AccountId: 011433970860
ContactId: 8c25ea65-2a90-43ef-8089-a82e1bacb757
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386529 ms
Total Talk Time (AGENT): 156671 ms
Total Talk Time (CUSTOMER): 112024 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/8c25ea65-2a90-43ef-8089-a82e1bacb757_20250113T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I just need a benefits breakdown for a patient.
[AGENT][POSITIVE] Sure, I can assist you with benefits. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], and Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII] um option two.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] It looks like it is 02516632.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is [PII]. Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And you need this information given to you verbally or faxed over to you.
[CUSTOMER][NEUTRAL] Um, she's in the office now, so can I just get it over the phone?
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] And is this under a um a policy with Carrington or would it be American Public Life?
[AGENT][NEUTRAL] If the
[AGENT][NEUTRAL] It's gonna be through American Public Life if the provider participates with Carrington, they can use their fee schedule, but it's not required. We're not contracted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, give me just one second.
[CUSTOMER][NEUTRAL] Mm I'm just gonna be then.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is there a deductible?
[AGENT][NEUTRAL] Yes, uh, the deductible is $50 and the deductible does not apply to preventative, so it's only for radiograph, FMX, basic expense, and basic restorative expense.
[CUSTOMER][NEUTRAL] OK, give me one second. BPO.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh here OK so.
[CUSTOMER][NEUTRAL] Is there a deductible, I mean not a deductible, a maximum?
[AGENT][NEUTRAL] Mhm. Yes, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. We have a calendar year maximum of $500 per insured.
[CUSTOMER][NEUTRAL] OK, 500 OK.
[AGENT][NEUTRAL] And this is one of our basic dentals.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] And is basic and not basic is.
[CUSTOMER][NEUTRAL] Diagnostic and preventative covered at 100%.
[AGENT][NEUTRAL] Uh, yes. Preventative expenses cover 100%. Radiograph FMX is covered at 80%. Basic expense and basic restorative expenses covered at 80%, and there is no major service. So endodontics, periodontics, prosthodontic, repain surgery are not covered.
[CUSTOMER][NEUTRAL] OK, so no, no oral surgery is not covered?
[AGENT][NEUTRAL] No, unless it's a simple extraction, which is under the basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then are implants covered?
[AGENT][NEGATIVE] No, no coverage for implants.
[CUSTOMER][NEGATIVE] No coverage for dentures either.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No major service at all on this one. It's just basically.
[CUSTOMER][NEUTRAL] OK, and no
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] How many exams can they have in a year?
[AGENT][NEUTRAL] OK, so the exams, let's see, is 2 for 12 month period. The cleanings is once every 6 months.
[AGENT][NEUTRAL] Um, the bite wings is once every 12 months, and the full X-rays or panel is once every 5 years.
[CUSTOMER][NEUTRAL] Once every 5 years, OK.
[CUSTOMER][NEUTRAL] And then you said the cleaning is one every 6 months?
[AGENT][NEUTRAL] Yes, can use once every 6 months. Mhm.
[CUSTOMER][NEUTRAL] OK, and then, um, everything else is not covered like fluoride, per maintenance, none of that's covered.
[AGENT][NEUTRAL] Um, fluoride, uh, that one has like an age limit. It is under preventative. Um, the fluoride, let me give you that information. So it's going to be limited to dependent children age [PII], maximum of 1 procedure per 12 months. Um, and you said the Clans.
[CUSTOMER][NEUTRAL] Perio maintenance.
[AGENT][NEUTRAL] Um, period is not covered now.
[CUSTOMER][NEUTRAL] OK, so everything else is not covered. OK, what is um the mailing address?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The address is make claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] All right, that's all I needed to know.
[AGENT][POSITIVE] All right, well thank you for calling APL. Have a good day. If you have any other questions, just feel free to call us back, Miss [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling ATM. Have a good afternoon.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.