AccountId: 011433970860
ContactId: 5ca5082d-736d-493c-b9f3-af5f49d0d7d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 715940 ms
Total Talk Time (AGENT): 227167 ms
Total Talk Time (CUSTOMER): 299103 ms
Interruptions: 0
Overall Sentiment: AGENT=-2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/5ca5082d-736d-493c-b9f3-af5f49d0d7d7_20250514T20:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was just calling to see if my patient had any dental coverage with y'all.
[AGENT][POSITIVE] OK, I can help you with dental benefits. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Phone number is [PII].
[AGENT][NEUTRAL] OK, [PII], and do you have the policy number of that patient?
[CUSTOMER][NEUTRAL] Patient provided with 02623420.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's gonna be for [PII], date of birth [PII].
[AGENT][NEUTRAL] Uh, yes, I show the policy is active and effective [PII], and I can send over a fax back um unless there's something you need to go over on the phone.
[CUSTOMER][NEUTRAL] Um, just quick question, what insurance is this because I've never, I don't know what this is.
[AGENT][NEUTRAL] And so we're American Public Life.
[CUSTOMER][NEUTRAL] American Public Life and is the patient's plan a PPO plan HMO? what type of plan is this?
[AGENT][NEUTRAL] Um, they do use Carrington, so that's, that's one of their, the network for this plan.
[CUSTOMER][NEUTRAL] Uh huh, because I did call Carrington but they couldn't find the patient at all.
[AGENT][NEUTRAL] Yeah, they're not they're not gonna be able to give you eligibility or benefits they're just strictly the PPO.
[AGENT][NEUTRAL] So they're not the TPA for it.
[CUSTOMER][NEUTRAL] Mhm so
[CUSTOMER][NEUTRAL] Yeah, because I know our office only accepts PPO plans so I just wanna know if this is a PPO plan.
[AGENT][NEUTRAL] Yes, I mean, they use Carrington as the network. So if you're in network with Carrington.
[AGENT][NEUTRAL] Then
[CUSTOMER][NEUTRAL] We're actually out of network with Carrington.
[AGENT][NEUTRAL] OK, I mean we, we don't require them to use the network and we would process your claim if you send it to us.
[AGENT][NEUTRAL] Um, and pay according to the policy, so, but I, if you have certain criteria for the patient, I.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean that's up to your office, obviously.
[CUSTOMER][NEUTRAL] No, I'm just asking because uh I'm just asking because the patients coming in today and provided this insurance and I just didn't know what American Life or whatever you said was.
[AGENT][NEUTRAL] Um, yeah, so we're, I mean we have several different dental policies that we offer for group like employers.
[CUSTOMER][NEUTRAL] Mhm and um you said that the patient can go out of network with this insurance correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK and you said what was the name of this insurance again? American what?
[AGENT][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] Public life.
[CUSTOMER][NEUTRAL] OK, so any dental doctor can see this patient.
[CUSTOMER][NEUTRAL] Um, and is that member ID that I provided correct?
[AGENT][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] OK, and is there any way that I can get benefits through the phone or is it just strictly from a fax?
[AGENT][NEUTRAL] Uh, no, I can provide them over the phone.
[CUSTOMER][NEUTRAL] OK, what was the effective date of this plan again you said?
[AGENT][NEUTRAL] A date is [PII].
[CUSTOMER][NEUTRAL] Does it run calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what's gonna be the annual max and the individual deductible?
[AGENT][NEUTRAL] Annual max is $750. This is not a guarantee of payment. It's a basic outline of the policy. Annual max is $750 the calendar year deductible is $50.
[CUSTOMER][NEUTRAL] OK, is there a family deductible?
[AGENT][NEUTRAL] Family deductible is 150.
[CUSTOMER][NEUTRAL] OK, has the patient used anything of the annual max or deductible?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 750 and does the annual max apply to all services?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is this going to be an individual plan or a family plan?
[AGENT][NEUTRAL] Individual
[CUSTOMER][NEUTRAL] OK, is there gonna be any waiting periods or missing tooth cloths?
[AGENT][NEUTRAL] Uh, there is a missing two clause. There's no waiting period.
[CUSTOMER][NEUTRAL] No waiting period. OK, does this patient have any history on file that can affect frequency?
[AGENT][NEUTRAL] No, he's he's effective 55, so we don't have any claims on file.
[CUSTOMER][NEUTRAL] OK, and what's gonna do you accept the assignment of benefit for this plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK, and what's gonna be the out of network percentage for preventative basic and major?
[AGENT][NEUTRAL] Preventative, which which only includes cleanings and profies, pays 100%, no deductible.
[AGENT][NEUTRAL] Uh, radiographs, FMX, X-rays, basic expenses, and basic restorative pay 80% after a $50 deductible.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEGATIVE] Um, there is no major coverage under this policy, and that includes perioendo, implants, crowns, bridges, dentures, no coverage for any of that.
[CUSTOMER][NEUTRAL] OK, um, and, um, for the SMX and panel, do they share frequency?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what is that frequency?
[AGENT][NEUTRAL] Uh, once for 5 years.
[CUSTOMER][NEUTRAL] And you said it was covered under basic 80%?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and do all other exams share frequency like for the 0 120 and 0 140?
[AGENT][NEUTRAL] Yes, they do, 2 per 12 month period.
[CUSTOMER][NEUTRAL] 2 for 12 months and 2 per 12, OK, and what about for the profy and the bite wings?
[AGENT][NEUTRAL] Trophies are 1 for 6 months, bit wings are 1 for 12 months.
[CUSTOMER][NEUTRAL] And all of those were covered at 100%?
[AGENT][NEUTRAL] Uh, profies and exams are covered at 100%.
[AGENT][NEUTRAL] Everything else is
[CUSTOMER][NEUTRAL] So the bite wing is.
[AGENT][NEUTRAL] Yes, 80%.
[CUSTOMER][NEUTRAL] By wing is 80, OK.
[CUSTOMER][NEUTRAL] And do you know how many PAs will equal an FMX?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or if you don't know it's OK I'll just pretty.
[AGENT][NEUTRAL] You have the code?
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Uh 0 2:30.
[AGENT][NEUTRAL] Uh, it just says it's listed under basic. It doesn't have a frequency attached to it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No frequency with no age limit, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and is the patient is the patient even going to be eligible for sealans floor and space maintainers or no due to age limit?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah, that's no due to age limit.
[CUSTOMER][NEUTRAL] No 2, OK, not covered, not covered and not covered. OK, um, and then for the fillings, do they downgrade?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, 80% on downgrade and uh what is the frequency?
[AGENT][NEUTRAL] Feelings are.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months, max of 1, each tooth for 24 months.
[CUSTOMER][NEUTRAL] One every 2.
[CUSTOMER][NEUTRAL] OK, um, I do have other codes that I do need to see if they're covered or not. I'm not sure if I can give them to you all at once or one by one.
[AGENT][NEUTRAL] one by one.
[CUSTOMER][NEUTRAL] OK, that's fine, uh, 3310?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 4341.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 4910.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 29:30.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 2950.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, 4355.
[AGENT][NEUTRAL] Covered.
[CUSTOMER][NEUTRAL] OK, 70 to 10.
[AGENT][NEGATIVE] And not covered.
[CUSTOMER][NEUTRAL] OK, 7240.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK 4266.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 78,310.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 3110?
[AGENT][NEUTRAL] All covered.
[CUSTOMER][NEUTRAL] OK, 2740.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7951.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4249.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9944.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 5213.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 5820.
[AGENT][NEUTRAL] covered.
[CUSTOMER][NEUTRAL] 9248.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 9243.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] 90 to 30.
[AGENT][NEGATIVE] Not covered
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEGATIVE] Implants are not covered, so major bridges, dentures, crowns, all of that's not covered. Implants not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And now I just have 3 more it's gonna be 9910?
[AGENT][NEUTRAL] October.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEUTRAL] Covered
[CUSTOMER][NEUTRAL] And 4381.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, um, and there is, is there any or coverage under this plan or no?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, OK, uh, let me just put that not covered, and can I just get the group name and group number of this plan?
[AGENT][NEUTRAL] Group number 70101. Group name superior skilled trades.
[CUSTOMER][NEUTRAL] OK, and you said group number is 70101 correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and can I just get the um.
[CUSTOMER][NEUTRAL] The claims address so whenever we send the claims.
[AGENT][NEUTRAL] Claims address is [PII], [PII] 73124-8950.
[CUSTOMER][NEUTRAL] OK, give me a second.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, can you repeat the [PII] again? You said 2.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you said [PII] correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And you said [PII]. Give me a second because I'm writing that down with my pen. [PII] and then what was after Ok [PII]? sorry.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII] and then that's what was the zip code again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 50. OK, can I get the payer ID also?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801 correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alrighty, well, can I just get your name again and a reference number?
[AGENT][NEUTRAL] Uh, my name is [PII], first initial to last name, [PII], and today's date with my name is the reference.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] you were very helpful helpful.
[AGENT][POSITIVE] Thanks for, thanks for calling APL. I hope you have a good evening.
[CUSTOMER][NEUTRAL] You bye bye.