AccountId: 011433970860
ContactId: 7bcf9793-8f5a-4cfe-8108-8903788628ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 715229 ms
Total Talk Time (AGENT): 298671 ms
Total Talk Time (CUSTOMER): 181007 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/7bcf9793-8f5a-4cfe-8108-8903788628ec_20250317T17:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, how are you doing?
[AGENT][NEUTRAL] I'm fine, and yourself?
[CUSTOMER][POSITIVE] I'm doing good. I'm trying to figure out if
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] If my insurance is accepted at.
[CUSTOMER][NEUTRAL] Um, checking I.
[CUSTOMER][NEUTRAL] I'm trying to see if it accepted at chemistry.
[CUSTOMER][NEUTRAL] At Galley Station.
[CUSTOMER][NEUTRAL] But then, then.
[AGENT][NEUTRAL] OK, so you're calling to verify if your insurance is accepted at a particular dental office?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, what is your name and policy number, please?
[CUSTOMER][NEUTRAL] My policy number is.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 48.
[CUSTOMER][NEUTRAL] 42
[AGENT][NEUTRAL] It sounds like it's missing number, you said uh 254-842?
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 148.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 42
[AGENT][NEUTRAL] OK, thank you. And your name is?
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Right [PII].
[AGENT][NEUTRAL] OK. Well, with your dental policy, we don't have a particular provider you have to go to or have a network, meaning that the policy is open. Um, so any dental provider you prefer, you can just give them your policy number with us and our phone number and that way they can call and verify benefits and eligibility, but we don't have a network of dental providers with your plan.
[CUSTOMER][NEUTRAL] You know, they, they just told me to call and.
[CUSTOMER][NEUTRAL] To verify.
[AGENT][NEUTRAL] Uh, you can just, uh, advise him that the policy, it doesn't have a network that is open and that a better way to tell him that the policy pays by UCR. We don't follow a fee schedule with any other insurer or with the like Carrington or any other network.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. I did not understand that.
[AGENT][NEUTRAL] You can advise, you can let them know that we do not have a network, that we do not participate with Carrington. I know that most dental providers do. You can explain that the policy pays by UCR, it's usual customary and reasonable.
[CUSTOMER][POSITIVE] You said us personally and reasonable.
[AGENT][NEUTRAL] Uh-huh, UCR, we just pay by UCR.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] If I was to go get like a cook.
[AGENT][NEUTRAL] I'm sorry, your phone keeps cutting in and out. Say again.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] So if I was to go get a coon, would that covered?
[AGENT][NEUTRAL] Uh, cleanings are covered under the policy, yes, sir, like a regular, uh, cleaning that is covered on the policy is, um.
[AGENT][NEUTRAL] Preventative.
[CUSTOMER][NEUTRAL] OK, what about like a book?
[AGENT][NEUTRAL] Uh, that is considered major and you do have a twelve-month waiting period. Well, let me double check because I don't believe major services is covered under your plan. Uh, the policy only covers for preventative and basic services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is this American public life and Carrington are these two different companies?
[AGENT][NEUTRAL] Carrington is what um providers usually may have a contract with or how much they charge.
[AGENT][NEUTRAL] If they go, if an insured goes to a Carrington provider, whereas this policy doesn't pay by a fee schedule, it pays by UCR.
[CUSTOMER][NEUTRAL] So by usage.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So they pay by usage.
[AGENT][NEUTRAL] The policy you have with us pays by UCR. It doesn't pay by a fee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So my, my question is there's, there's no way for
[CUSTOMER][NEUTRAL] 325.
[CUSTOMER][NEUTRAL] Uh, this insurance is set.
[CUSTOMER][NEUTRAL] I was just different.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] So, is there's no way for me to verify that this insurance is accepted by
[CUSTOMER][NEUTRAL] Pacific dental office.
[AGENT][NEUTRAL] Uh, not really, not unless they call and verify, but we don't have a network.
[AGENT][NEUTRAL] So if the policy is open to where you can go to any dental provider, whether they accept it or not, it's uh we can only verify that you do have dental coverage with us.
[AGENT][NEUTRAL] But we don't have a list or a network of providers that would say yes, that they do accept our insurance. Most providers would just call and that way we can verify benefits and eligibility.
[CUSTOMER][NEUTRAL] So how are they
[CUSTOMER][NEUTRAL] How are they call all the time.
[AGENT][NEUTRAL] Well, you can give them your policy number and our phone number and that way they can call our office.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Sorry, I'm confused because I'm I'm calling, I'm, I'm trying to do the same thing.
[CUSTOMER][NEUTRAL] They will be
[AGENT][NEUTRAL] Yes, sir, but we do not have a network, so we can't say yes, this dental office will accept this insurance. Most times what a provider would do if they receive policy information like your policy number and our phone number, they will call, we verify benefits and eligibility, but we don't have a network. We don't have a list of providers to say, yes, this provider will accept this insurance.
[CUSTOMER][NEUTRAL] Because I'm calling in
[CUSTOMER][NEUTRAL] But I know what dental office.
[CUSTOMER][NEUTRAL] I'm trying to verify.
[AGENT][NEUTRAL] We can just verify that the policy is open. Like I said, the provider can give us a call, uh, with your policy number and we can verify benefits.
[AGENT][NEUTRAL] But we don't have a network of dental providers.
[CUSTOMER][NEUTRAL] So all they would do is call and verify if the policy is open, correct?
[AGENT][NEUTRAL] They, they can verify benefits and eligibility. Yes, sir. They can verify the policy is active and what benefits are covered.
[CUSTOMER][NEUTRAL] So it's basically the same thing as accepting the insurance, right?
[AGENT][NEUTRAL] Well, it's up to their office on whether they accept the insurance, but we can just verify that you do have dental coverage with our company.
[CUSTOMER][NEUTRAL] If it's if it's probably.
[CUSTOMER][NEUTRAL] I, I mean, I know I do have dental coverage.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What do you want to tell them that's different? Because I know I have dental, I could tell them I have dental coverage. I know I have dental coverage.
[AGENT][NEUTRAL] Well, we can tell them the same thing if you, if you're giving them your information, we can explain to them what is covered, what are the benefits. Most time when providers verify with the insurance company that the insured or the patient does have dental coverage or does have coverage, then they will be satisfied, but the only way they can really do is give us a call so we can verify that yes, Mr. [PII] has insurance and these are the benefits that are covered.
[CUSTOMER][NEUTRAL] I'm just trying to understand because it sounds like.
[CUSTOMER][NEUTRAL] You're saying, yes, it is a 7.
[AGENT][NEUTRAL] I don't know if the dental office will accept it. We can only verify coverage. We can't say yes, uh, this provider will accept the insurance since we don't have a network.
[CUSTOMER][NEGATIVE] Or don't really want it.
[CUSTOMER][NEUTRAL] Oh, you're not the provider?
[AGENT][NEUTRAL] No, the provider will be the dental office that you go to to receive service. We will be your insurer.
[CUSTOMER][NEUTRAL] But you're not the insurance provider?
[AGENT][NEUTRAL] We are the insurance, but we do not have a network, so we wouldn't have a list of providers that will accept the insurance. Most providers with medical or dental providers will accept the insurance when they give us a call and we can verify that you have benefits.
[AGENT][NEUTRAL] But we don't have a network.
[AGENT][NEUTRAL] Meaning the policy is open to where you can go to any dental provider. So if the provider submits the claim, we're not going to deny the claim or reject the claim because they're not in network since we don't have one.
[CUSTOMER][NEUTRAL] So they don't, if y'all don't accept the claim or deny the claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So if y'all don't accept the claim deny the claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] So how does the rental offices get paid?
[AGENT][NEUTRAL] I'm not understanding what you're saying. Say it one more time.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] So, American, American public life.
[CUSTOMER][NEUTRAL] I have dental insurance, but for basic needs, right, for basic and preventive care, right.
[AGENT][NEUTRAL] For preventative and basic services, correct.
[CUSTOMER][NEUTRAL] And that's all.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, thank you.