AccountId: 011433970860
ContactId: 8be930ff-a806-4b7d-8e62-0a8911af3a28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 932409 ms
Total Talk Time (AGENT): 425880 ms
Total Talk Time (CUSTOMER): 305725 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/8be930ff-a806-4b7d-8e62-0a8911af3a28_20250324T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I had a dental cleaning, um.
[CUSTOMER][NEUTRAL] At a dental facility in [PII] over the weekend.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] They just got a call from their admin, they're they're um not sure exactly how to um proceed with the claim, so I wanted to call and uh find out for myself what needs to happen.
[CUSTOMER][NEUTRAL] Um, so what, what steps do I take now? I, I've never had.
[CUSTOMER][NEUTRAL] Uh, this plan before this year.
[CUSTOMER][NEUTRAL] So I've never had a dental experience before with this plan. Um, what do I need to do in order to get my dental cleaning covered?
[AGENT][NEUTRAL] I can help you with that. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And do you have your dental, um, APL ID number available?
[CUSTOMER][NEUTRAL] I sure do.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Yep it's 025.
[CUSTOMER][NEUTRAL] 84613
[AGENT][NEUTRAL] And what is your name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And if you don't mind, can we verify your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] Yeah, um, my billing address is [PII]. The zip code is [PII].
[CUSTOMER][NEUTRAL] Uh my phone number is [PII].
[AGENT][NEUTRAL] And then finally, your Gmail address, please, sir?
[CUSTOMER][NEUTRAL] My gmail, [PII].
[AGENT][POSITIVE] Perfect, thank you for that verification. We do um try to protect your information so just making sure you are you.
[AGENT][NEUTRAL] And it
[CUSTOMER][POSITIVE] That's good.
[AGENT][POSITIVE] It would be my pleasure to assist you now. Did they say that they were going to file a claim with us?
[CUSTOMER][NEUTRAL] No, I think the admin was pretty much confused um and asked me to call you directly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I wonder what they're confused about. OK, let me give you all the information on your policy and see if that helps.
[CUSTOMER][NEUTRAL] Yeah, it's like uh like.
[CUSTOMER][NEGATIVE] It's a phrase. It was, it was not very nice. Uh, basically they just said, uh, we don't know if they're gonna pay anything at all, um, so, um, yeah, yeah, uh, that's, so I wanted to call you and get, you know, directly from the horse's mouth like what you guys are willing, what you guys do, um.
[AGENT][NEUTRAL] What?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEGATIVE] Yeah, well, because when I heard that voicemail, it was almost like, oh my gosh, like this is a scam, what's going on? So I wanted to call you and find out what needs to happen, um, and then we can go from there.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely, and I can help you with that. Now, Mr. [PII], your policy, if they ask for a network, it does participate in the Carrington PPO network.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Now it is not required that you go, I tell you what, if you were, are you at a computer? I can help you create that login and password and you can actually pull up your policy online.
[CUSTOMER][POSITIVE] Oh, that'd be great thank you yeah.
[AGENT][NEUTRAL] Sure, if you will go to [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, just let me catch up. Hold on a second, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I want to get on.
[CUSTOMER][NEUTRAL] Like a work computer I wanna get to my personal computer.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] Alright, here we go now, alright, I am ready. What's the email? What's the what's the website address?
[AGENT][NEUTRAL] It's secured [PII]
[CUSTOMER][NEUTRAL] Security.
[CUSTOMER][NEUTRAL] So basically it's it's secured SVC and then what?
[AGENT][NEUTRAL] Uh secured [PII] I just spelled out the word secured.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh, OK, got it. OK, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, good. All right, I'm on the website.
[AGENT][NEUTRAL] Go to a new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It'll ask you a question. You're gonna choose, I am an individual with an APL policy.
[CUSTOMER][POSITIVE] Great. OK.
[AGENT][NEUTRAL] And then it's gonna ask you to enter your information. You will need to put in your complete social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] To email
[CUSTOMER][NEUTRAL] OK, date of birth.
[CUSTOMER][NEUTRAL] Right, next.
[CUSTOMER][NEUTRAL] Username
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] It's word, um.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] thing.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's my email again.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Text message from then.
[CUSTOMER][NEUTRAL] OK, I read and accept, OK.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] Submitting
[AGENT][NEUTRAL] OK, I see that it's been activated.
[CUSTOMER][NEUTRAL] I'm thinking.
[CUSTOMER][POSITIVE] Great
[AGENT][NEUTRAL] Once it gets through thinking.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] You can sign in and we can.
[CUSTOMER][NEUTRAL] All right, my here we go.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] So, if you, once you're in, you'll see your three policies that you have with APL, your dental, life and disability. You can click on the dental pol[PII].
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Uh, I just logged in. Uh, it's gonna need to do something. I.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] Ok, verify uh what is it for.
[CUSTOMER][NEUTRAL] I just want you to verify something just a second.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I want to, uh, just a minute, yeah, bear with me. Hold on a second. I need to do something real quick.
[AGENT][POSITIVE] Take your time. You're fine.
[CUSTOMER][NEUTRAL] people that were on, um.
[CUSTOMER][NEUTRAL] OK, let's see if I can.
[CUSTOMER][NEUTRAL] Do do do.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, and I have all the time in the world. OK, so now.
[CUSTOMER][NEUTRAL] Um, I'm in here. I'm looking at the group voluntary dental.
[AGENT][NEUTRAL] And you can click on your, that policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it will download your policy documents, your certificate.
[CUSTOMER][POSITIVE] Great. OK.
[AGENT][NEUTRAL] And if you look on page.
[AGENT][NEUTRAL] Let's see. Mine is page 7.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So can I give you the category of expenses?
[AGENT][NEUTRAL] Showing that your preventive expenses are covered at 100%.
[AGENT][NEUTRAL] And then your radiographs FMX basic and basic restorative procedures are covered at 80%.
[CUSTOMER][NEUTRAL] OK, so it says you, it's your page 7, is that right?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It's my page 7. It's um called the cert certificate schedule of Benefits, GCD 4 dental insurance certificate.
[AGENT][NEUTRAL] And it's got your name, your policy number, your
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Associated company.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I think it's like 3 page 3, I think, um.
[AGENT][NEUTRAL] Oh, is it? Yeah, it could be.
[CUSTOMER][NEUTRAL] Yeah, yeah, it might be true, OK.
[AGENT][POSITIVE] And if you scroll down a little bit, it'll show you your preventive expenses are covered at 100%.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And then your radiographs mix and basic and basic restorative is covered at 80%.
[CUSTOMER][POSITIVE] Good, OK.
[AGENT][NEUTRAL] Now, if you scroll down through the policy.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So just just a quite random question. So let's say I had a filling, what would that fall under?
[AGENT][NEUTRAL] That's under basic at 80%.
[CUSTOMER][POSITIVE] OK. All right, all right, great.
[AGENT][NEUTRAL] Now there is a $50 deductible per calendar year, so they would deduct deduct that $50 deductible from any benefit payment.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, including the preventative or no?
[AGENT][NEUTRAL] For preventive, the deductible does not apply to preventive services.
[CUSTOMER][POSITIVE] OK great thanks.
[AGENT][NEUTRAL] The cleanings, your just your um annual exams.
[AGENT][NEUTRAL] Um, your basic, they're called bite wing wing X-rays. Those are covered under preventive. That is all covered at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Nice.
[AGENT][NEUTRAL] And if you continue to scroll through the policy under part 3, it will give you the procedures that are covered.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And at what it'll tell you whether it's preventive or basic. It's gonna be part 3 in the top, it's gonna say schedule a covered dental services and procedures.
[CUSTOMER][POSITIVE] OK, I see that great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the top portion that little block is like your code for frequencies saying how many we would pay per calendar year.
[AGENT][NEUTRAL] If there's any limitations, those are all the procedures that are listed, um, covered, that are listed that are covered, sorry.
[CUSTOMER][POSITIVE] All right, good.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] And um providers can file claims for you and we can pay them direct.
[AGENT][NEUTRAL] If you're calling to schedule and they ask you, is it a PPO plan, the policy does participate in the Carrington PPO network, but it is not a requirement. We pay both in and out of network benefits the same.
[AGENT][NEUTRAL] That just simply means according to that schedule that you're looking at?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's what we pay whether they're in network or out of network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Nice. OK, good.
[AGENT][NEUTRAL] So if you go to a
[CUSTOMER][NEUTRAL] So what uh what information do I need to relate back to them, um.
[AGENT][NEUTRAL] I would tell them that your policy pays both in and out of network benefits.
[AGENT][NEUTRAL] It does participate in the Carrington PPO network. That simply means if they're a Carrington provider, they will use the fee schedules that they are contracted to use through Carrington Network. If they're not, they'll use their office.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they schedule what they charge and then we pay according to the policy guidelines.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And we do pay providers, you know, if, if you provide that assignment of benefits, they may ask, what about the assignment of benefits? It is standard if they do happen to ask that, it's standard.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And beyond that, they can call us.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And we can verify your benefits and we can fax them a fee schedule showing what's covered.
[CUSTOMER][NEUTRAL] OK, um, alright, let me do this real quick, um.
[CUSTOMER][POSITIVE] So the outfit is Century Dental. It's, it's a rather, it's a good size dental practice, um, probably one of the largest one.
[CUSTOMER][NEUTRAL] In terms of the size of their office.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Do let me see if I can get a fax number for them.
[AGENT][NEUTRAL] Yeah, actually if they would call us we can give them all of the information and we would send them a provider breakdown of benefits which is gonna have the procedures listed it'll have your effective date and they pay the paying information, you know, where they submit claims it's for the providers it's a little different than what you have, but it, it includes the same information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright great alright I'll call him back and um.
[CUSTOMER][NEUTRAL] Let them know
[CUSTOMER][NEUTRAL] That you guys are on the up and up and um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And then they should call you for more information. I don't, you know what happened to fax numbers I don't know, but they're not, they're not providing one, so I will, I will call them back and then, uh, talk to their admin.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, please do it if there's still an issue. Here's what I suggest, Mr. [PII]. Ask them if while you've got them on the on the call if you can do a three way call to APL and let, let us talk to them that way, you know, if they're not gonna take the time to call, you call us. Let's talk to him, tell him to get that claim over here so we can get you taken.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Care of
[CUSTOMER][POSITIVE] All right, let's do it right.
[CUSTOMER][POSITIVE] Thank you very much for your help. I really appreciate it.
[AGENT][NEUTRAL] And on that portal if you ever want, sure it's my pleasure and if you ever want to view your disability and life policy, you would just click on those claim numbers as well. And then once we receive a claim if you want to sign in to see if we've received a claim, it'll be an open document you can also sign up for text messaging for when we receive a claim and when it's processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, I did actually when I logged in it prompted me and I did that, so good.
[AGENT][POSITIVE] Good deal.
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] No, I think I'm good, um.
[CUSTOMER][POSITIVE] Oh, OK, OK, good. I think I'm good. All right, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] My pleasure, Mr. [PII]. You give us a call back if we can be of further assistance, and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you bye bye.