AccountId: 011433970860
ContactId: b378c472-a8d7-4d33-8a59-43172e19bcc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 834099 ms
Total Talk Time (AGENT): 264351 ms
Total Talk Time (CUSTOMER): 390265 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/b378c472-a8d7-4d33-8a59-43172e19bcc2_20250203T19:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling because, um, well, you know, I'm just not really sure what I'm covered for and um
[CUSTOMER][NEUTRAL] I, uh, want to get some work done and I'm not even sure how I would go about, um, you know, claiming my coverage I guess.
[AGENT][NEUTRAL] OK. Do you have a phone number in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yeah, phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][POSITIVE] Yeah, I do.
[CUSTOMER][NEUTRAL] Alright, 02.
[CUSTOMER][NEUTRAL] 3 025.
[CUSTOMER][NEUTRAL] 14463
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Address [PII].
[CUSTOMER][NEGATIVE] And the email should be [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And you were wanting to know what this policy covers?
[CUSTOMER][NEGATIVE] Yeah, so, you know, I signed up, uh, when I got fired and I just, uh, I wanna go get some dental cleaning done, and, uh, you know, like is that something that would be covered or, you know, I just, I don't really understand what I, what, you know, I'm paying for.
[AGENT][NEUTRAL] OK, I can help you with that. Your effective date was [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment.
[AGENT][NEUTRAL] For cleanings, we pay 100% the usual and customary rate.
[AGENT][NEUTRAL] For basic work like filling, simple extraction, we pay 80%.
[AGENT][NEUTRAL] And this policy does not cover any type of major work, so any endodontics, periodontics, oral surgery or.
[AGENT][NEUTRAL] Surgical extractions, anything like that, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have a $500 calendar your maximum?
[AGENT][NEUTRAL] And a $50 deductible on everything except for your preventative work.
[CUSTOMER][NEUTRAL] Like which is the cleaning
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEGATIVE] So I could just go get cleanings with with no money out of pocket up to $500.
[AGENT][NEUTRAL] It just depends on how much they charge for their areas paid by usual and customary rate. So if they charge way out of their customary rate for their area, then you may have an out of pocket.
[CUSTOMER][NEUTRAL] OK, um, how would I go about like identifying that?
[AGENT][NEUTRAL] You can call and ask them what.
[CUSTOMER][NEUTRAL] Because there's like there's like 8 dentists near me, you know what I mean?
[AGENT][POSITIVE] You can call and ask them what they gonna do for your first visit and give you the procedure codes and give us a call back and we can tell you how much we're gonna pay for those.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Just ask them what the procedure code is and the charge for each code.
[CUSTOMER][NEUTRAL] I should write down one second.
[CUSTOMER][NEUTRAL] Gentle.
[CUSTOMER][NEUTRAL] I didn't.
[CUSTOMER][NEUTRAL] You said procedure code.
[AGENT][NEUTRAL] And the charges for each code.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh is there a way that I can, cause I'm gonna be calling like several different places to find out which is like a good one to go to.
[CUSTOMER][NEUTRAL] Is there like I don't know some kind of way where I can kind of find out whether because you said call back when I have those two things, but is there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Some kind of guideline where I know like this is gonna be above, you know.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I, I really couldn't tell you that unless I had the procedure codes.
[CUSTOMER][NEUTRAL] Like just some kind of.
[CUSTOMER][NEUTRAL] I, I, I guess I'm, uh, you know.
[CUSTOMER][NEUTRAL] Because it's by area you said right?
[AGENT][NEUTRAL] Right, uh-huh.
[CUSTOMER][NEUTRAL] Now, is, is it by area in the sense of like by zip code, by city municipality by
[AGENT][NEUTRAL] Right, by their zip code.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] How often am I likely to encounter, would you say in your experience, like something being way overpriced? Like is that something I have to worry about or?
[AGENT][NEUTRAL] That I'm not sure. It just depends on the area.
[CUSTOMER][NEUTRAL] Right. OK. Um, I guess I'm just trying to figure out like, cause I'm, cause like I said, I've got like several dentists near me and I'm gonna be calling each one trying to get a bead on which is the right one and so am I gonna have to just compile a list of each different place and then call and then we're gonna run the codes on all of them or like I'm trying to figure out if there's a way to kind of simplify that process, you know.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] If you're trying to figure out which one is the cheapest, that would be the only way to ask them what they're going to do for your first visit and what the codes would be.
[CUSTOMER][NEUTRAL] Well, I don't necessarily want the cheapest. I want the maximum I can get under coverage, right? Like, uh, or not necessarily like I just want, you know, obviously the best possible treatment. So I'm gonna go, I'm gonna analyze factors like, you know, reviews and.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Things of that nature. Also, you know, if I'm doing preventative, you said it's like 500 a year, right? So I'm gonna want something that kind of can do everything in one year, um.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I don't know, I'm just, I'm just trying to, I guess I'm thinking out loud here, but I'm just trying to.
[CUSTOMER][NEUTRAL] Find I don't know the.
[CUSTOMER][NEUTRAL] And because right now it just seems like call around, get the procedure codes and the charges for each code, and then call back and then run that list to see what's approved and what's verified.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Now you can go to any dentist, you don't have to go to one on the list, but
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, but I want to be.
[AGENT][NEGATIVE] The ones on the, yeah, the one on the list can only charge so much.
[CUSTOMER][NEUTRAL] Now you say list what list is this? Is there a list that like.
[AGENT][NEUTRAL] We, we have a list of providers that go through Carrington.
[CUSTOMER][NEUTRAL] Just to provide work.
[AGENT][NEUTRAL] They do our
[AGENT][NEUTRAL] They do our provider list.
[CUSTOMER][NEUTRAL] Uh, is there a way that I can kind of cross reference with that list?
[AGENT][NEUTRAL] I can give you their phone number and see if they have a provider in your area.
[CUSTOMER][NEGATIVE] Yeah, because I wouldn't even be able to go something that's not on that list, right?
[AGENT][NEUTRAL] You can go to any dentist, yes, what we pay is gonna be the same. The only difference is the provider on the list can only charge whatever they contracted with Carrington.
[CUSTOMER][NEUTRAL] Is that more beneficial for me or or not?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] It's more beneficial for me to use something on the list.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, where can I find that list?
[AGENT][NEUTRAL] Um, I can give you their phone number. It's [PII].
[AGENT][NEUTRAL] 290.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Now, they won't be able to pull up your policy or anything like that, so you don't have to give them your policy number. All you ask them is there a provider in your area?
[CUSTOMER][NEUTRAL] There uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And this is who you said [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, and OK, is there a provider in my area, so I just call that number and they'll be able to point me in the right direction.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK fantastic now um this is purely for dental, right?
[AGENT][NEUTRAL] Yeah, just for dental, this policy is.
[CUSTOMER][NEUTRAL] Now are you able to look up uh what else I'm covered under or do I have to go to a different department?
[AGENT][NEUTRAL] Hold on just a moment, let me see what else you have. I may have to transfer you if you want benefits on that policy. Hold on one moment.
[CUSTOMER][POSITIVE] Well, because I'm, yeah, I'm also looking to get some vision work done.
[AGENT][NEUTRAL] OK, looks like you have a hospital indemnity policy, an accident policy, a disability policy, a cancer policy.
[AGENT][NEUTRAL] Life policy and a dental policy.
[CUSTOMER][NEUTRAL] No vision.
[AGENT][NEUTRAL] Uh, we do not carry vision insurance.
[CUSTOMER][NEUTRAL] Uh, just don't carry it. OK, uh, can I get that list one more time? So you said accident.
[CUSTOMER][NEUTRAL] I'm gonna write this down. Accident, how do you spell in Dennis, I N D.
[AGENT][NEUTRAL] In indemnity.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] How do you spell that?
[AGENT][NEUTRAL] I N I N D E M I T Y indemnity.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] I N D E M I T.
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] That's hospital indemnity policy, um.
[AGENT][NEUTRAL] You got an accident.
[AGENT][NEUTRAL] Disability.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Cancer.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And group term life policy.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] It's a life policy.
[CUSTOMER][NEUTRAL] Like life insurance?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, what does a group term mean?
[AGENT][NEUTRAL] That I'm not sure I can let you talk to somebody in the life department.
[CUSTOMER][NEUTRAL] OK. In hospital indemnity means like if I'm in the hospital?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It covers a lot of stuff like.
[AGENT][NEUTRAL] Let me see if it covers.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Like emergency room, um.
[AGENT][NEUTRAL] Office visits.
[CUSTOMER][POSITIVE] That's funny
[AGENT][NEUTRAL] Hospital stay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Some testing, but I could let you talk to somebody and let you they could tell you what all it covers.
[CUSTOMER][NEUTRAL] Right, uh, I, I'm gonna hold right now, but that's, that's not the same $500 as with the dental, correct? That's a completely different policy.
[AGENT][NEUTRAL] No, it's completely different.
[CUSTOMER][MIXED] OK cool OK um OK and so nowhere.
[CUSTOMER][NEUTRAL] Is that you don't, you don't cover vision at all, none of these other things at all kind of cover vision, vision.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I'm only I'm only covered dental and like this hospital stuff that you just listed.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cool, um, and then so if I call [PII] number [PII], they'll give me a provider that's in my area now, um.
[CUSTOMER][NEUTRAL] But I don't have to go necessarily to that provider, right? It's just that's gonna that provider is going to cap their rates.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Favorably for me, right?
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, um, are there any questions people in my position would usually be asking right now?
[AGENT][NEUTRAL] Mm, not really. I think I gave you everything that I can think of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, anything else, uh, OK, OK, you just answered that.
[CUSTOMER][NEUTRAL] Um, OK, well, uh, at least for now I guess that's all I really need or.
[CUSTOMER][POSITIVE] Yeah, at least for now, hopefully I don't have to go to the hospital anytime soon and you need to find any of that out. OK, cool, thank you very much.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] Thank you. Thank you, Mr. [PII], for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank you. Bye-bye.