AccountId: 011433970860
ContactId: b9b93ac6-50b4-4d54-826c-8a3348ce9424
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1733219 ms
Total Talk Time (AGENT): 502326 ms
Total Talk Time (CUSTOMER): 470047 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b9b93ac6-50b4-4d54-826c-8a3348ce9424_20250402T13:57_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] Um, yes, and you said your name was [PII]?
[AGENT][NEUTRAL] So, [PII].
[CUSTOMER][NEUTRAL] Hi, so my name is [PII] and I am calling from Aspen Dental and I'm calling to verify whether or not we are in network with one of your subscribers.
[AGENT][NEUTRAL] OK, sure, Ms. [PII], I can assist you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] option 2.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEGATIVE] I don't have it. He didn't provide that to me. I asked him and he said he didn't know it.
[AGENT][NEUTRAL] What is his name?
[CUSTOMER][NEUTRAL] His name is [PII] Last name is [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, let me see if I can find them.
[AGENT][NEUTRAL] Do you have his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, Miss [PII], um, this particular dental policy doesn't have a network, so they can go to any dentist.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need a breakdown of benefits tax over?
[CUSTOMER][NEUTRAL] I do I'm I'm just gonna go ahead and try and get set up in the system here, um, so I can get that information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And what was the effective date for his policy?
[AGENT][NEUTRAL] Um, the effective date on this one is [PII].
[CUSTOMER][NEUTRAL] OK, he's the subscriber and what is that um member ID number?
[AGENT][NEUTRAL] That is 02560634.
[CUSTOMER][NEUTRAL] OK, let me repeat 02560634.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] And is there a group name?
[AGENT][POSITIVE] Oh yes, let me get that for you one moment.
[AGENT][NEUTRAL] And the group name is Universal Trucking Great White Truckload.
[CUSTOMER][POSITIVE] Universal trucking great wide truck load.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, and is there a group number?
[AGENT][NEUTRAL] Yes, the group number is 18463.
[CUSTOMER][NEUTRAL] OK, 18463.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, and is this a um single policy or a family policy?
[AGENT][NEUTRAL] Um, let me check. I think it's an individual, let me double check, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is a single parent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, let's see what I need next, um, and as far as us being able to do claims with you, um, what would be the fee schedule that I would use?
[AGENT][NEUTRAL] OK, so you, we pay on the usual and customary rates, UCR.
[CUSTOMER][NEUTRAL] UCR
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Mm mm I don't have anything like that so for us we have to have I guess um a fee schedule that we would use like Humana or Delta Dental or MetLife.
[CUSTOMER][NEUTRAL] If you have a Met.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The UCR is the normal ones, um.
[AGENT][NEUTRAL] Because we have had a lot of claims from Aspen before and not.
[CUSTOMER][NEUTRAL] What is, what is UCR stand for?
[AGENT][NEUTRAL] Not sure, but yeah.
[CUSTOMER][NEUTRAL] What what does Universal stand for?
[AGENT][NEUTRAL] Not sure where you can find it.
[AGENT][NEUTRAL] Universal trucking?
[CUSTOMER][NEUTRAL] I mean UCR what does this stand for?
[AGENT][NEUTRAL] Oh, usual and customary rates.
[CUSTOMER][NEUTRAL] Usual
[CUSTOMER][NEUTRAL] And customary rates mm mm.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No other company name.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] You would go by?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said you've had claims with the Aspen Donal before.
[AGENT][POSITIVE] Oh yes, mhm, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, are you able, I guess to go back and research, uh.
[AGENT][NEUTRAL] Research.
[CUSTOMER][NEUTRAL] How the claims are being submitted.
[AGENT][NEUTRAL] Oh, they just come normal. I mean, they, um, they put their fees and we pay on the usual and customary rates, um, based on the place where they have their service done.
[AGENT][NEUTRAL] And it's just processed that yeah, we have many claims from Aspen.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we have many calls from it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, because I can't, I can't get any further without a carrier name where we can file the, the uh claim.
[AGENT][NEUTRAL] OK. Um, you, um, I don't know if you can ask somebody there. Maybe they can tell you what to do. I'm not sure.
[CUSTOMER][NEUTRAL] R
[CUSTOMER][NEUTRAL] Is it, would it be in to Max or anything like that?
[AGENT][NEUTRAL] No, um, because we're not, um, we don't, we're not affiliated to any of those, um, so it's, it's on the usual and customary rates, which is a regular rate, usual and customary rate, um.
[AGENT][NEUTRAL] But I'm not sure how to, how you can find it in your, yes, yes.
[CUSTOMER][NEUTRAL] Usual customary rate.
[AGENT][NEUTRAL] So I'm not sure how you can find it in your end.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] I really don't, I'm not sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] But what I can do is send you the, the, the fax with the information and maybe you can maybe, you know, with that, you know, get a little bit more information in your company and see if it's something you take, um, but yeah, that I'm sorry, I don't know what else to tell you because I don't know how it is in your system. Yeah, sure, no problem. OK, what is the, the fax number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, that's fine. I would appreciate the fact, yeah.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me repeat this back to you. That's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you right now?
[CUSTOMER][NEUTRAL] Sure.
[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.
[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 Miss. Can. OK, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, that's it. Um, hopefully the facts will provide me with a little bit more, um, details.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, but you can always call like I'm, I'm not sure where they usually get that information, but, um, I don't know if they call the main office or something like that to get it, but yeah, um, you might wanna just call maybe a, I don't know, a different appointment to get that information. I'm not sure. Yeah, but it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, alright, and you all don't go by any other name?
[AGENT][NEUTRAL] No, it's just gonna be [PII]
[CUSTOMER][NEUTRAL] Other than the universal.
[AGENT][NEUTRAL] No, it's not under the Universal trucking. It's under APL Universal Trucking is um the group in usual and customary rates is just the cover expense.
[CUSTOMER][NEUTRAL] You're.
[CUSTOMER][NEUTRAL] OK, yeah, when I put in APL, all I get off is Amero plan, and that's not you, is it?
[AGENT][NEUTRAL] No, no, it's gonna be A as in apple, P as in Peter, L as in Larry, APL, American Public Life.
[CUSTOMER][NEUTRAL] Oh OK let me try that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Americans, I, I found it. Why didn't you tell me that the first time?
[AGENT][NEUTRAL] I thought you had it right, so you keep saying APPL. I'm like, OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next time I know I need to spell it.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] And what is the [PII] mailing address?
[AGENT][NEUTRAL] It's in [PII], so it's gonna be [PII].
[CUSTOMER][NEUTRAL] And is the payer ID [PII]?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so now we can move forward.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Right, good.
[CUSTOMER][NEUTRAL] Uh oh my goodness. All right, the deductible individuals.
[AGENT][NEUTRAL] Yeah, I'm like, I know I have spoken to [PII] many, many times.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, so next time if someone else calls, make sure you tell them American public life.
[AGENT][NEUTRAL] Yeah, I had to spell it? A.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, what's the deductible for his policy?
[AGENT][NEUTRAL] 50 per insured. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much has been used year to date?
[AGENT][NEUTRAL] OK, let me check on that. Let's see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] All right. He has not used his benefits for [PII] as of today, so he still have the full amount available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is that full amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $1500 is the calendar year maximum, and $50 is the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there ortho coverage for this policy?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and now there any waiting periods?
[AGENT][NEUTRAL] Yes, there is a waiting period on major services which it which it includes endoontics periodontics, prosthoonic repair and neural surgery on the 12 month waiting period, it looks like it's gonna be up on [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, and you said um major services include endoperio and oral surgery?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, and what percentage is that?
[AGENT][NEUTRAL] 40%.
[CUSTOMER][NEUTRAL] Or.
[CUSTOMER][NEUTRAL] OK, it's not giving me the option for put 40% in. OK, alright, is there a basic services covered under this policy?
[AGENT][POSITIVE] Yes, we have preventative expense which is cover 100%.
[AGENT][NEUTRAL] Um, radiograph FMX which is covered 80%.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Basic expense and basic restorative expense, which is covered 80%.
[AGENT][NEGATIVE] And the deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and is there a waiting period for the diagnostic preventative and the basic services?
[AGENT][NEUTRAL] No, there's no waiting period on that.
[CUSTOMER][NEUTRAL] OK, let me make sure I notate waiting period for major services is up on [PII].
[AGENT][NEUTRAL] Yes, mhm, because the effective date is [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and are crowns, bridges, implants, and dentures included in this policy?
[AGENT][NEUTRAL] Yes, but they're all on their major, so it's gonna be after the twelve-month waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if I could get some procedure codes.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Do you want me to give them to you one day at a time?
[AGENT][NEUTRAL] One at a time, yes, go ahead.
[CUSTOMER][NEUTRAL] OK, alright, 0120.
[AGENT][NEUTRAL] And this is also gonna be on the fax back, OK. All right, so 0120. Let me see, that's the oral evaluation. So that's on preventative and that's going to be, let's see, limited to two oral evaluation procedures in any combination of 120, 140, 150, 160, and 180 per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 11:10.
[AGENT][NEUTRAL] OK, so that is a profy and that's gonna be also under preventative and that's once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, you say once every 6 months.
[CUSTOMER][NEUTRAL] OK, um, by wing 0270.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You said 7270. OK, let's see.
[AGENT][NEGATIVE] No, that's not a right.
[AGENT][NEUTRAL] You said 270, correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, right. OK, so for the bite wing we have.
[AGENT][NEUTRAL] OK, so that's under basic.
[AGENT][NEUTRAL] And oh no, I do apologize. The bite one is gonna be under preventative, which is 100%. And let's see, it's going to be limited to one bite with X-ray procedures and any combination of 270, 272, and 274 per 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what about fluoride 1208?
[AGENT][NEUTRAL] OK, so the fluoride, let's see what we have.
[AGENT][NEUTRAL] All right, so limited to dependent children under the age of [PII].
[AGENT][NEUTRAL] And maximum of 1 procedure for 12 months.
[CUSTOMER][NEUTRAL] OK, and period maintenance 4910.
[AGENT][NEUTRAL] OK, and this is gonna be after the 12 month waiting period. Um, that one is going to be on the periodonals, which is, um, that one is maximum of 1 procedure for 6 months.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] One procedure for 6 months and you said it's under major?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's 40% after the 12 month waiting period.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what coverage is simple extractions under? Would it be under basic, major oral surgery?
[AGENT][NEUTRAL] And the simple extraction is gonna be on the basics.
[CUSTOMER][NEUTRAL] OK, and basic does not have a waiting period, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, um, missing tooth cloths.
[AGENT][NEUTRAL] Um, there is a missing clause, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, Perial SRP 4341.
[AGENT][NEUTRAL] OK. 4341 is gonna be on the periodonics and that's 40% after a 12 month waiting period. And let's see, the limitation on that one is maximum of each quad for 24 months.
[CUSTOMER][NEUTRAL] OK, so 1 every 24 months and how many clots can be done on the same day?
[AGENT][NEUTRAL] All 4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, oral cancer screening 0431?
[AGENT][NEUTRAL] And that was 0431.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that one is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And dentures 5110.
[AGENT][NEUTRAL] OK, so that's gonna be under major.
[AGENT][NEUTRAL] And so it's uh 40% after the 12 month waiting period and that's going to be maximum of 1 per 5-year period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what about bridges?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So the bridges are gonna be, let's see, once every 7 years per tooth.
[CUSTOMER][NEUTRAL] OK, and crowns.
[AGENT][NEUTRAL] Also under major.
[AGENT][NEUTRAL] That crowns is also gonna be once every 7 years for truth and that's on major, so it's 40% after the 12 month waiting period.
[CUSTOMER][NEUTRAL] OK, and are crown and bridge on restoration on molars downgraded?
[AGENT][NEUTRAL] We don't downgrade.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's predetermination mandatory?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, so thank you so much. Um, can I get a reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect I do appreciate that.
[AGENT][POSITIVE] You're welcome. No problem.
[CUSTOMER][POSITIVE] This is very very interesting.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK. Yeah, have a good day. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I know, I think that is it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, well, if you have any other questions, just feel free to call us back, OK?
[CUSTOMER][POSITIVE] I will. Thank you so much.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEGATIVE] You are on hold.