AccountId: 011433970860
ContactId: a26cace7-4f92-4011-a437-424d5000f08e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 888900 ms
Total Talk Time (AGENT): 323651 ms
Total Talk Time (CUSTOMER): 393393 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/a26cace7-4f92-4011-a437-424d5000f08e_20250129T18:07_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII] how are you?
[AGENT][POSITIVE] Oh, I'm doing so wonderful. How about yourself today?
[CUSTOMER][POSITIVE] I am doing all right thank you um I'm just calling. I, I called already and talked to somebody she was very nice. I have a reference number if that makes it easier uh to not have to go through everything.
[AGENT][POSITIVE] Uh, I, I'll probably still have to do the whole verification process with you, um, but I can definitely do my best to help you out today. What's going on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm just a little bit confused on this patient's policy.
[AGENT][NEUTRAL] On the patient's policy, um, what is their policy number and I can help you with that.
[CUSTOMER][NEUTRAL] Uh, yeah, I have ID number is 2563718.
[AGENT][NEUTRAL] Alright, and while I'm, oh, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I am so sorry, um, my screen just like gave me a bunch of spinning circles. Um, while I'm pulling up this call, I think it knows it's cold out today.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Oh, that happens to me.
[CUSTOMER][NEGATIVE] Yeah, it just doesn't wanna do anything.
[AGENT][NEUTRAL] And could you mind if I get your name and a good call back number real quick while I'm pulling this up?
[CUSTOMER][NEUTRAL] Sure it's [PII] and it's [PII].
[AGENT][NEUTRAL] [PII]. Perfect. And if you could just verify, verify for me please, your insured's first and last name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's [PII].
[AGENT][POSITIVE] Perfect. And how can I help you with Ms. [PII] today?
[CUSTOMER][NEUTRAL] So, uh, the fax back is, it shows some stuff, but it is still kind of, kind of vague. Um, it's weird because the fax back says to uh claims should be submitted to American Public Life. Uh, the gal that I talked to said to submit it to Carrington.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, no, you can absolutely file claims with American Public Life. Um, the, the policy like is based off the Carrington B schedule, but we're gonna honor benefits no matter if you're in network with them or not, um, and you can absolutely send those claims here to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I, we'll say, OK, so yeah, claims do get sent to you guys. It's just the Carrington fee schedule.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's OK, so I think she just didn't, she just didn't have that correct is all. OK, um, and then.
[CUSTOMER][NEUTRAL] Let's see, I do wanna double check.
[CUSTOMER][NEUTRAL] Uh, so in and out of network, it doesn't matter, it's the same.
[CUSTOMER][NEUTRAL] Everything is the same, the coverage table, everything.
[AGENT][POSITIVE] Yes, absolutely, we don't have a network with APL, so we'll honor benefits anywhere.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I got you. OK, so you, you don't know if I should put it under like UCR or under my Carrington.
[AGENT][NEUTRAL] I would put it under Carrington because the way this policy is set up is the reason they partnered it with the Carrington PPO network is so that if a provider is in the Carrington PPO network, um, the insured gets it's a little cheaper right because Carrington like contracts those prices out um and if you're not in network whatever you end up charging is what you're gonna charge and we're gonna pay it based off of how Carrington prices it out.
[CUSTOMER][NEUTRAL] I just don't know what the schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, right, so I know there's different Carrington. There's like Carrington PPO. I have, I, I don't know if it's.
[CUSTOMER][NEUTRAL] Uh, Carrington Care PPO is different than Carrington PPO, right?
[AGENT][NEUTRAL] I think so, but honestly, I am like.
[AGENT][NEUTRAL] Very minimally aware of Carrington because this is the only dental plan we have that partners with them and, and that's as much as I know about their policies.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that makes it super hard. OK, um, so that's fine I guess I can look into that further, um.
[CUSTOMER][NEUTRAL] Could I just confirm what is the group name on this plan? It doesn't have a group name or group number on the fax.
[AGENT][NEUTRAL] OK, you bet you, and um, yeah, for whatever reason we actually don't have the group name or numbers on any of our fax backs, but I can give those to you, no worries um the group number is 70073.
[AGENT][NEUTRAL] And the group name is.
[AGENT][NEUTRAL] Vertella, V E R S T E L A.
[AGENT][NEUTRAL] Then the letter A
[AGENT][NEUTRAL] And then Terra, T E R R A.
[AGENT][NEUTRAL] Services
[AGENT][NEUTRAL] LLC Company.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] And uh let's see here so the max is 500.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And is this a calendar year plan or is this a policy or plan?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Perfect and um.
[CUSTOMER][NEUTRAL] is there are there any services for major?
[AGENT][NEUTRAL] Not with this policy, no, ma'am. I'm sorry.
[CUSTOMER][NEUTRAL] OK, no, that's OK. Hey, I, that's what I just wanted to confirm that I had it correct. Um, OK, so.
[CUSTOMER][NEUTRAL] Then I was wondering.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] OK, uh, are all exams 2 for 12 months combined? They're all 2 for 12 months.
[AGENT][NEUTRAL] Um, the oral evaluations.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] So it's only the procedure codes 120, 140, 150 and 160 in any combination two for 12 months.
[CUSTOMER][NEUTRAL] OK, OK, and uh, could you tell me if 9110 is a covered benefit please?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I do see 9110 covered under there. It's listed under their basic expenses.
[CUSTOMER][NEUTRAL] OK, so would that be, let's see, basic 80?
[AGENT][NEUTRAL] 80, yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, perfect.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there a frequency on that one?
[AGENT][NEUTRAL] That one actually has no limitations listed on it.
[CUSTOMER][NEUTRAL] OK, perfect. Um, OK, so let's see, I think I did see by wings once for 12 months. Do PA X-ray 0220 have a frequency?
[AGENT][NEUTRAL] 020.
[CUSTOMER][NEUTRAL] 0220 sorry.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm actually not sure if I'm showing that one as covered at all. Hold on one second.
[AGENT][NEUTRAL] Oh, of course.
[AGENT][NEUTRAL] Hang tight with me, Miss [PII].
[CUSTOMER][POSITIVE] Oh sure, you're fine thank you.
[AGENT][NEUTRAL] OK, yes, I'm not showing.
[CUSTOMER][POSITIVE] That covered? OK, no problem.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] I'm not showing a limitation on 0220 either, no, so that one, it doesn't show anything limiting it.
[CUSTOMER][NEUTRAL] OK, it is a covered benefit then?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And you said it it was a covered benefit or it's not a covered benefit?
[AGENT][NEUTRAL] It is covered. I'm not showing any limitations on it, and it's listed under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under basic, OK, so 80%. OK, thank you. Our so let's see, is FMX and.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK, yeah, FMX and bite wings, those are also under basic, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sorry, I've never
[CUSTOMER][POSITIVE] Dealt with this plan, so I'm just kinda running through it sorry about that.
[AGENT][NEUTRAL] You're OK, and it really is like a lot to look at, so.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah, it's really, it really is, um, would you be able to tell me if 12:06, what the frequency is for that please?
[AGENT][NEUTRAL] 1206.
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm actually not showing 1206 is covered. It looks like I have 12:01 through 12:05 on here, but no 1206. I don't even know if 12:01 through 5 are related to 1206, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I know, right?
[CUSTOMER][NEUTRAL] No, you're fine. It is, it's, it's kind of a strange plan, so, um, and Profi is one for 6 months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] Is that one at 100%?
[AGENT][NEUTRAL] That one is covered at, yes, preventative.
[CUSTOMER][NEUTRAL] OK, OK, thank you, um, how about 4346 please?
[AGENT][NEUTRAL] 4347.
[AGENT][NEUTRAL] I'm not showing that one is covered at all.
[CUSTOMER][NEUTRAL] OK, OK, um, and is 4355 covered?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, is 4910 covered?
[AGENT][NEUTRAL] No, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, don't be sorry, it's OK. Um, OK, and see.
[CUSTOMER][NEUTRAL] It so I'm assuming 4341 is definitely not covered in.
[AGENT][NEUTRAL] No, it looks like I only have like 2 codes that start with 4 on this policy.
[CUSTOMER][NEUTRAL] OK, that's OK, and um how about steel 1351 please.
[AGENT][NEUTRAL] 1351.
[AGENT][NEUTRAL] I'm not showing that one either.
[AGENT][NEUTRAL] You said for sealants?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No problem. OK, um.
[AGENT][NEUTRAL] It's oh I do see 1351. I'm sorry, I did have to search under the word ceiling instead, so it is covered under preventative. It has three limitations. Let me read them to you.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] I have one maximum 1 procedure for 36 months limited to dependent children [PII] and under and applications made to permanent molar teeth only.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you and um let's see.
[CUSTOMER][NEUTRAL] How about you guys downgrade on posterior composites? Is there like is there an alternate.
[AGENT][NEUTRAL] We don't downgrade.
[CUSTOMER][NEUTRAL] OK, no downgrade, OK, and what is the frequency to replace uh a uh.
[CUSTOMER][NEUTRAL] Resin composite.
[AGENT][NEGATIVE] For the resins, um, they list to replace only if I'm so sorry, I cannot talk replace existing only if in place for 24 months and then it's a maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And is 2950 a covered benefit?
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] Or is that considered, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not seeing 2950. I do see 2951.
[AGENT][NEUTRAL] But not 29
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK. So crowns like 2740.
[CUSTOMER][NEUTRAL] Doesn't look like crowns are covered benefit either then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so, uh, let's see. Sorry, it's like this is really strange.
[CUSTOMER][NEUTRAL] Um, OK. So then I'm assuming everything else pretty much is not covered. There's like no, uh,
[CUSTOMER][NEUTRAL] IV sedation or anything either.
[AGENT][NEGATIVE] No, I think those all fall under the major expenses.
[CUSTOMER][POSITIVE] It's a pretty pretty basic plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, yeah. OK, perfect.
[CUSTOMER][POSITIVE] OK. Well, that's easy enough. That's pretty easy. Is oral surgery a covered benefit?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, so endo and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] And that makes it easy.
[CUSTOMER][POSITIVE] I appreciate your help.
[AGENT][POSITIVE] Yeah it's my pleasure. If you have any other questions, go ahead and let us know we'll be here all day every day.
[CUSTOMER][NEUTRAL] OK, thank you so I do, OK, so I do send it to the [PII] then?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] OK, I appreciate that.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely I'm so glad you called back for clarification. Um, it's my pleasure.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah, me too, gosh.
[AGENT][POSITIVE] I wish you the best of luck and I hope you have a fabulous week.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK thanks you and you too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm bye bye.
[AGENT][NEUTRAL] Bye bye.