AccountId: 011433970860
ContactId: 7583f880-4e22-4587-9653-f3b84c686a09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565969 ms
Total Talk Time (AGENT): 308035 ms
Total Talk Time (CUSTOMER): 202178 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/7583f880-4e22-4587-9653-f3b84c686a09_20250520T21:10_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My daughter is at the dentist's office, and um she's trying to use the insurance, and they say they've never seen this type of insurance on the dental. So how do I, um, what does she, they're asking her if it's a PPL, PPO, I'm sorry.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And excuse me?
[AGENT][POSITIVE] No no no that's perfectly fine, OK.
[CUSTOMER][NEUTRAL] So what
[AGENT][POSITIVE] Yeah I could definitely get that pulled up and see what we can do to help um and she's at the dentist right now you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, ideally, um, the provider can give us a call and we can send them all of the covered information regarding her policy um that might clear up a bunch of confusion but I can definitely share that information with you in the meantime um what was your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you need the policy number?
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] Oh, yes, please.
[CUSTOMER][NEUTRAL] It's 021361777.
[CUSTOMER][NEUTRAL] The group number is 25017.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK and then uh before we go any further, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. OK, and then just gonna verify some information really quick. [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you. Looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Awesome thank you for verifying all of that OK and then uh which dependent was this for?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Got it. OK, all right, um, now I imagine she's a bit older, um, so you're not there with her right now currently, are you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, I'm not, but I can get her on the other line. Um, is there something you can email me that I could send her to where she could use it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's OK again um.
[AGENT][NEUTRAL] Yeah I mean I could send you a copy.
[CUSTOMER][NEUTRAL] Because they're telling her they don't take it.
[AGENT][NEUTRAL] Sure, OK, and that's where there is a lot of confusion. A lot of places have not heard of APL, um, in short, this particular policy does not operate within a network. It can be used potentially anywhere. It pays a percentage based off of what's called UCR, so that's, um, within the region, whatever region y'all are in, there's a base price line for each procedure, right? So like for a a crown or for cleaning, um.
[AGENT][NEUTRAL] Preventative pays 100% basic at 80 major at 40, um, that's the general gist of that so I really think if we're able to get the provider on the line um I can send them what's called a fax back uh that shows all of the benefit information, everything that they need, including the codes, um, and what the frequencies things like that, that should probably clear up quite a bit of confusion.
[CUSTOMER][NEUTRAL] OK, um, so should I call her and maybe you could talk to them? I can add her to this call and you can talk to them and then get the information from them? OK.
[AGENT][POSITIVE] We can do that, yeah, whatever is easier, whatever is easier for you, that is perfectly fine.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let me add her to the call. 1 2nd, hold on.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK. OK, ma'am, are you there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, [PII]'s on the phone, um.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi, OK, so I think what might be easiest is you can either, you know, if you wanna put me on speaker or just hand me to one of the um staff in the provider's office there um I can send them information regarding this dental policy for you.
[AGENT][NEUTRAL] Answer any questions they might have.
[CUSTOMER][NEUTRAL] OK, is it a PBO she was asking?
[AGENT][NEUTRAL] No, no, so that's, yeah, I was telling your mom, yeah, it's uh not affiliated with any sort of network it pays a percentage based off of what's called UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Let me wait for her to come back. I am in line and then I'll hand it to her.
[AGENT][POSITIVE] Sure. OK, got you, no worries.
[CUSTOMER][NEUTRAL] But you said the cleanings are 100%.
[AGENT][NEUTRAL] Yes, uh, so.
[CUSTOMER][NEUTRAL] And then, um,
[AGENT][NEUTRAL] Mhm. So any preventative, uh, preventative expenses are all gonna be covered at 100%. Basic and, uh, like X-rays and things like that, that's at 80%. Anything major, which would be like oral surgery, um, you know, periodontic and adontic, that's at 40%.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] So out of curiosity, does this cover anything towards braces if they're needed?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, so orthodontic treatment is not covered under this policy.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so like I right now I'd be getting a retainer made that wouldn't be covered since it's orthodontic.
[AGENT][NEUTRAL] Oh, no. Now there might be, if they're doing anything additional, it's possible that there could be other coverages, um, but for that retainer itself, no, that would not be covered under this policy.
[CUSTOMER][NEUTRAL] OK, let me see I I helping me with my insurance and the lady's on the phone because she said it'd be easier for her to send the info because I guess some people do get confused with the provider, the provider on it, you just need an email? Um, do you just need an email from them?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I could do, I tell her I could send her a fax back.
[CUSTOMER][NEUTRAL] A fax. They don't have a fax.
[AGENT][NEUTRAL] Oh man, OK, um, I could send it to her email.
[CUSTOMER][NEUTRAL] I think you know would work.
[CUSTOMER][POSITIVE] Thank you. OK, let me know when you're ready.
[AGENT][POSITIVE] I am ready.
[CUSTOMER][NEUTRAL] OK, so [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, that was [PII]
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Got it. OK, um, let them know I will be sending this information over. It is called a fax back and it does show all of your, uh, covered procedures and benefit. Um, you can let them know, um, if they don't wanna talk, um, that if they're looking for anything specific as far as the procedure and they don't see it listed, that means it's not going to be covered under this policy.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][POSITIVE] And then of course if they have any additional questions I would strongly recommend that they give us a call so y'all don't have to play you know middleman.
[CUSTOMER][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] OK awesome and is there like a site or anything we could look at the providers that do accept this?
[AGENT][NEUTRAL] There are some um again most of the time, sure, so it is going to be up to each provider as this policy is not affiliated with any sort of set network so you can simply give a um I would do some research call um you know what places that you'd like to go just explain that you're with APL and again if there's any confusion or anything like that have them give us a call so that we can try to clear that up because this policy could potentially be used anywhere.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect and are you able to email me a copy of what you're gonna send them as well that way I could see.
[AGENT][NEUTRAL] All right, we'll let them know.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely so I can what I'm sending them is going to be more um provider jargon um if you'd like I can send you uh the actual policy that does show everything that is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that would be great.
[AGENT][NEUTRAL] That'd probably be a bit easier. OK, sure, I'll send that to you. Um, let's see, do you want me to just send that to your email, [PII], that we've got on file for you, the Gmail, I think, yes.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][POSITIVE] OK awesome alrighty I will send all of that um if there's any hiccups you'll need anything else, uh, definitely give us a call back OK?
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] OK thank you so much thank you have a good day.
[AGENT][POSITIVE] Alright, you are very welcome you'll have a good one.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] You too bye bye bye bye bye.