AccountId: 011433970860
ContactId: ac7b166f-65e0-4395-bb76-1036c37a4977
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 654309 ms
Total Talk Time (AGENT): 277222 ms
Total Talk Time (CUSTOMER): 213212 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/ac7b166f-65e0-4395-bb76-1036c37a4977_20250304T15:42_UTC.wav
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[CUSTOMER][NEUTRAL] I'm calling.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Pearl Dentistry, and I'm calling in regards to a patient and just some information about the insurance cause I have never heard of this insurance, so I need some information.
[AGENT][NEUTRAL] OK, [PII], so you're only needing instrument do you need eligibility and benefits for the member?
[CUSTOMER][NEUTRAL] Yes, but before I even do that, I need information about the insurance cause like I said, I've never heard of it, so I need to know, uh, like.
[CUSTOMER][NEUTRAL] Where we would send claims, so I need a claims address. I need a payer ID I need to know what fee schedule to use. I don't know anything.
[AGENT][NEUTRAL] OK, [PII], yes, I can help you with all of this and a lot of that information too, just so you're aware, is also on the fax back of the benefits that I would send to you. But first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, let's see if they even gave me that. The ID number potentially cause I don't have a copy of the card. I just have the information they gave us is 60801.
[AGENT][NEUTRAL] OK, so that is our electronic payer ID number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's one piece of your information.
[CUSTOMER][NEUTRAL] How about a social?
[AGENT][NEUTRAL] Yeah. Is your patient the subscriber on the policy, [PII]?
[CUSTOMER][NEUTRAL] No, it's a child of the subscriber. I have the subscribers. I have the subscribers social, yes.
[AGENT][NEUTRAL] OK. But you have the subscribers though?
[AGENT][NEUTRAL] Social.
[AGENT][NEUTRAL] OK, what is that number, please?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Put you in.
[CUSTOMER][NEUTRAL] Sure, can you spell?
[CUSTOMER][NEUTRAL] Let me do you have your last name correct.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you would be a verification of benefits, not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII] and the last name is [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the date of birth for him, please?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK, thank you. So yes, I did locate a policy. Uh, he is a dependent on this policy. This policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And the policy number that you should have and this information will also be on the fax back but it's 225.
[AGENT][NEUTRAL] 9614.
[CUSTOMER][NEUTRAL] And you said that's the the like member ID number.
[AGENT][NEUTRAL] That is the policy number, yes.
[AGENT][NEUTRAL] Call the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a non-network plan?
[AGENT][NEUTRAL] Covered services are based on a percentage of the UCR of the service region.
[AGENT][NEUTRAL] So they may select any provider to go to.
[CUSTOMER][NEUTRAL] OK, so we don't use any type of fee schedule.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Mhm. And we do not have any history on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is the claims address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And again, that will be on your fax back.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] That is correct. American Public Life. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So I guess how
[CUSTOMER][NEUTRAL] Like they are scheduled to come in today for a new patient exam and X-rays, so they're going to owe a percentage of today's appointment or is anything covered at 100% like preventative?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Preventative expenses are covered at 100%. Radiographs, excuse me. Radiographs and FMX is basic, basic restorative, that's at 80% of the UCR subject to the calendar year deductible.
[CUSTOMER][NEUTRAL] And what is their deductible?
[AGENT][NEUTRAL] Their calendar year deductible is $50 per covered insured up to $150 per family.
[AGENT][NEUTRAL] And the calendar, your maximum benefit is $1500 per covered insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then everything else will be listed on the the fax back.
[AGENT][NEUTRAL] Yes, ma'am, that is correct. And any code, anything not listed on the fax, that hardly means it is not covered.
[CUSTOMER][NEUTRAL] OK, can I give you a couple codes just to check on a couple?
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Um, OK, so let's try fluoride would be 1208.
[AGENT][NEUTRAL] That is not covered?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For any age.
[AGENT][NEGATIVE] It is not covered. Code 1208 is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how about 1351?
[AGENT][NEUTRAL] That is covered under this plan under preventative.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] It is covered under what was that?
[AGENT][NEUTRAL] Preventative.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Up to a certain age.
[AGENT][NEUTRAL] It's a maximum of 1 tooth. The limitations are maximum of 1 tooth for 36 months.
[AGENT][NEUTRAL] Also applications made to permanent molar teeth only.
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][NEUTRAL] And limited to dependent children under the age of [PII], and that information is also on the fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it specifies on the fax back um how often the X-rays are covered like by wings and pans.
[AGENT][NEUTRAL] Uh-huh. It does. Yes, ma'am. All of the um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All of the limitations, it's gonna give you the it'll give you a column with the procedure code. Then the middle column is your services, and then the limitation column is to the right and on the very last page, it has all of the, you know, the limitation codes with the details.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the schedule of coverage services and procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am. Alright, so, um, give me just a moment let's, I do, but one moment first.
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] OK, so you just need my fax number?
[AGENT][NEUTRAL] OK, go ahead and give me your fax number while this is loading.
[CUSTOMER][NEUTRAL] Yep, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right. And will the facts need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] No, that's not necessary.
[AGENT][NEUTRAL] OK, alright, so just one moment.
[AGENT][NEUTRAL] And again that fax number is [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, well, I have just sent that to you so provided that there's not any type of technical mishap, you should be receiving that very shortly, [PII] and then one last thing, once uh the claim has been processed by APL, we do have a portal in which you should be able to check claim status in and have access to our EOB and our website for that is secured.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Well, glad you feel better.
[CUSTOMER][NEUTRAL] Secured. [PII].
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I don't believe so thank you very much for all your help.
[AGENT][POSITIVE] You're certainly welcome, [PII]. It was my pleasure and thank you again for calling APO. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] I will follow up