AccountId: 011433970860
ContactId: 5334948b-34da-44f3-af7e-49093709c86d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342940 ms
Total Talk Time (AGENT): 121611 ms
Total Talk Time (CUSTOMER): 141239 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/5334948b-34da-44f3-af7e-49093709c86d_20250623T21:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. I am calling from a provider's office and I am trying to locate a patient's insurance.
[CUSTOMER][NEUTRAL] Dental insurance.
[AGENT][NEUTRAL] OK, um, so you're calling for eligibility?
[CUSTOMER][NEUTRAL] Well, yeah, um, the card we have that I made a copy of does not have a phone number on the call, so on the top of the card it has American Public Life and then Carrington off to the side. So I'm trying to locate where even to call to get his benefits. So I googled your phone number.
[CUSTOMER][NEUTRAL] So I have a policy or certificate number. Would you be able to check that to see where we need to go?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, it's 02619193.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Uh, yes, ma'am. I do show he has a policy with us effective [PII] of this year and is active.
[CUSTOMER][NEUTRAL] OK, um, and what is the group name?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Group name is HG Staffing LLC.
[CUSTOMER][NEUTRAL] OK, and the group number?
[AGENT][NEUTRAL] 70034.
[CUSTOMER][NEUTRAL] OK and then um does this run on a calendar year or does it run from effective date?
[AGENT][NEUTRAL] Uh, calendar year.
[CUSTOMER][NEUTRAL] OK, and does he have a deductible?
[AGENT][NEUTRAL] Yes, there is a $50 deductible that is applied to everything but preventative.
[CUSTOMER][NEUTRAL] OK, and a maximum?
[AGENT][NEUTRAL] Um, not a guarantee of payment, just a verification coverage. It has a benefit max of $500 per calendar year.
[CUSTOMER][NEUTRAL] OK, and does this go as an in or out of network policy or?
[CUSTOMER][NEUTRAL] Does he have to go to a particular particular provider to be in network or?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No, ma'am. Well, we don't have a network. Uh, the policy is open to where they can go to any dental provider.
[CUSTOMER][NEUTRAL] OK, alright, and then preventative is covered at what percent?
[AGENT][NEUTRAL] Uh, 100% of UCR.
[CUSTOMER][NEUTRAL] OK, and basic?
[AGENT][NEUTRAL] Uh, basic, basic, restorative FMX and Pan are at 80.
[AGENT][NEUTRAL] And with this plan, it does not cover any major services.
[CUSTOMER][NEUTRAL] None OK so endoperio oral surgery, all of that falls under major?
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] So the only thing under basic would be the pan FMX and fillings.
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK, all right, um, are there any waiting periods?
[AGENT][NEUTRAL] Uh, no, ma'am. There's no waiting period.
[CUSTOMER][POSITIVE] I guess and no missing tooth claws since there's no major.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, any coverage for the Brexism clusal guards?
[AGENT][NEUTRAL] Uh, no, ma'am. That's considered major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK, and your payer ID for electronic?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and what is the company name that this goes to?
[AGENT][NEUTRAL] American Public Life or APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and has he used any of that Macs or anything yet?
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Uh, no, ma'am. He hasn't used his policy and nor has he met his deductible, so it is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and are there frequencies for pro fees?
[AGENT][NEUTRAL] Uh, cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] OK, and a pen or an FMX frequency?
[AGENT][NEUTRAL] Uh, once every 5 years.
[CUSTOMER][NEUTRAL] OK, um, bite wings?
[AGENT][NEUTRAL] Uh, once every 12 months.
[CUSTOMER][NEUTRAL] OK, fluoride.
[AGENT][NEUTRAL] Under the age of [PII], once every 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you know if there's coverage for a full mouth debridement the 4355?
[AGENT][NEUTRAL] Oh, it's not covered. It falls under endoontics, so it's not covered under the plan.
[CUSTOMER][NEUTRAL] Is it fall under Pario?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, all right, that should be what I need thank you.
[AGENT][POSITIVE] Uh yes, ma'am. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.