be a 0140. Would you want a one by one or all at once?
[AGENT][NEUTRAL] No, ma'am, uh, one by one, but 0140 is covered.
[CUSTOMER][NEUTRAL] OK, is that at 100% and what's the frequency?
[AGENT][NEUTRAL] Let's see 140.
[AGENT][NEUTRAL] Let me back up. Sorry, my computer is spinning, so bear with me, [PII].
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEGATIVE] Yeah, it is super slow. Like I said, we're having bad weather, so I don't know if it has anything to do with it, but yeah, it's just spinning.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 0140 is basic. That's twice a year. Basic is 2 times a year.
[CUSTOMER][NEUTRAL] OK, does that share the same frequency with the 0 150?
[AGENT][NEUTRAL] Yes, and they do share frequency.
[CUSTOMER][NEUTRAL] They do? OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alrighty, uh, the next code is 0220.
[AGENT][NEUTRAL] Let's see, covered under basic.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Did they have a frequency? I'm sorry, the 0 to 20.
[AGENT][NEUTRAL] Oh, that's OK. No, ma'am.
[CUSTOMER][NEGATIVE] No frequency.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, um, what about the space maintainer 1516?
[AGENT][NEUTRAL] 1516. Let me see if that's even covered. Let's see.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] No, ma'am, that's not covered.
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, at 9230 for nitrous oxide.
[AGENT][NEUTRAL] 9230.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] 9230 is covered, yes.
[CUSTOMER][NEUTRAL] A basic or major?
[AGENT][NEUTRAL] Mm, let me go back. That's major, so it will not be covered until 101.
[CUSTOMER][NEUTRAL] Yes ma'am, um, the major is that, is that considered as 50?
[AGENT][NEUTRAL] 40.
[CUSTOMER][NEUTRAL] 40 40%.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Got you. Um, what about the 9248?
[AGENT][NEUTRAL] Oh see I need.
[CUSTOMER][NEUTRAL] Yes ma'am, for cautious sedation.
[AGENT][NEUTRAL] Looking to see if it's on the specs.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 9240 is not on my back. It's not covered.
[CUSTOMER][NEUTRAL] That's the 48, right? 9248.
[AGENT][NEGATIVE] 9248 is not on my facts, not covered.
[CUSTOMER][NEUTRAL] Got you. Um, what about the 29:30?
[AGENT][NEUTRAL] Let's see, what's that for?
[CUSTOMER][NEUTRAL] Uh, this is a primary stain stainless steel crowns.
[AGENT][NEUTRAL] Yeah, yeah, that's major, of course. Um, not gonna be covered until 101.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] 101 got you. OK, is there a frequency to those to that those crowds?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yes. Let's see. The, the frequency is going to be maximum of 1 + 7 years.
[AGENT][NEUTRAL] Of course, it's not covered at all until 101, 2025.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And it does that is that the same for the 2931 it's a permanent stainless steel crowns.
[AGENT][NEUTRAL] What was that code again? 229.
[CUSTOMER][NEUTRAL] 2931.
[AGENT][NEUTRAL] 31. I think my phone's trying to static out, so bear with me. 2931.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Let's make sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 2931.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah, same.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It's covered under basic time once every 7 years, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course the waiting period, got you. Um, let's see, we're almost done here um, is that the same for the 2933 for resin crown?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, same.
[CUSTOMER][NEUTRAL] Got you. 2934 for the white the Kinder smile, the stainless steel crown.
[AGENT][NEUTRAL] 2934.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] Not on my back to back, not covered.
[CUSTOMER][NEUTRAL] OK, at 3120 for a pulled cap.
[AGENT][NEUTRAL] 3120.
[CUSTOMER][NEUTRAL] 20.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] I'm not seeing that on my back, so I'm not gonna be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 302 20 for popotomy.
[AGENT][NEUTRAL] 3220, let's see.
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][NEUTRAL] Don't think it is, but let me make sure.
[AGENT][NEUTRAL] Um, 32, 20.
[AGENT][NEUTRAL] Yes, that is covered under your course, your basic, I mean, uh, your major.
[AGENT][NEUTRAL] And the frequency is going to be E, which is limited to dependent children under age [PII], so.
[AGENT][NEUTRAL] Yeah, and the frequency, if they have a frequency or any limitations, once you get your bags back, it's gonna tell you that on the very last page. Each code has um the letters beside it.
[AGENT][NEUTRAL] So you'll know what the frequencies are as well for each each procedure code that's listed on your fax back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so the, so the 30 to 20, it was just an age requirement under the age of [PII]. So that's it, so, so I'm guessing no frequency.
[AGENT][NEUTRAL] Right, that's it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, and then the night guard, the 9944.
[AGENT][NEUTRAL] 9944, let's see.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] No, ma'am, not on my back, back, so not covered.
[CUSTOMER][NEUTRAL] My cupboard.
[CUSTOMER][NEUTRAL] OK, and then the deductible um for individual and family, what is that?
[AGENT][NEUTRAL] 50 each family members.
[CUSTOMER][NEUTRAL] What's the amount for that?
[CUSTOMER][NEUTRAL] 50, so 100.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The family deductible is 100.
[AGENT][NEUTRAL] The family deductible is 3 times 50, so 3 people, but it's $50 each. So each child will have to meet the $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you OK and is this a calendar or physically your policy?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] And what is the payer ID number for electronic games?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 801.
[AGENT][NEUTRAL] Mhm. You want a mailing address as well?
[CUSTOMER][NEUTRAL] Um, for
[CUSTOMER][NEUTRAL] Uh, please.
[AGENT][NEUTRAL] Yes, ma'am, just in case. Of course, it will be on that first page of your fax back as well, but it's uh it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] We're in [PII].
[CUSTOMER][POSITIVE] Thank you, um, and then uh.
[AGENT][NEUTRAL] And the zip that, uh, go ahead.
[CUSTOMER][NEUTRAL] Sorry, yeah, go ahead, the zip code I forgot about that.
[AGENT][NEUTRAL] Yeah, the zip, that's OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, ma'am. um, and then, and again you just said the waiting period is only for major services.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, the deductible, does that apply to preventative services or is it waived?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No deductible for preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, OK, got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I think that's all I needed to know. Oh, just one last question, um, is there any history for both dependents that will affect the frequency or anything like that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No claims ever on either child, so there's no history.
[CUSTOMER][NEUTRAL] Yes ma'am. OK, um, if I could just get, yes ma'am, thank you. If I could just get a reference number for the call please.
[AGENT][POSITIVE] So you're good I guess.
[AGENT][NEUTRAL] Well, we don't give reference numbers, [PII], but you can use my name in today's date and my name is [PII] spelled [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, say that again.
[AGENT][NEUTRAL] That's OK, that's OK. It's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] [PII]. All right, Miss [PII], well you have a great afternoon, OK? Thank you for helping out.
[AGENT][POSITIVE] Well, you as well, [PII], and thank you for calling APL. You have a great day as well. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][POSITIVE] Thank you you too thank you bye bye.