AccountId: 011433970860
ContactId: a39045a5-9503-4291-8841-df1330ce21d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558580 ms
Total Talk Time (AGENT): 184097 ms
Total Talk Time (CUSTOMER): 121596 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/a39045a5-9503-4291-8841-df1330ce21d2_20250305T19:06_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I had a patient come in who is insured through APL Carrington Solutions, um, where I send claims to American Public Life Insurance Company.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And during her exam today, she, it was discovered that she needs a
[CUSTOMER][NEUTRAL] Uh, filling for a 3 surface, uh, posterior.
[CUSTOMER][NEUTRAL] And the code is D2393?
[CUSTOMER][NEUTRAL] And we would be out of network and she needs to know how much her portion would be.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me take a look at the policy, but I'll be more than happy to help you with our coverage. And um may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. I'm with New Image Dental.
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the policy number?
[CUSTOMER][NEUTRAL] 02569963
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] what
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But I have to go and I was trying to get her date of date of birth.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] I'm sorry, did you hear me?
[AGENT][POSITIVE] Thank you. Yes, I did.
[CUSTOMER][NEUTRAL] Oh, OK, great. Sorry, I didn't mean to talk over you.
[AGENT][NEUTRAL] Alright, it's fine and thank you for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. Um, so let me see, you said it was called.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] 2393.
[CUSTOMER][NEUTRAL] D as in David,
[CUSTOMER][NEUTRAL] 2393.
[AGENT][NEUTRAL] OK, hold on one moment. 2393.
[AGENT][NEUTRAL] So 2393 resin composite posterior is under basic restorative, which is at 80%, um.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months. And what was the other code? Hold on one moment.
[AGENT][NEUTRAL] And maximum of 1 each tooth per 24 months. So, um, the policy will pay up to 80%.
[CUSTOMER][NEUTRAL] 80% of the 182.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 80% of what the, whatever the amount is for that code.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, what was the 182 you mentioned?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Did you say that it was a maximum of 182?
[AGENT][NEUTRAL] 182.
[AGENT][NEUTRAL] I mean, it's 800% the policy would cover.
[AGENT][NEUTRAL] 182.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah because when I heard you say 182.
[AGENT][NEUTRAL] Oh, no, I'm not sure. No.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and what's, um, do you know what the usual and customary for zip code [PII] is for that code?
[AGENT][NEUTRAL] This policy isn't under um UCR.
[CUSTOMER][NEUTRAL] Oh, I thought that's what I was told before.
[AGENT][NEUTRAL] Hold on one moment, let me double check.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Who is here.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, yeah, I definitely do apologize for the wrong information, um.
[AGENT][NEUTRAL] was given for this policy is not on UCR, it's on allowable um or percentage of allowable and um even if the the provider is not in network with there's no in or out of network, um, the benefits are the same. There's just an additional percentage if you are a Carrington provider that they would get off the balance. If you're not a Carrington provider, you just don't get that percentage, but the benefits are the same.
[CUSTOMER][NEUTRAL] OK, and what's the allowable for this code?
[AGENT][NEUTRAL] 80%
[CUSTOMER][NEUTRAL] No, the dollar amount usually you guys have a.
[AGENT][NEUTRAL] 00000, this is not that type of policy. So there, there are policies that have like a code and then it'll show the dollar amount will pay for that code. This, this doesn't work like that because it's not UCR, it's on percentage of allowable, so whatever that charge amount is that the provider charges for the fillings will, um, we could pay up to 80% of that, but that charge comes from the facility.
[CUSTOMER][NEUTRAL] Like if I'm
[CUSTOMER][NEUTRAL] OK, it would be up to 80% but not necessarily, OK.
[CUSTOMER][NEGATIVE] OK, um, I had requested that her be I, I got a fact of her benefits and, um, that was like 4 hours ago. I still haven't received anything.
[AGENT][POSITIVE] OK, well, I'm definitely sorry for that. I can go ahead and email it to you. What's a good email address for you?
[CUSTOMER][NEUTRAL] Contact us.
[CUSTOMER][NEUTRAL] New image.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So contact us at [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so hold on one moment. I'll do you want me to go ahead and send it to you now? I'd rather wait, I'd rather send it to you now since you've been waiting. OK, hold on one moment.
[CUSTOMER][POSITIVE] That would be lovely.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hi
[AGENT][POSITIVE] Hey, thank you so much for holding. I apologize for that wait. Um, so I've sent the email over to you. It may come to your spam folder, um, but it's gonna come from the care team.
[CUSTOMER][POSITIVE] No, I got it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye