AccountId: 011433970860
ContactId: 9e46007e-c1a1-4056-8512-a1c7a2469fb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415100 ms
Total Talk Time (AGENT): 116977 ms
Total Talk Time (CUSTOMER): 210510 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/9e46007e-c1a1-4056-8512-a1c7a2469fb9_20250306T18:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], this is the last initials [PII] How are we doing today?
[AGENT][NEUTRAL] I'm doing fine. How are you, [PII]?
[CUSTOMER][POSITIVE] I'm great, thank you for asking. Um, I was calling to see um if I can get breakdown benefits for a patient of mine or to see if she have benefits with you guys.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yes ma'am, [PII] option 2.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] It is 02451088.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] It is [PII]. It's [PII] Last name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. Do you want them over the phone or would you like a fax back?
[CUSTOMER][NEUTRAL] We can do it over the phone, but this is Carrington Network and is the Carrington PPO plan.
[AGENT][NEUTRAL] We use Carrington's network. The insurance is through APL.
[CUSTOMER][NEUTRAL] OK, APO. OK, give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] AP.
[AGENT][NEUTRAL] We only use their network.
[CUSTOMER][NEUTRAL] Is it a mirror plan?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That's what I'm OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK, there it goes.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] And and your claims address?
[AGENT][NEUTRAL] PO [PII] 248,950.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oklahoma City, Oklahoma.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, and your payer ID is?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yes ma'am. OK, and can we start with the deductible?
[AGENT][NEUTRAL] Any benefits given over the phones, not a guarantee of payment. The deductible is $50. It applies to all classes but preventative.
[CUSTOMER][NEUTRAL] OK, what about her maximum?
[AGENT][NEUTRAL] Her max is 500 per calendar year.
[CUSTOMER][NEUTRAL] OK, and is, yeah, you did say calendar. I'm sorry. Does this patient have any orthro coverage?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, does this patient have any waiting periods?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, um, what about, um, group coverage diagnosed for any basic and major.
[AGENT][NEUTRAL] Preventative is paid at 100% of usual and customary rate.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic is 80.
[AGENT][NEUTRAL] And major is not covered. So any endodontics, periodontics, or surgery crowns, bridges, partials, dentures are not covered.
[CUSTOMER][NEUTRAL] Can you come around for me, please?
[CUSTOMER][NEUTRAL] Oh, nothing is really covered.
[AGENT][NEUTRAL] Only fillings and simple extraction fall under basic.
[CUSTOMER][NEUTRAL] OK, give me one second. Let me go back because it's giving me a yes and no answer, so give me, let's go back, hm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, let's see something really quick.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Let me see, give me one second. I'm so sorry. I just wanna make sure I put this in right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Do basic is 80 and she has, you said she have no major coverage.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so crowns, bridges, and dentures are not covered as well as endoparial uh surgery?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] No implants.
[AGENT][NEUTRAL] No, no, ma'am.
[CUSTOMER][NEUTRAL] No anything, huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, and what you said simple extractions was on the basic.
[AGENT][NEUTRAL] Uh-huh. Only the a simple extraction, the 7140.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is her exam 0120, is that covered?
[AGENT][NEUTRAL] Yes, it would be covered under preventative.
[CUSTOMER][NEUTRAL] OK, and then she get, is it 2 per plan here? The frequencies of those.
[AGENT][NEUTRAL] All exams are 2 for 12 months.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now, the only exams that fall under preventative is 120 and 150.
[AGENT][NEUTRAL] 140 and 160 is under basic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And the 180 is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, our plan is confusing. Um, I don't know I can I have a fax back on on this?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I can, OK.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll fax that to you.
[CUSTOMER][NEUTRAL] OK, I'm was just confused um before I let you go, I was just kinda confused because.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So the insurance name is American Public Life and the plan is Carrington.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, we only use Carrington's network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see.
[AGENT][NEUTRAL] It's American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yes.
[CUSTOMER][NEUTRAL] I was just confused because sometimes they give me the yes and no answers, so.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][POSITIVE] OK, um, yes ma'am, so whenever I just get the fax back I'll just fill in the rest of this. Thank you so much for your help today.
[AGENT][POSITIVE] You're welcome. Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] Get a pen
[CUSTOMER][POSITIVE] Yes ma'am you too bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.