AccountId: 011433970860
ContactId: 8e17029c-49a2-485a-aa76-a5069e4c211f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1065089 ms
Total Talk Time (AGENT): 413729 ms
Total Talk Time (CUSTOMER): 379043 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/8e17029c-49a2-485a-aa76-a5069e4c211f_20250523T20:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] at Doctor [PII]'s office again. Um, I was calling my office manager wants me to get a breakdown, I'm more of a breakdown of this patient's benefits, um.
[CUSTOMER][NEUTRAL] Like is it through an employer or is it private plan?
[AGENT][NEUTRAL] OK, [PII], what type of policy are you calling about?
[CUSTOMER][NEUTRAL] Um, the.
[CUSTOMER][NEUTRAL] It's the American Public Life.
[AGENT][NEUTRAL] Is it medical, dental, what type of policy?
[CUSTOMER][NEUTRAL] Uh, dental, it's it's dental says group voluntary dental.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you're needing, you've already called you said that you're needing some additional information?
[CUSTOMER][NEUTRAL] Yeah, I got, yes ma'am, I got them to fax me the fax back um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But my office manager's never heard of this company before she's wanting me to ask a bunch of questions.
[AGENT][NEUTRAL] OK, so
[AGENT][POSITIVE] OK, so I can try and help you with this, [PII]. So first off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02613989
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] They got me out of it.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's been
[CUSTOMER][NEUTRAL] Crazy this afternoon.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so how can I help you?
[AGENT][NEUTRAL] And again, any information that I did provide [PII] will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, yes ma'am, um, OK, so is this through an employer or is it a private plan?
[AGENT][NEUTRAL] This is through an employer and the information that her group number is 70095.
[AGENT][NEUTRAL] And the group name is Temp Staff Inc.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Hang on one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Temp Staff Inc.
[AGENT][NEUTRAL] All one word, yes, and that's Testaff is all one word.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So electronic claims, do y'all do electronic claims?
[AGENT][NEUTRAL] Yes, ma'am, and the payer ID is on page one of the fax back.
[CUSTOMER][NEUTRAL] Is it 6?
[AGENT][NEUTRAL] In the middle section. Uh-huh.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Do.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Um, um, and when was it effective? [PII]?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And that should also be on your phone. It is, and that is stated.
[CUSTOMER][NEUTRAL] Is this a calendar year?
[AGENT][NEUTRAL] Under the patient's name and effective date on page one, it gives you the calendar year maximum and the calendar year deductible.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, um, is the deadline to send claims.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] With us.
[CUSTOMER][NEUTRAL] No deadline, OK.
[AGENT][NEGATIVE] No, we have no timely filing limit.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And it's single coverage right just for the individual.
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Deductible.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It should be on page, uh-huh.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][POSITIVE] I'm trying to work with you, I promise.
[AGENT][NEUTRAL] OK, page one, under the patient's name and effective date, it has the calendar year maximum and the calendar year deductible, and that's in bold letters.
[CUSTOMER][NEUTRAL] OK, I see it, it is.
[CUSTOMER][NEUTRAL] 7:50.
[CUSTOMER][NEUTRAL] Deductible is.
[CUSTOMER][NEUTRAL] 50.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and she has no history so the max has not been reached.
[AGENT][NEUTRAL] That is correct. There is no history on file as of now.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Preventative coverage.
[AGENT][NEUTRAL] That's just below where the calendar month. Mhm.
[CUSTOMER][POSITIVE] Is 100%.
[CUSTOMER][NEUTRAL] I don't know why she's got me doing this, but she does, uh, is the deductible applied to the preventative?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It is not.
[AGENT][NEUTRAL] And, and it states that right up under the deductible information.
[AGENT][NEUTRAL] It says deductible does not apply to preventative services.
[CUSTOMER][POSITIVE] Alright thank you
[CUSTOMER][NEUTRAL] Uh, yeah, I saw that.
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Basic coverage is 80%.
[AGENT][NEUTRAL] And it is subject to the deductible.
[CUSTOMER][NEUTRAL] It is subject to the deductible.
[AGENT][NEUTRAL] It is. Everything other than as it states, preventative services, the deductible does not apply, but it would apply to the other covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It OK it will apply to.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, so, major.
[AGENT][NEUTRAL] No coverage?
[CUSTOMER][NEGATIVE] Major coverage is, she has no major coverage.
[AGENT][NEGATIVE] Not covered. Correct.
[CUSTOMER][NEUTRAL] 000.
[AGENT][NEUTRAL] Correct. If it's not listed under the categories there, it's not covered. If you come on down a little bit.
[AGENT][NEGATIVE] That's not listed, it's not covered. Same thing with the codes.
[AGENT][NEUTRAL] The codes are listed under each category. Those are the ones that are covered under her plan.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Noero.
[AGENT][NEUTRAL] It's basic and preventative only. Mhm.
[CUSTOMER][NEUTRAL] Sorry, I'm trying to look.
[AGENT][NEUTRAL] There it has the category, yeah, so it says category of expenses and it gives you the percentage. Those are the categories that are covered.
[CUSTOMER][NEUTRAL] Basic and preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Is there an uh oh it says no ortho coverage.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Missing tooth claws. I thought I saw something.
[AGENT][NEUTRAL] Under common explosions, it says does have a missing tooth cloth. Mhm.
[CUSTOMER][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Replacement calls.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So there's no missing too, I mean no replacement calls?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No waiting period, 0, it says all this right here.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEGATIVE] I feel like I'm wasting your time.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Exam frequency.
[AGENT][NEUTRAL] And that's listed right above or right under the categories of expenses that gives you the frequencies for services.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And it lists out for trophies, oral bite wing and full mouth and panos.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 2 for 12 month period for exams.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Fluoride, no fluoride, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Now there
[CUSTOMER][NEUTRAL] No ceiling.
[AGENT][NEUTRAL] What code are you looking at? Because
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Seances per tooth.
[AGENT][NEUTRAL] It's gonna be dependent upon the code.
[CUSTOMER][NEUTRAL] BD and E.
[AGENT][NEUTRAL] So the you've got the CDT codes in the far left column, your descriptions in the middle, and limitations and then your categories of what that falls under.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's gonna be dependent upon the code. Mhm.
[CUSTOMER][NEUTRAL] Yeah, I see it.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Perio maintenance.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There is no perio benefits.
[CUSTOMER][NEUTRAL] No period.
[AGENT][NEUTRAL] Only basic
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, only the, only basic and preventative.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] That's the only category.
[CUSTOMER][NEUTRAL] And then the
[CUSTOMER][NEUTRAL] Yeah. What about the pan, the panoramic X-ray, which is the big X-ray?
[AGENT][NEUTRAL] What's the code?
[CUSTOMER][NEUTRAL] I'm trying to find it.
[CUSTOMER][NEUTRAL] Code that we use.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] D 0330.
[AGENT][NEUTRAL] OK. So that if you look, that's false and the codes are numbered. I mean, they're a numbered order. So if you, if you go to page 3 or 4, it's listed on the very, the very last.
[CUSTOMER][NEUTRAL] I found it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Code.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] On that page.
[CUSTOMER][NEUTRAL] OK, so what's the we're under limitation when it has the letter what does that mean?
[AGENT][POSITIVE] Come all the way down to the to the next page.
[AGENT][NEGATIVE] You're on page 3 of 4, go to 404, and there's all the limitations, the A B C D.
[AGENT][NEUTRAL] In parenthesis?
[CUSTOMER][POSITIVE] I see it. I do. I see it. I'm so sorry.
[AGENT][NEUTRAL] So, that's OK. So you're looking for M.
[AGENT][NEUTRAL] And it tells you what the limitation is there.
[CUSTOMER][NEUTRAL] OK, so limited to one.
[CUSTOMER][NEUTRAL] X-ray procedure per 5 OK so it's 5.
[CUSTOMER][NEUTRAL] Every 5 years.
[CUSTOMER][NEUTRAL] OK, and is it covered under preventative?
[AGENT][NEUTRAL] And if you go right back up, yep, see it shows radi uh one page.
[CUSTOMER][NEUTRAL] Let me go back to my page.
[AGENT][NEUTRAL] That falls under the Radio FMX category.
[CUSTOMER][NEUTRAL] So, that is.
[AGENT][NEUTRAL] So that is subject to the deductible, and then the benefits are 80% of the allowable.
[CUSTOMER][NEUTRAL] So it's, it is covered under preventative.
[AGENT][NEUTRAL] No, it's it's, it's covered under. OK. On page one, it gives you your categories of expenses. Do you see that?
[CUSTOMER][NEUTRAL] But it's
[AGENT][NEUTRAL] And it shows you preventative expenses is 100% of allowable, and then it comes, it says radiographs, FMX expenses, basic expenses, and basic restorative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So on the
[AGENT][NEUTRAL] On that code on 0330, it showed that under the Radio FMX.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Category
[AGENT][NEUTRAL] So that's right below the word preventative expenses.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The only thing as it states, I mean, the only, the deductible does not apply to preventive services.
[AGENT][NEUTRAL] It does apply to the other three categories.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the deductible does apply.
[AGENT][NEUTRAL] Correct, 0330.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But it just doesn't go, it doesn't apply to the preventative, OK.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Are crowns paid on seat date or prep date?
[AGENT][NEUTRAL] Feet.
[CUSTOMER][NEUTRAL] And I'm sure that's on here too.
[AGENT][NEGATIVE] It's paid on the seat. Mhm. And crowns are not covered because there's no benefits for major services.
[CUSTOMER][NEGATIVE] Sick day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] But no coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and no history, so.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] OK, I'm sorry, I feel like I just wasted your time.
[AGENT][NEGATIVE] No, you're fine. You did. Not at all.
[CUSTOMER][NEUTRAL] But she did not wanna I guess she just didn't wanna go through and have to look at all that so she just wanted me to call.
[AGENT][NEUTRAL] Oh, OK then. Well, do you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That I can help you with?
[CUSTOMER][NEUTRAL] I don't think so.
[AGENT][NEUTRAL] OK. And then when, when you, um,
[CUSTOMER][NEUTRAL] I don't think so. You can come, you can answer this phone for me.
[AGENT][NEUTRAL] Well, I don't know. You, if you, I would need somebody to answer mine, so I don't know that you would really want to swap, but.
[CUSTOMER][NEUTRAL] Yeah, it's.
[AGENT][NEUTRAL] Um, and [PII], I did wanna ask you when you called in a little while ago, um, did they tell you about our portal that you can check claim status in once we process the claim?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, so we do have a portal that once we have processed the claim fully, you should be able to check the member's claim status there and that website that you would go to is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just for future reference, uh huh, and then yeah it's a self registering portal again, but that's not for eligibility, that is just for checking plane status as you know, as of now.
[CUSTOMER][NEUTRAL] So that's the portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right well uh thank you for being patient.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are, oh, no, ma'am. You're very welcome. It was my pleasure in speaking with you, [PII]. So, if there's nothing else that I could help you with, I hope you have a wonderful holiday weekend.
[AGENT][POSITIVE] And thank you again for calling APL, yes ma'am.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you. All right.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.