AccountId: 011433970860
ContactId: 832096b1-035f-4ad2-8f87-87c9a1c9b552
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401440 ms
Total Talk Time (AGENT): 192561 ms
Total Talk Time (CUSTOMER): 189173 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/832096b1-035f-4ad2-8f87-87c9a1c9b552_20250128T22:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, um, I would like to know if I have uh.
[CUSTOMER][NEUTRAL] Uh, my policy have
[CUSTOMER][NEUTRAL] Um, out of network benefits.
[AGENT][NEUTRAL] Out of network benefits?
[CUSTOMER][NEUTRAL] Yeah. Um, is that a.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We can get your policy pulled up and take a look at that. Um, what was your name?
[CUSTOMER][NEUTRAL] Yeah, uh
[CUSTOMER][NEUTRAL] OK. Yeah. Uh, I have an account number. My name is [PII]. Will account number help?
[AGENT][NEUTRAL] Um, is it a policy number?
[CUSTOMER][NEUTRAL] I mean, yeah, policy number.
[AGENT][NEUTRAL] Sure, yeah, go ahead.
[CUSTOMER][NEUTRAL] 0215
[CUSTOMER][NEUTRAL] 3331.
[CUSTOMER][NEUTRAL] But yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I believe
[AGENT][POSITIVE] OK, what did you say your name was? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 1, OK.
[AGENT][NEUTRAL] And then um really quick before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, area code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Alright, and I did get your policy pulled up. I'm just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes, thank you for verifying that information. OK, so for this dental policy that you've got, um, it does not have a set network.
[AGENT][NEUTRAL] It goes off of what they call UCR, so potentially any provider could take it and the rates of UCR uh really depends on again that's more.
[AGENT][NEUTRAL] Of of what they would charge we pay a percentage based off of that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm sorry, can you, can you, can you repeat that? I was having a problem with my phone, um, yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No that's OK it does seem to be cutting out a bit um so this this dental policy does not have a network, it does not participate in a network, so potentially any carrier or any provider could accept it it would be up to them individually of course if they chose to if they have any questions they're more than welcome to give us a call and we can explain your plan um but again there's no set network to it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] Yeah, I'm at, I'm, I'm at the place now.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Maybe you maybe um yeah because it.
[AGENT][NEUTRAL] Did they tell you they don't?
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] Did they tell you that they don't take APL?
[CUSTOMER][NEUTRAL] And then also, you know, how those.
[CUSTOMER][NEUTRAL] No, like, no, um, most people never heard of APL, so they really a lot of people don't know.
[AGENT][POSITIVE] Sure, that's why we offer we can talk to them, of course.
[CUSTOMER][NEUTRAL] Yeah, OK, um, yeah, I'm inside right now. I have an appointment for.
[AGENT][NEUTRAL] OK, I can talk to them.
[CUSTOMER][NEUTRAL] Uh, next week, and yeah, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll, I'll have you speak to them and they can, so, so basically you're saying that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I go to a provider and they'll they'll still get paid for the um yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, they would just follow those claims directly to us um we can send them information and go over over the excuse me, go over it over the phone as well about your covered benefits and procedures and such so that there's no confusion.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, because they.
[CUSTOMER][NEUTRAL] They were saying that they were saying that they don't see that they would they they were saying basically that they were out of network and for me to ask you if you had out of network.
[AGENT][NEUTRAL] Well, and again it is ultimately sure unfortunately it is going to be up to each provider again if they take it or not I can't explain it but if they won't accept it then they won't accept it um so I can talk to them though um if not I do recommend calling around um and just asking anyone who does take APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, well.
[CUSTOMER][NEUTRAL] OK, yeah, because this is my, you know, I wanted, this is my preference, so yeah, I'm gonna have you, but, but I'm sure they probably will take it. They just don't understand.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know what, what exactly, you know.
[AGENT][NEUTRAL] Yeah if I can explain it to him if it's just something they've never heard of, yeah exactly.
[CUSTOMER][NEUTRAL] Um, OK, yes, um, can she, she has stepped away from my dad. She, she's about to come back in a minute. I want you to speak to her.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Yeah, so I have them on the phone now, right? And um, she, she wanna kinda she can she explain to you exactly what it is that it entails? OK.
[CUSTOMER][NEUTRAL] Hey there, this is [PII] from N Da Dental. How are you?
[AGENT][NEUTRAL] Hi, this is [PII] with APL. Uh, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, um, I'm doing well how are you?
[CUSTOMER][POSITIVE] I I'm doing pretty good, thank you for asking.
[AGENT][NEUTRAL] OK, glad to hear it. All right, um, so in short, I was kind of just explaining how his plan works. He does have a dental policy with us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it is not part of a network. It does just go off of UCR. That being said, I did tell him it is up to each individual provider, uh, whether they would file the claims with us or not, um, so I can give you more information if you'd like if you need a fax back, um, I'm not quite sure how your system works, but again this does just go off of UCR.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, alright, no that was all that I needed. Sounds good.
[AGENT][NEUTRAL] OK, did you want me to send you a fax back with his benefits?
[CUSTOMER][NEUTRAL] Um, it looks like he already had a copy of that and he already sent that over to me, so I think we should be all good.
[AGENT][POSITIVE] Oh, OK, cool. All right, glad to hear it. OK. Did you have any questions for me?
[CUSTOMER][POSITIVE] All right then, no, ma'am, that was all. Thank you so much.
[AGENT][POSITIVE] All right well thank you yeah you too have a great day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could do to help?
[CUSTOMER][NEUTRAL] No, no, that's it.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right, same to you.
[AGENT][POSITIVE] Thank you. Bye-bye