AccountId: 011433970860
ContactId: 59e3524b-b32f-4b00-96b5-26e79ec9208c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284980 ms
Total Talk Time (AGENT): 78059 ms
Total Talk Time (CUSTOMER): 154638 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/59e3524b-b32f-4b00-96b5-26e79ec9208c_20250304T17:12_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Good morning, [PII]. This is [PII] in customer service. I have Miss [PII] on the line. Um, she's the spouse of the applicant with a dental policy. Policy number is 617357.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Callback number?
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that information. I'm ready.
[CUSTOMER][NEUTRAL] OK, um, her question is about how much is this policy covering for, um,
[CUSTOMER][NEUTRAL] Pretty much any type of service because apparently she's seen that it went down. She has been paying more than she used to pay. I already looked into the policy and the only change I was able to find is that we dropped the dependents, but the coverage um benefits were not changed at all. So, um, she wants to know about how much um the services are covered by us.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] Hi, this is [PII] with APL claims department. How are you?
[CUSTOMER][POSITIVE] Good how you doing?
[AGENT][NEUTRAL] I'm good. I understand you were calling uh for information on your dental benefits.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, please be advised the verification of coverage is not a guarantee of payment, um.
[AGENT][NEUTRAL] Now I do show that your policy has a $1000 calendar year maximum with the $50 deductible.
[AGENT][NEUTRAL] Per cover insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so whenever, so before when I went to the dentist, y'all paid a lot more and then now like you're only paying $50 and so I'm paying like it's they, they're very expensive. They, they're charging me like $300 so that was, you know, when my total is $350. So anyway, but we haven't had any dental work done, you know, as far as like root canals, fillings or crowns or anything, so I wanted to see what the coverage is on that.
[AGENT][NEUTRAL] OK, so I would need the coding.
[AGENT][NEUTRAL] For that cause.
[CUSTOMER][NEUTRAL] OK, so you, so you don't have like, like you don't have a percentage amount or like.
[AGENT][NEUTRAL] It's not paid on a percentage. It's paid like uh we have a set fee that we, uh fee schedule that we fax over to them and then they would just look at the code and see what amount we pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] So you, so you don't have it, so you don't have any idea, say like if we needed a root canal. Well, what it used to be, this is what it used to be like, like I remember like a root canal, they, uh, they paid like, uh like say if it was $1500 they pay like 5 or 600.
[CUSTOMER][NEUTRAL] Is that about how it is now still with the insurance that we have or do you know?
[AGENT][NEUTRAL] Yeah, the fee schedule has not changed and now the maybe what's changed what we pay hasn't changed. If there's a change, it means they're charging more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] But on our end, nothing has changed.
[CUSTOMER][NEUTRAL] OK, alright, so the $50 so I just must have I must have not remembered that it was just $50 maybe I'm not sure. I just thought that I was, you know, that it paid more, but maybe it maybe they went up so much that that's the problem. OK, alright, that's what I needed to know and uh can you send me a new insurance card?
[AGENT][NEUTRAL] OK, one moment, I'll get that order one moment please.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, you should receive that card within the next 5 to 10 business days.
[CUSTOMER][POSITIVE] OK, that sounds good. Thank you very much.
[AGENT][NEUTRAL] Was there anything else I can assist you today?
[CUSTOMER][NEUTRAL] Uh, no, no, and if there's like some more information that you can send me along with that to help with the policy if possible, but you know, if not, that's fine.
[AGENT][NEUTRAL] OK, so you want a copy of the policy? OK.
[CUSTOMER][NEUTRAL] Can I do that? I mean, is that a bigger?
[AGENT][NEUTRAL] Yeah, I can put that
[AGENT][NEUTRAL] Yeah, we can put that in the mail with the card as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That sounds good.
[AGENT][POSITIVE] OK, well thank you for choosing ATO.
[AGENT][POSITIVE] You have a good day.
[CUSTOMER][POSITIVE] All right, thank you very much.
[AGENT][NEUTRAL] Mhm bye bye.
[CUSTOMER][NEUTRAL] Bye bye.