AccountId: 011433970860
ContactId: bc07e3e2-05e3-4510-90e1-910ef862b9a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366160 ms
Total Talk Time (AGENT): 156910 ms
Total Talk Time (CUSTOMER): 138325 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/bc07e3e2-05e3-4510-90e1-910ef862b9a6_20250619T13:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] and I'm calling from Bergen Oral Surgery regarding one of our patients dental insurance.
[AGENT][POSITIVE] Oh OK, well, I'll be more than happy to help you with the dental insurance, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] 2013438297.
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK um.
[CUSTOMER][NEUTRAL] Hold on one second, um, 02569266.
[AGENT][POSITIVE] Mhm, take your time.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is um [PII] [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] I wanted to know for in network with this dental plan.
[AGENT][NEUTRAL] OK, so this particular policy doesn't have a network. Um, it's on, well, yeah, this product doesn't have a network. We use usual and customary. Um, did you need a copy of the fax back?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So is this, is this like um.
[CUSTOMER][NEUTRAL] A savings plan?
[AGENT][NEUTRAL] No, it's just not on a PPO or HMO network. It's not through um Carrington. So, for example, there's a lot, I mean, we can go over the facts back if you like, um, but there's a calendar year max of $1500 per person, um, the deductible is $50 up to $150 per family, and the policy covers preventative, basic and major services.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it's, it's a dental policy, it's just.
[CUSTOMER][NEUTRAL] So for oral surgery?
[AGENT][NEUTRAL] For oral surgery, it will be at 40%. There is a 12-month waiting period for major. Let me see, hold on one second. So [PII], uh, they will be eligible for their major services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be um um uh surgical extraction complex and simple, simple and complex.
[AGENT][NEUTRAL] Simple, um, is under basic, but major for us includes endodontic, periodontic, prosodontic, and oral surgery, so everything under those.
[CUSTOMER][NEUTRAL] So if I give you like a code, can you tell me if um if the patient needs uh uh a waiting period for those codes?
[AGENT][NEUTRAL] Sure. Mhm.
[CUSTOMER][NEUTRAL] Um, so I have, um, 7210.
[CUSTOMER][NEUTRAL] 7220.
[CUSTOMER][NEUTRAL] 7230 and 7240.
[AGENT][NEUTRAL] Yeah, so those are all major codes. Hold on one moment. Oh, you have more?
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Oh, so the, OK.
[CUSTOMER][NEUTRAL] Yeah, I have two more, 60, 10 and 7953.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, these are all major, so that's 40% and it's a 12-month waiting period.
[CUSTOMER][NEUTRAL] So even for the 6010 is 40%.
[AGENT][NEGATIVE] 6010 is not covered on this policy. It's not a covered code.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] What about 7953?
[AGENT][NEUTRAL] 7953 is also not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can you just give me a [PII] box?
[AGENT][NEUTRAL] Yes, our [PII] is 24.
[CUSTOMER][NEUTRAL] For this
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's [PII] 248.
[CUSTOMER][NEUTRAL] 2 for what?
[CUSTOMER][NEUTRAL] 248 mhm.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh cool.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and then the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Yes, [PII] and in the state.
[CUSTOMER][NEUTRAL] And what's your payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And this, and the, the name of the insurance is American Public Life.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because we have it down as um medical plan.
[AGENT][NEUTRAL] Um, this is a dental only policy.
[CUSTOMER][NEUTRAL] I mean OK.
[CUSTOMER][NEUTRAL] And then if you could just send me the fax back and and if I could get a reference number.
[AGENT][POSITIVE] Sure, um, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], and the fax back has already been faxed to you. You should be receiving that shortly. If you haven't received it by the end of day today, just give us a call back. We'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for the oral surgery, um, the patient has a waiting period until January, right?
[AGENT][NEUTRAL] Yes, anything major.
[CUSTOMER][POSITIVE] Anything major. OK, thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Thank you, [PII]. Also, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That would be all. Thank you so much.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Have a good day. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.