AccountId: 011433970860
ContactId: 8ad490de-8d4d-4856-ac4a-63e4d24b5bc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384059 ms
Total Talk Time (AGENT): 136517 ms
Total Talk Time (CUSTOMER): 173709 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/8ad490de-8d4d-4856-ac4a-63e4d24b5bc9_20250505T14:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is. How may I assist you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, I'm calling to find out exactly what my insurance covers.
[AGENT][NEUTRAL] OK, may I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. 0234. Let me get right back. 02346810.
[CUSTOMER][NEUTRAL] How about that.
[CUSTOMER][NEUTRAL] Let air out for a sec.
[AGENT][NEUTRAL] May I have
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do need to verify your mailing address listed on file.
[CUSTOMER][NEUTRAL] I don't know if they have a PO box or a physical address.
[AGENT][NEUTRAL] OK, you would just have to give me one of them so I can say yes or no.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Alright, hold on
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, we don't have that one.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes ma'am, that's the one we have on file is that the correct one?
[CUSTOMER][NEUTRAL] But see, I ain't know if it went to the company or what, yeah. It's just like I say I have a PO box and have a physical one, and then I have a business one so I didn't know which one was on there.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And I'm pulling your information up for you.
[AGENT][NEUTRAL] Now, it looks like you only have dental with us.
[CUSTOMER][NEUTRAL] I do. That's why I'm trying to see what it, what does it cover because I mean I've been had it since [PII]. Well, I've been had it almost two years, but um, you know, so I'm just trying to see what actually, I know they said after 12 months before the cover like a root canal or crown or anything. So I'm just trying to see exactly what the coverage is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull that up for you.
[AGENT][NEUTRAL] And you were checking for a root canal?
[CUSTOMER][NEUTRAL] No, I just need a row.
[AGENT][NEUTRAL] Just a row, OK.
[CUSTOMER][NEUTRAL] And to see at the dentist, they told me I have $1500 that I can use or something a year or so uh however so often, but I still have to pay the majority of what needs to be paid, so I'm just trying to see exactly what do you cover.
[AGENT][NEUTRAL] OK, I'm pulling that up for you now and so it does show verification of coverage does not guarantee the payment of the claim. You do have up to the 1500 calendar year max, and for your crown and bridges, you get one once every 7 years per tooth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me go down to.
[AGENT][NEUTRAL] So I do see with the 1500, you, you're, you're allowed up to that one every 7.
[CUSTOMER][NEUTRAL] Right, OK, that's what I'm saying cause I'm at the dentist now and it's 1300 for the crown.
[CUSTOMER][NEUTRAL] And I'm trying to see how much of it do you pay? I do I pay the whole thing because I do have 1500 or what?
[AGENT][NEUTRAL] We pay up to the 1500.
[CUSTOMER][NEUTRAL] I'm just saying it's 13, so that's what I'm trying to find out it's it's 13 something so I'm just trying to see that under the 1500, do y'all cover all that or do y'all just cover a percentage?
[AGENT][NEUTRAL] It's showing you have the calendar year mix, but see, I will have to ask them what.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Category of expenses are they using for that? Let me see if I can find it.
[CUSTOMER][NEUTRAL] Yeah, cause I mean they trying to, um, you know, cause I just paid for this thing because they saying like y'all don't y'all only cover so you know you don't really, you only cover a certain amount, so I'm just trying to see so I double pay for something.
[AGENT][NEUTRAL] OK. So, if there, if it's considered for your major expenses, it does show that you only have 40% covered expenses of the UCR. So you, and then you did have a 12 month waiting period. So we will only pay up to that 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have had it over 12 months.
[CUSTOMER][NEUTRAL] Oh yeah, I paid the 40% of the 1500.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of the cover of the amount of the brace of the um the bread. So if it's 1350 of the crown, if it's 1350, we'll pay 40% of that.
[CUSTOMER][NEUTRAL] That's crazy, so, uh.
[CUSTOMER][NEUTRAL] Crown.
[CUSTOMER][NEUTRAL] OK, I'm just trying to make sure. So up so you pay for one up to 1500 but only pay 40%?
[AGENT][NEUTRAL] Yes, it's in up to 40% for the major expenses, but we do, you do have a calendar year max of 1500, so.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Within different categories, you only have a certain percentage. The only thing that's 100% is your preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's all I needed.
[CUSTOMER][NEUTRAL] OK, that's all I need. Well technically, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the crown wouldn't be considered preventative to keep me from needing a root canal.
[AGENT][NEUTRAL] No, the crown is not considered preventative. The crown is considered a major expense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just making sure though, cause like I said, my tooth broke yesterday when I was chewing gum, so I'm just trying to see what my insurance cover it. I'm just trying to make sure they're doing what they're supposed to do the right way cause I ain't never used it. So that's all. I'm just trying to make sure I'm paying what I'm supposed to pay.
[AGENT][POSITIVE] OK. It's no problem.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that was all I need to know, thank you.
[AGENT][POSITIVE] You're welcome and thank you so much, [PII] for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] No