AccountId: 011433970860
ContactId: a4bc873d-e469-4ef0-b0b5-0e1e5134e69f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445100 ms
Total Talk Time (AGENT): 136796 ms
Total Talk Time (CUSTOMER): 101589 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/a4bc873d-e469-4ef0-b0b5-0e1e5134e69f_20250320T13:09_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from provider's office. Um, I need to get a dental breakdown for a patient.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a call back number?
[CUSTOMER][NEUTRAL] My name is [PII]. It's [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number of the member that you're requesting a dental breakdown for?
[CUSTOMER][NEUTRAL] Um, it is 715-803.
[AGENT][NEUTRAL] Can you verify this patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yep, so the patient is gonna be [PII]
[CUSTOMER][NEUTRAL] [PII]. Last name [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] And I apologize. What was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], this policy has been active since [PII] and is currently active. This member has a maximum benefit amount of $1000 per calendar year.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] This is not a guaranteed benefit it's just a disclaimer of the policy's coverage, and we do offer fax packs as well.
[CUSTOMER][NEUTRAL] OK, really quick, can you tell me the employer group name of this policy?
[AGENT][NEUTRAL] L as in Lima, A as in Alpha 0503 is the group number. Pine Crest Development Center is the group name.
[CUSTOMER][NEUTRAL] Wait, you said Pine like P I N E?
[AGENT][NEUTRAL] Yes, Christ.
[CUSTOMER][NEUTRAL] Firest, OK.
[CUSTOMER][NEUTRAL] It's one word or two?
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Pine Crest, what was it?
[AGENT][NEUTRAL] Development Center.
[CUSTOMER][NEUTRAL] And do they have out of network benefits?
[AGENT][NEUTRAL] This policy is a PPO. It doesn't have a network.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And really quick, what is the claim's mailing address?
[AGENT][NEUTRAL] The claim's mailing address will be addressed to American Public Life Claims Department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], [PII]. And the zip code is
[AGENT][NEUTRAL] Make sure I'm giving you the correct one.
[AGENT][NEUTRAL] [PII]. It's [PII]. We have a payer ID as well.
[CUSTOMER][NEUTRAL] And what is that?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Alright, and you said he has a $1000 annual maximum. Does he have a deductible?
[AGENT][NEUTRAL] Yes, the calendar year deductible is $50 per cover insured up to $150 per family, and the deductible does not apply towards exams and proffe.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and then the co-insurance for preventative basic and major services?
[AGENT][NEUTRAL] It's not, it's based on a set fee schedule. That's why I asked, would you like for me to send you over a dental schedule?
[CUSTOMER][NEUTRAL] Oh, so it follows the fee schedule.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yeah, I'll need that, um, and can you tell me if there's a missing two cloths?
[AGENT][NEUTRAL] There is
[CUSTOMER][NEUTRAL] Do y'all pay crowns on cedar prep?
[AGENT][NEUTRAL] Prep.
[AGENT][NEUTRAL] And what is your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And do y'all accept assignment of benefits?
[AGENT][NEUTRAL] We do.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Are implants covered on this policy?
[AGENT][NEUTRAL] Um, what is the procedure code so I can verify, but I don't think they are.
[CUSTOMER][NEUTRAL] It would be 6010.
[AGENT][NEGATIVE] Oh it's not covered under the policy.
[CUSTOMER][NEUTRAL] And what about Kuo Guards that's 9944.
[AGENT][NEUTRAL] I was on the major.
[CUSTOMER][NEUTRAL] Any frequency for it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's not specified.
[AGENT][NEUTRAL] Bear with me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You can do the frequencies.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Similar to those aged [PII].
[AGENT][NEUTRAL] Maximum of 1 per 7 year period.
[CUSTOMER][NEUTRAL] You said 1 for 7 years, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well this fax bag I have a few scheduled but as well as breakdowns for like exam pro fee, um, OK.
[AGENT][POSITIVE] It will, it'll have the yearly max the deductible amount, the category of expenses, the frequencies, where to submit a claim it's gonna have the list of procedure codes and the amount that we will actually pay towards the procedure code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well, um, I guess I could just get it off the fax and you say you did send it already?
[AGENT][NEUTRAL] I did.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Um, I think that's it.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] You too bye bye.