AccountId: 011433970860
ContactId: a8c777a8-0d39-4ff2-9872-486725e2d754
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 829760 ms
Total Talk Time (AGENT): 237380 ms
Total Talk Time (CUSTOMER): 199109 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/a8c777a8-0d39-4ff2-9872-486725e2d754_20250410T18:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling to verify dental coverage for a patient.
[AGENT][POSITIVE] OK, I appreciate. I can help you with uh eligibility and benefits. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, ma'am. 02511225.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] That's [PII] [PII].
[AGENT][NEUTRAL] Um, I can send a fax back of all the benefits or we can go over, um, benefits on the phone as well.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So, I don't know which is best, um.
[CUSTOMER][NEUTRAL] Is it uh uh.
[CUSTOMER][NEUTRAL] I guess if I have some questions I can um I can ask, would that be OK?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So we are out of network. So do y'all have out of network benefits?
[AGENT][NEUTRAL] Um, yes, there's no network on the plan, so he can go to any dentist he likes.
[CUSTOMER][NEUTRAL] OK, and is the name of the insurance APL or is it Group Voluntary Dental?
[AGENT][NEUTRAL] At APL.
[CUSTOMER][NEUTRAL] APL that's the name of the insurance.
[AGENT][NEUTRAL] Yes, American Public Life.
[CUSTOMER][NEUTRAL] OK, and he gave me a group number of 19863.
[AGENT][NEUTRAL] Um, let me see what his group number is.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, you said American what's APL stands for?
[AGENT][NEUTRAL] Um, it's American Public Life.
[CUSTOMER][NEUTRAL] Life, L I F E.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, is there a claims mailing address or pay ID code?
[AGENT][NEUTRAL] Um, we have a payer ID which is 60801.
[AGENT][NEUTRAL] And the mailing address is [PII].
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um, and I guess he gave me the group name is Blair something logistics.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Is that the group name?
[AGENT][POSITIVE] Um, yes, that's correct.
[CUSTOMER][NEUTRAL] OK can you spell that for me if you don't mind?
[AGENT][NEUTRAL] Yeah, it's Blair, B L A I R, and then logistics is L O G I S T I C S.
[CUSTOMER][NEUTRAL] OK, thank you. And is there a maximum or deductible and if he used anything this year?
[AGENT][NEUTRAL] Um, this is not a guarantee of payment. It's a basic outline of the policy. So the calendar year maximum, um, benefit is 1500.
[AGENT][NEUTRAL] Deductible does apply to um basic services.
[AGENT][NEUTRAL] And let me see if he's used anything.
[AGENT][NEUTRAL] Mm, let's see.
[AGENT][NEUTRAL] Sorry, just give me one moment.
[CUSTOMER][NEUTRAL] I know that's OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh, he's not used anything this year.
[CUSTOMER][NEUTRAL] OK, and what was the deductible? I didn't hear that part.
[AGENT][NEUTRAL] Oh, it's 50.
[CUSTOMER][NEUTRAL] 50? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, um, and I have like 4 codes. Would you be able to tell me, um, the coverage, um, percentage and if it's so, the loud amount or if our charge is under or within?
[AGENT][NEUTRAL] Um, yes, what's the code?
[CUSTOMER][NEUTRAL] Um, it's 0140.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that for an evaluation or?
[CUSTOMER][NEUTRAL] Limited exam, yeah, like pro promise focus problem focus limited exam.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, looks like that is, let's see.
[AGENT][NEUTRAL] Um, it's limited to 2.
[AGENT][NEUTRAL] Uh, procedures for 12 month, um, period.
[AGENT][NEUTRAL] And then let me pull up, hold on just a second, I'll pull up our UCR.
[AGENT][NEUTRAL] So we just pay 80% of what's reasonable and customary, um, I mean that's the allowed amount. Let me, I can give you a dollar amount though.
[AGENT][NEUTRAL] What's your zip code?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me, do you mind if I place you on a brief hold?
[CUSTOMER][POSITIVE] Oh, not at all, thank you so much.
[AGENT][NEUTRAL] OK, hold on one moment. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why does it not?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, sorry about that. What, OK, will you give me your zip code one more time, please?
[CUSTOMER][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] Sure, um, [PII].
[AGENT][NEUTRAL] I don't know, it's not pulling up on our system.
[AGENT][NEUTRAL] Yeah, I don't know if I, I don't, I don't have access to look at the UCR. I'm on the screen, but it's not giving me access, so, but what we pay, we allow 80% of what's reasonable and customary for your region, so.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, so you, so you and you say you can't pull that up because our zip code is not coming up?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, I, but I can, like I said, the fax back will tell you all of the codes, what they fall under because it actually lists all the codes for the plan.
[AGENT][NEUTRAL] Um, but I can go over
[CUSTOMER][NEUTRAL] So it gave me the loud amount though?
[AGENT][NEGATIVE] No, it won't give you the allowed amount.
[CUSTOMER][NEUTRAL] Oh yeah, that's what I really need to give them an estimate how much they have to pay.
[CUSTOMER][NEUTRAL] Uh, but, um, OK, so I just had 3 more calls. You can just give me the percentages is under if you don't mind.
[AGENT][NEUTRAL] OK, um, the one that you, uh, asked about the [PII].
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Going to be preventative, so it pays.
[CUSTOMER][NEUTRAL] I think you said 80%.
[AGENT][NEUTRAL] Um, well, it's, what we allow is 80% of what's reasonable and customary for your region, but this will pay.
[AGENT][NEUTRAL] Um, under the preventative service, which is 100%.
[CUSTOMER][NEUTRAL] OK, that's confusing.
[AGENT][NEUTRAL] Well, what, so,
[CUSTOMER][NEUTRAL] You said it it'll pay 100% on the preventative, but.
[CUSTOMER][NEUTRAL] You pay 80% of what's allowed.
[AGENT][NEUTRAL] We allow 80% of what's reasonable and customary. So, for instance, I, I don't know what's reasonable and customary in your region, so.
[AGENT][NEUTRAL] It pays 100%. We allow.
[CUSTOMER][NEUTRAL] Yeah, me either.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, did you want to check on another code?
[CUSTOMER][NEUTRAL] Yeah, I'm just writing it down. Hold on one second.
[CUSTOMER][NEUTRAL] Alright, um, the next one is um D0220.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, that's under basic, pays 80%.
[AGENT][NEGATIVE] After a $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um 0460.
[AGENT][NEUTRAL] Um, that's also basic, pays 80% after a $50 deductible.
[CUSTOMER][NEUTRAL] OK and the last one is 3320.
[AGENT][NEUTRAL] It looks like it's limited to dependent children under [PII].
[AGENT][NEUTRAL] What was the code again?
[CUSTOMER][NEUTRAL] So adults can't get a root canal, [PII].
[AGENT][NEUTRAL] OK, I think I had the wrong number. OK, [PII] is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, endedonics pay 40%.
[AGENT][NEUTRAL] And there is a 12-month waiting period.
[CUSTOMER][NEUTRAL] OK, so, um, when is his effective date? I would need that too.
[AGENT][NEUTRAL] effective date is [PII].
[CUSTOMER][NEUTRAL] OK, so his year is not up yet.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] All righty. I would appreciate that, [PII]. Thank you so much.
[AGENT][NEUTRAL] Do you wanna fax back or no?
[CUSTOMER][POSITIVE] Um, sure, yeah, I'll take one if you don't mind.
[AGENT][NEUTRAL] OK. What's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just take a few minutes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.