AccountId: 011433970860
ContactId: a99a0458-07d8-44da-b689-f3b48c54be4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1324170 ms
Total Talk Time (AGENT): 315995 ms
Total Talk Time (CUSTOMER): 293301 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/a99a0458-07d8-44da-b689-f3b48c54be4b_20250423T13:11_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I have a patient that I need to um verify his insurance.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and may I have your name?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Um, 0244524770019.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That might be it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it's a little bit too many numbers, um.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Try.
[CUSTOMER][NEUTRAL] Um, 834-243-87774.
[AGENT][NEUTRAL] No, our policy numbers are really short. They're gonna be 10 followed by seven digits only. Um, is this for [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, um, no, this is for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mr. [PII].
[AGENT][NEUTRAL] OK. Um, um, I think I got it. I just wanna ensure that first number. Um, what's his date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Uh yes, yes, OK, alright, what's the last name for Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, it is [PII]
[AGENT][NEUTRAL] OK, yes, thank you. And is this um for dental or is it medical?
[CUSTOMER][NEUTRAL] Um, dental.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and you just need eligibility information or you also need benefit information?
[CUSTOMER][NEUTRAL] Um, I need benefit information.
[AGENT][NEUTRAL] OK. All right. And you need this information given to you verbally or you need this information faxed over to you?
[CUSTOMER][NEUTRAL] Verbally please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just to see where it goes in it OK.
[AGENT][NEUTRAL] OK, and the policy number is going to end on the 247. So it's gonna be 02445247.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We have an effective date of [PII]. It is active at the moment and this is uh one of our basic dental policies, so it will cover basic, it will not cover major. There's a calendar year maximum of $500 with the deductible of $50.
[AGENT][NEGATIVE] And the deductible does not apply to preventative.
[AGENT][NEUTRAL] Pres cover 100%. Radiograph FMX is covered at 80%.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Basic expense and basic restorative expenses cover 80%. And again, this one doesn't have any major service. So inoonics, periodontics, prosodon repair or surgeries are not covered.
[CUSTOMER][NEUTRAL] OK, so you said the preventative is covered at 100% X-rays is 80%?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK and then what was after X-rays?
[AGENT][NEUTRAL] Basic and basic restorative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's covered at 80%?
[AGENT][NEUTRAL] 80%. Mhm. Sure.
[CUSTOMER][NEUTRAL] 2027.
[CUSTOMER][NEUTRAL] OK, and nothing's covered under major.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then just make sure the notes are transpired.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is Pero covered?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and how much?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] No OK.
[AGENT][NEUTRAL] No, periodontics or um it's not covered. That's gonna be considered the major, major is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and is oral surgery covered under major as well?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Same, OK. What about simple extractions?
[AGENT][NEUTRAL] That one is gonna be on the basics.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And that one would be the 80% as well.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about perio maintenance?
[AGENT][NEGATIVE] not covered.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And then what about for the.
[CUSTOMER][NEUTRAL] And then what about preventative frequencies?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, now for the preventative frequency, and we can add one month.
[AGENT][NEUTRAL] OK, so for health cleanings, it's gonna be once every 6 months.
[AGENT][NEUTRAL] Oral evaluation is 2 for 12 month period.
[AGENT][NEUTRAL] By wings is once per 12 month period.
[AGENT][NEUTRAL] And pull my X-rays or panels at once every 5 years.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright and you said that first one was um what was that first one?
[AGENT][NEUTRAL] Of cleanings once every 6 months.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the oral evals once every 12 months.
[AGENT][NEUTRAL] Our evaluation is too.
[CUSTOMER][NEUTRAL] And then FMX is one.
[AGENT][NEUTRAL] Mm. No.
[CUSTOMER][NEUTRAL] 2 every 12 months.
[AGENT][NEUTRAL] Yes, 2 for 12 month period. Mhm.
[CUSTOMER][NEUTRAL] And then FMX
[CUSTOMER][NEUTRAL] OK, and FMX is once every 5 years.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then fluoride, is he covered under that or has he aged out?
[AGENT][NEUTRAL] Yeah let me go back to the age of the member.
[AGENT][NEUTRAL] He's aged out.
[AGENT][NEUTRAL] It's gonna be limited to depend on children aged [PII] for fluoride.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the On fillings, do you downgrade?
[AGENT][NEUTRAL] We don't.
[CUSTOMER][NEUTRAL] No, perfect. Is there a missing tooth cloth?
[AGENT][NEGATIVE] Not for this one, there's no major service on this one.
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] So it's just the ID number.
[CUSTOMER][NEUTRAL] Um, is the policy number gonna be the ID number or group number?
[AGENT][NEUTRAL] Mhm. It's gonna be the ID number. It's the same as the policy number.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] ID number and then do you have the group number by chance?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The group number is 70019.
[CUSTOMER][NEUTRAL] OK and then do you have the name?
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] BG staffing.
[CUSTOMER][NEUTRAL] What was the first word?
[AGENT][NEUTRAL] B G B [PII] girl, [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Staffing
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and then what's the claims address?
[AGENT][NEUTRAL] The address to submit claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, can you repeat that zip code one more time?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I'm just gonna repeat the address it's [PII].
[CUSTOMER][NEUTRAL] And the zip code is [PII].
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] Perfect. Few more questions um bone grafting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I don't believe that's covered. That's more than likely on the major. Um, do you have a code for that one?
[CUSTOMER][NEUTRAL] The code is [PII].
[AGENT][NEGATIVE] Mm, that one is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you have the payer ID?
[AGENT][NEUTRAL] Yes, the payer ID is 60801.
[CUSTOMER][NEUTRAL] 0801 and then the insurance plan name?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The insurance name.
[CUSTOMER][NEUTRAL] Like what company it falls under?
[AGENT][NEUTRAL] APL American Public Life.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I think that's it.
[AGENT][NEUTRAL] All right. Is there anything else I may help you with today? Any other questions or concerns?
[CUSTOMER][NEUTRAL] Um, are you able to do a fax, um, of all of this as well just so we have a paper copy too?
[AGENT][NEUTRAL] Um, yes. What is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] 7043235913 to your attention.
[CUSTOMER][NEUTRAL] It is, um, not a 9, it's a 4, after the 5.
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] Yeah, that's what I have 5413.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And it's gonna be under your attention?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Yes. Oh, sorry.
[AGENT][NEUTRAL] Can you hold for me while I send this out to you while I get you on the line?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Miss [PII].
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] This is what I filled out the window.
[AGENT][NEUTRAL] Hello, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah I can help me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hello Miss [PII].
[CUSTOMER][NEUTRAL] It's like
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yeah, I'm like.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Miss [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] Hey, I can't believe it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] I didn't mean to put to a period. I meant to put.
[AGENT][NEUTRAL] OK. Uh, I came back a minute ago but you were not there. I tried to call um back. Um, it looks like I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you verify what the maximum is?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome well thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, I think that's it.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye, Mr.