AccountId: 011433970860
ContactId: 51721316-c0b5-4ae4-b8b2-5b25f4cbc0b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 739150 ms
Total Talk Time (AGENT): 264733 ms
Total Talk Time (CUSTOMER): 290012 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/51721316-c0b5-4ae4-b8b2-5b25f4cbc0b1_20241230T20:47_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hey, um, I was calling, um,
[CUSTOMER][NEUTRAL] So, I just received my insurance card um through APL and so I was trying to find a, a dentist in my area, but the ones that I called, they're saying that they're out of network and they can file it, but um what my insurance don't cover, I will be responsible. And I was calling to see, um, would you be able to help me, um let me know like what I um that the insurance will cover?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Last name.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, the policy number is, so I actually have, hold on, let me see if it's the same. Um, I actually have two. I have one for the plan is group volunteer dental, and then I have one for this is limited benefit med plan or, or it don't matter which one I give you, well I'm getting one for the dental.
[AGENT][NEUTRAL] So are you, is, are you, are you trying to get dental services?
[CUSTOMER][NEUTRAL] The policy.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So give me the one that has the dental.
[AGENT][NEUTRAL] On it.
[CUSTOMER][NEUTRAL] Thank you. OK, the policy is the policy number is 025.
[CUSTOMER][NEUTRAL] 64616
[AGENT][NEUTRAL] OK, thank you. And what's a good phone number [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Verify your date of birth and your mailing address, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and my mailing address is [PII].
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] Um, I have two of them. Um, one of them is [PII], and my other one is
[AGENT][NEUTRAL] It's that one.
[AGENT][POSITIVE] We have that one that you just gave me. Thank you for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, under your dental policy, it covers preventive and basic only. Major is not covered.
[AGENT][NEUTRAL] Um, all of your preventive services are covered at 100% and then your basic services are reimbursed at 80%, so you stated that the provider.
[AGENT][NEUTRAL] You said that the claim that
[CUSTOMER][NEUTRAL] Um, that's just they are out of network and they can file it, but, uh, I'm just responsible for what my insurance doesn't cover.
[AGENT][NEUTRAL] OK, so if the preventive is reimbursed at 100%, so you shouldn't be responsible for, mhm, and then the basic is reimbursed at 80% so that means you'll be responsible for 20%. We can't tell you what you would be you would be responsible for 20%, but we can't tell you what the dollar amount is because it depends on how much they charge.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right. Um, so would you be able to tell me what the preventative and the basic procedures are?
[AGENT][NEUTRAL] Uh, what's covered, so under the preventive services, it's basically your cleanings.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, your X-rays.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I'm pulling up your schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, put the car with the shoes on.
[AGENT][NEUTRAL] So preventive will consist of like your bite wing X-rays, your cleanings, um.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, there's a benefit for space maintainers, um.
[AGENT][NEUTRAL] And that's pretty much it for your preventive services. Your basic services is going to be like if you fillings like if you had a cavity and it needed to be filled, they're like restorative services and then there is one extraction code under your policy, um, that's covered. Any other extractions like if it's a surgical removal or if it's an impacted tooth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Those are considered major and would not be covered.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, and it doesn't cover major at all?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Would I be able to change it?
[AGENT][NEUTRAL] Well, it's a group policy. I is this the only dental policy that they offered when you enrolled?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, all I know is when I was doing my paperwork, um, I just checked out that I wanted dental and medical, and then shortly after they just sent me insurance, um, you know, the little cards in the mail, and, um, that's all it was, it's just the APL um policy.
[AGENT][NEUTRAL] Yeah, so I mean since they're group policies if this is what they offer, it's what they offer um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's the policies that.
[CUSTOMER][NEUTRAL] I thought it could be like, you know, if I change it, it could be more that's coming out of my check that they do take out. I thought it could be that way.
[AGENT][NEUTRAL] And if it's changed, it would have to be done through your employer if they offer a different dental policy. Mhm.
[CUSTOMER][NEUTRAL] Employer, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so now I just have to find some, yes ma'am, so now I'll just have to find someone that's in network with my insurance.
[AGENT][NEUTRAL] That makes sense.
[AGENT][NEUTRAL] So even if the provider is not in network will stay still pay a benefit and kind of like your scenario that you gave me before if they're not um then you would be responsible for 20.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] If you have access, well, I can do it two ways. I can give you the phone number to Carrington, which is the uh PPO network of contracted dental providers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they would be able to tell you uh a list of contracted uh providers that would that are within your demographic area where you live or geographical area.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that number should be on your card.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Carrington
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The only thing I see about Carrington on my um on the paper, it just have Carrington Solutions simplified and up top it just have um the number that I just called, the [PII] number and a website, [PII].
[AGENT][NEUTRAL] Are you looking at your identification card?
[CUSTOMER][NEUTRAL] I'm sorry, could you repeat that?
[AGENT][NEUTRAL] Are you getting that information from your ID card?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me pull up your card.
[AGENT][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Yeah, so I'm on the back of the card.
[AGENT][NEUTRAL] It says
[AGENT][NEUTRAL] For benefit eligibility eligibility or claim status, it gives the [PII] and then it says to locate a participating provider called [PII].
[CUSTOMER][NEUTRAL] I see the first number you call um.
[CUSTOMER][NEUTRAL] You said the the second number ending in [PII]?
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII] yeah, I don't, I don't see that number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] OK. I wonder you we may have a different.
[AGENT][NEUTRAL] Card
[AGENT][NEUTRAL] Reaching me what's on the back.
[CUSTOMER][NEUTRAL] Um, so I have a little, um, it's like a little plastic Medicaid, like a little plastic insurance card. Um, it's laminated though. Um, it has, in the left-hand corner, it has my employer, it has the group number, um, they have the employee name, the ID, and the medical coverage. And then, um, at the bottom it has pharmacy. It's um E L I X I R.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you looking at your medical card or your dental ID card?
[CUSTOMER][NEUTRAL] The medical card, um, so they can, that's what I was saying, they sent me a dental and then they sent me the dental and the little medical card.
[AGENT][NEUTRAL] Yeah, look at your dental card.
[CUSTOMER][NEUTRAL] Those are like paper like the one I was reading from is like lemonade.
[AGENT][NEUTRAL] Yeah, and that's how it comes, but look on your dental card to see if that number is on there for [PII].
[CUSTOMER][NEUTRAL] Um, the dental card, it just says insured, pay your ID coverage. It has the policy number, the group number, effective date, and the plan, and on the other side is the.
[AGENT][NEUTRAL] On the back of the card. Uh-huh.
[CUSTOMER][NEUTRAL] The back of the card.
[CUSTOMER][NEUTRAL] Yeah, the back of the car, it has nothing, um.
[CUSTOMER][NEGATIVE] The back of the card is missing.
[CUSTOMER][NEUTRAL] And like if I remove it, it's gonna be like a sticker, like.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, I was saying like the, the medical and the dental card, if I remove it from the paper, it, it's like sticker, it's gonna be like a sticker.
[AGENT][NEUTRAL] Yes, is there anything on the back of the dental card?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK. OK, no worries. I always like to check that.
[AGENT][NEUTRAL] So it's the [PII]. That's the number to [PII].
[AGENT][NEUTRAL] Um, and then they will be able to assist with locating a dental provider within your area.
[CUSTOMER][NEUTRAL] OK, um, could you repeat that number one more time for me?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 800
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 290.
[CUSTOMER][NEUTRAL] 390.
[AGENT][NEUTRAL] 2900523.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 05.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All [PII]. Anything else I can help out with today?
[CUSTOMER][NEUTRAL] No, ma'am, that'll be all.
[AGENT][POSITIVE] OK, [PII], thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] All right you too.
[AGENT][NEUTRAL] Bye bye.