AccountId: 011433970860
ContactId: 74f1cda6-db6e-43a7-bebb-6ef1064c5571
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622950 ms
Total Talk Time (AGENT): 378447 ms
Total Talk Time (CUSTOMER): 187677 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/74f1cda6-db6e-43a7-bebb-6ef1064c5571_20250416T22:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, I'm calling because uh.
[CUSTOMER][NEUTRAL] I, uh
[CUSTOMER][NEUTRAL] Um, I'd like to know about my benefits that I have under this policy.
[AGENT][NEUTRAL] OK, yeah, I can check those benefits for you um what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 10:37.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, no, I do not.
[AGENT][NEUTRAL] OK, um, I can start using your social.
[CUSTOMER][NEUTRAL] Uh, OK, my social is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. And then sir just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Uh, say that again.
[AGENT][NEUTRAL] Can I get your mailing address please?
[CUSTOMER][NEUTRAL] Oh yeah, [PII].
[AGENT][NEUTRAL] Perfect, uh, last thing I need is the email address we've got on file for you. uh, looks like it might be, uh, [PII]'s.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Perfect thank you for verifying that. OK, so you've got a couple of policies with us, [PII]. You've got a dental policy and a medical limited indemnity medical plan. Which one were we needing to look at the benefits for?
[CUSTOMER][NEUTRAL] The dental plan.
[AGENT][NEGATIVE] That's all. Gotcha.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can give you kind of a brief rundown if you like um in short, the way that this policy works is it does not have a network it's not a part of a network at all it can be used potentially anywhere um it pays a percentage based off of what's called UCR so that's about the average cost of the specific procedures that are um per your area um so it really does depend on the provider, uh, whether or not of course they would.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][POSITIVE] Accept this uh kind of insurance, I would try to find someone that does so that they could file the claims for you, but even if they don't, you can still file the claims yourself uh there's no problem with that it's just a little bit extra for you to have to worry about.
[AGENT][NEUTRAL] And if there's ever any confusion with providers um maybe they haven't heard of us or they're not familiar with what kind of policy this is um they are more than welcome to give us a call as well if there's a place that you really like and they're like I don't know about them um have them give us a call so we can explain the plan to them.
[CUSTOMER][NEUTRAL] Yeah, yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, understood.
[AGENT][NEUTRAL] Alrighty and then if you would like if you don't have it, I can send you a copy of the policy as well um it does go, it's not a bunch of jargon, it's very easy to read I promise um but it does go in depth as to what is and is not covered, uh, frequencies, limitations, things like that.
[CUSTOMER][NEUTRAL] Uh, sure, yeah, yeah, that's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can mail that to you or I can email it. uh, what would you prefer?
[CUSTOMER][NEUTRAL] Emailing is fine.
[AGENT][NEUTRAL] OK, did you want me to send it to uh this Gmail that we've got on uh on your account?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, and so again in short, um.
[AGENT][NEUTRAL] Preventative expenses are 100% of UCR we would pay that 100% um, if there was anything additional, again that's going to depend on that specific provider, how much they charge, um, so radiographs like the full mouth X-rays, um, and any sort of basic expenses, that's going to be at 80% and then anything major anigontic, uh, periodontic, anything like that, uh, that's going to be at 40% of UCR.
[AGENT][NEUTRAL] And now you do have a well you're outside well just about uh there is a 12 month waiting period for um major expenses but as the effective date was [PII] y'all are almost there.
[CUSTOMER][NEUTRAL] Yeah, that's what I hadn't saw when I first enrolled is that it would take a year, so that's also why I'm calling is to just re-verify that soon, um I believe major expenses will be not entirely covered, but at like what percentage is it say?
[AGENT][NEUTRAL] 40 40%, 40%, yes sir, um, and that's the only thing that has a waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 40% of the average car.
[AGENT][NEUTRAL] Correct, so UCR is again how much right depending on I believe it's uh by zip code um but it's also going to be, you know what the if the providers um you know, charge a little bit more than that then you know there's gonna be that difference there so that's something that you know once you find a provider you can kind of speak with them about.
[CUSTOMER][NEUTRAL] OK, 40% of the average.
[CUSTOMER][NEUTRAL] Provider
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, and it's, um, and it's major, is that, uh, like something like a root canal or something like that?
[AGENT][NEUTRAL] So what would be easier I can go ahead and look um the way that this works is it goes off of specific codes so there are different procedures and then there's different ways that they can do them um and specific things are covered that way so if a root canal was needed I would strongly recommend um just so that there's no misinformation.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I would recommend uh that the provider call us with that specific code that they believe would be necessary for that kind of procedure and then we can see if that's a covered procedure code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, understood, understood. Um, does it cover, uh, fillings like completely or only a portion of that?
[AGENT][NEUTRAL] I believe that's going to be considered basic, um, again depending on how extensive that is and what all is needed, uh, so that would be at 80%. The 100% things are going to be more preventative, so the um examination itself, the little bite wings that they use, uh, things like that, yes, yes, all of that that's gonna be considered preventative, so that's 100%.
[CUSTOMER][NEUTRAL] Be there.
[CUSTOMER][NEUTRAL] Cleaning fish.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] Understood. OK, but it's all.
[CUSTOMER][NEUTRAL] Most of it is applicable now it's just the major ones that won't be applicable until after the [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, understood um and then what about finding a provider? Are you guys able to help me find one? Like is there a website or an app or something?
[AGENT][NEUTRAL] Well that's again as there's no set network with this plan, they don't, it's not something that you can locate like that there's not usually much difficulty in locating one once you tell them that it's, you know, a percentage of UCR they're pretty open to that they just send the claim information directly to us.
[AGENT][NEUTRAL] A lot of them are you know familiar with APL, but again if you find a place that you really like and they're never heard of us or they're not sure, um, encourage them to give us a call, uh, so that we can clear up any kind of confusion.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] Understand
[CUSTOMER][NEUTRAL] OK, OK then, well, well, uh, I think that's what I needed to know. Oh, what about like a copays and stuff? Does it mention what I would expect to pay? Like I does it depend on what all needs to be done or what?
[AGENT][NEUTRAL] Sure, uh, there's no copays. Uh, there is a $50 calendar year deductible, um, and that's going to be per covered person.
[AGENT][NEUTRAL] And that does not apply towards preventative expenses though so if you were to just go in for an oral evaluation or cleaning or something like that, you would not have to that, you know, deductible wouldn't count towards that. So after that $50 deductible has been met, then that's when the uh $1500 that's per calendar year your benefit maximum, that's when that would kick in.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so then, huh, so then you being in the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] In the, the position that you're in and knowing what all you know about the policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, it might behoove me to go ahead and utilize the amount that I have for this year before [PII].
[AGENT][NEUTRAL] No, OK, so.
[CUSTOMER][NEUTRAL] That way it's like renewed or no?
[AGENT][NEUTRAL] No, so this goes off of calendar year, so it resets beginning of January. Yes sir, yes, I know it's a bit confusing, but yes, it is a calendar year plan, yes.
[CUSTOMER][POSITIVE] Oh, calendar year. Oh yeah, you're right, you're right.
[CUSTOMER][NEUTRAL] Understood, understood. OK.
[CUSTOMER][NEUTRAL] Ah, OK, OK, it's, it's, it's the uh.
[CUSTOMER][NEUTRAL] They're not covered until after a year that the policy has been enacted, right? That's.
[AGENT][NEUTRAL] Correct, yes, and then of course after that you can use it however it's just that 112 month period, uh, right after the policy's effective date.
[CUSTOMER][NEUTRAL] That's where that year OK.
[CUSTOMER][NEUTRAL] Understood. OK, OK. Oh wow.
[CUSTOMER][NEUTRAL] OK, well then, uh, yeah, that's, that's what I needed to know, man, um.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yeah, I think I have everything I needed to know. So basically find a provider that I think I like or that I wanna go to and then have them call you to go over what the code would be for whatever pricing they give me.
[AGENT][NEUTRAL] Right, um, and of course if that's necessary it's possible that they are fully aware of APL. I just know that some of them are not, um, and we do talk to providers all the time so that's not a problem.
[CUSTOMER][POSITIVE] OK, OK, I understood. Well, thank you for all the assistance, ma'am, and uh, yeah, that's all I needed to know.
[AGENT][POSITIVE] Of course, yes, and I'm getting this I'm getting this uh email sent right now uh with the policy, so if you review that and you have any further questions, need clarification on anything, uh, don't hesitate to give us a call back and we'll do our best to explain that to you.
[CUSTOMER][NEUTRAL] Understood and uh.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] Of course yeah thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.