AccountId: 011433970860
ContactId: 9f8e4ac2-7fcb-4e04-a7cc-49eb08f18f2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432739 ms
Total Talk Time (AGENT): 164570 ms
Total Talk Time (CUSTOMER): 195038 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/9f8e4ac2-7fcb-4e04-a7cc-49eb08f18f2f_20250303T16:20_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I have an insured on the line, Mr. [PII].
[CUSTOMER][NEUTRAL] Um, with policy number 2554424.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, he is requesting, um, uh, to have information about his benefits, what is covered and what is not. Is that something you can help him with?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'll be happy to assist.
[CUSTOMER][POSITIVE] All right. Well, thank you very much. I already have um verified everything for him and ordered an ID card for him.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] Hi, this is [PII] with APO claims department. How are you?
[CUSTOMER][POSITIVE] I'm doing pretty good. Thanks for asking. How are you doing?
[AGENT][NEUTRAL] OK, I'm good. I understand you were calling for information about your benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, please be advised the verification of coverage is not a guarantee of payment.
[CUSTOMER][NEUTRAL] I sure am.
[AGENT][NEUTRAL] And I do show you have our dental policy with the calendar year maximum of $1500 and a $50 copay or I'm not copay but deductible.
[AGENT][NEUTRAL] Um, and what questions in regards to the benefits did you have?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I need to see, um, actually, let me tell you what I'm up against. Um, I'm a truck driver, and, um, I have got an abscess tooth.
[CUSTOMER][NEUTRAL] I'm trying to get home to get the abscess tooth infection taken care of and possibly get that tooth um pulled out.
[CUSTOMER][NEUTRAL] So I need to see if my insurance or what the benefits is and how that works. I've never used dental insurance before.
[AGENT][NEUTRAL] OK. Um, now, do you know whether or not it's gonna be considered a simple extraction or oral surgery?
[CUSTOMER][NEUTRAL] I'm hoping it's just a simple extraction because I just this that one tooth is the only tooth in on that side of my mouth that I've got.
[CUSTOMER][POSITIVE] And I've got to get it's got to come out.
[CUSTOMER][NEUTRAL] I don't know yet until I get to a dentist to, you know, to get an X-ray done, um, to see what, you know, what it is.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] If it's a
[CUSTOMER][NEUTRAL] I'm thinking just a regular extraction just to pull that tooth out.
[AGENT][NEUTRAL] OK. So if it's a simple extraction, that's covered under the basic, um, that will be subject to the $50 deductible, and then we will pay 80% up to that $1500 maximum. Now, if it's considered major oral surgery, that will be considered major and major is not covered until after your waiting period is up on [PII] of this year.
[AGENT][NEUTRAL] So it's, you're just gonna have to.
[AGENT][NEUTRAL] Um, ask the provider, well, they'll more than likely the provider is gonna call us anyway to have us fax over your benefits.
[AGENT][NEUTRAL] But just so you know, um, if it's a simple extraction, then you're good to go because it's under the basic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, is there a list of dentists and stuff that you guys use that carries the APL, or do you have a list of a dentist in my area?
[AGENT][NEUTRAL] I do. OK, and if you can verify that email address for me?
[CUSTOMER][NEUTRAL] It is um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the zip code um for the area that you would like the providers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I've just emailed you a list of providers in that zip code.
[AGENT][NEUTRAL] You should receive that uh within the next few minutes.
[CUSTOMER][NEUTRAL] Yeah, I think I just heard it click on my phone. Um, so basically, I'll just make sure I have this correct because I've got to, I got to get it taken care of either way. Um, it's, if it's just a simple extraction, it's um.
[CUSTOMER][NEUTRAL] $50 deductible which I pay the $50 when I go to the dentist and
[CUSTOMER][NEUTRAL] You guys would pay 80% up to $1500.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, um, I will get that, um.
[CUSTOMER][NEUTRAL] Email and look at the doctors and stuff and go, go get me one so I get taken care of. And um
[CUSTOMER][NEGATIVE] Everything, I think she's supposed to be sending me some cards and stuff too because I never.
[CUSTOMER][POSITIVE] Got the cards. OK, that helps me out, you know that I know.
[AGENT][NEUTRAL] Yes, she did say she.
[AGENT][NEUTRAL] But she did say she.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Yeah, now X-rays, X-rays that is that paid 100% or is that still gonna be included in the $50 deductible if I'd have the extraction done?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, X-rays are covered at 80%. So that's considered basic, so we would cover that at 80%.
[AGENT][NEUTRAL] And it's still subject to the deductible.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The only thing covered at 100% would be the exams.
[CUSTOMER][NEUTRAL] I know, I
[AGENT][NEUTRAL] The preventative services.
[CUSTOMER][NEUTRAL] X-ray.
[AGENT][NEUTRAL] Well, actually.
[AGENT][NEUTRAL] Let's see, the bite wings are preventative, so that will be covered at 100%.
[AGENT][NEUTRAL] But any
[AGENT][NEUTRAL] Yeah, any other type of X-rays would be considered basic and that would be covered under the 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then they're probably gonna have, they're probably gonna have to do an X-ray of my jaw to see what it looks like in there, infection and stuff so I know, I know an X-ray is gonna have to be done. That's why I wanted to just to know what the, what the coverage is to have an X-ray done.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, it just depends I don't, it depends on which code they're gonna be billing. So if it's a preventative code under by wing, um, then it's under the preventative and, and that's covered at 100%. But if it's one of the codes that's under the basic.
[AGENT][NEUTRAL] Um, then that will be covered at the 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. So, but they'll call the, whoever I go to, they, they're gonna call and get my benefits anyway before anything is done, so, uh.
[AGENT][NEUTRAL] Yeah, they're gonna call and have us fax over your benefits. Yeah, there you'll know, yes.
[CUSTOMER][NEUTRAL] I'll know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah. OK, well, I thank you, ma'am.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, can you, can, can, can you verify my policy number to make sure I have my right policy number down?
[AGENT][NEUTRAL] OK, I'm showing it's 2554424.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yep, that's it.
[CUSTOMER][POSITIVE] All right, thank you, ma'am.
[AGENT][POSITIVE] OK, well thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] Uh, uh-huh, you too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.