AccountId: 011433970860
ContactId: bec46275-b580-418c-8cbf-bca93dd2e32e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284540 ms
Total Talk Time (AGENT): 146428 ms
Total Talk Time (CUSTOMER): 112095 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/bec46275-b580-418c-8cbf-bca93dd2e32e_20250116T20:24_UTC.wav
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[CUSTOMER][NEUTRAL] Hey
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from the provider's office, not familiar with this insurance, but um,
[CUSTOMER][NEUTRAL] Is this like a third party to another insurance or is that the name of the insurance? I, I've never heard of it.
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Mhm, that's the insurance.
[CUSTOMER][NEUTRAL] OK, are you were, um.
[CUSTOMER][NEUTRAL] OK, and can you check if we're a participating provider?
[AGENT][NEUTRAL] Um, so we don't have like a list of providers. Do you, well, 1st may I have your name?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you for that. And do you have like a member's policy number I can look up or because we have different types of products, so I can't just give it like a general answer.
[CUSTOMER][NEUTRAL] OK, so I don't know. I mean we have a patient coming in on Monday. This is the insurance they have, so I don't know maybe if I can get like a fax or like a breakdown of benefits if, I mean, I, we, we haven't taken it. Yes, it's dental.
[AGENT][NEUTRAL] So this is dental?
[AGENT][NEUTRAL] OK. Um, do you have the member's insurance card?
[CUSTOMER][NEUTRAL] Um, they gave me, I have a group number, member ID.
[AGENT][NEUTRAL] What is, um, what's the member ID number?
[CUSTOMER][NEUTRAL] Sure, let me take a look here hold on one sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, they're coming in for the first time, so they provided.
[CUSTOMER][NEUTRAL] Oh hold on, here it is, so member ID is 02574163.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it is [PII], last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, um,
[AGENT][NEUTRAL] APL, this is, is not a secondary insurance for dental, um, there.
[AGENT][NEUTRAL] Provider, it's a Carrington PPO network.
[AGENT][NEUTRAL] However, if you're not um a car, if your dentist is not a Carrington provider, the benefits are the same whether it's Carrington or not.
[CUSTOMER][NEUTRAL] Oh yes, yes, OK, because we do not participate with Carrington.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The benefits are the same though. Um, I can send you a copy of the fax back. It'll show you the calendar year max deductible, the percentages, you know, the frequencies.
[CUSTOMER][NEUTRAL] Oh OK, yeah, because if we don't take, I mean we're not in network with Carrington, would this be the same thing then under that same umbrella?
[AGENT][NEUTRAL] I mean, so, yes, the policy is under a Carrington PPO network, but the benefits are the same, so there's no in or out of network benefits. It's all the same. If you were in network with Carrington, the patient could get like an additional percentage off, but if you're not, the benefits are still the same.
[CUSTOMER][NEUTRAL] OK, so we can still see the patient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, and then, um, so that taxes they're gonna have like the, you know, maximum deductible and like what preventative basic and major services are covered at?
[AGENT][NEUTRAL] Correct, um, and then it has all the frequencies, the exclusions, all the ways to file a claim, and then there's a list of covered codes. So if the codes that you're looking for are not on this list, it would not be covered. Um, but I can let you know this policy only covers preventative, um, radiograph, FMX expenses, and then basic and basic restored if there's no major coverage.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So, um, what is a good fax number for you?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Uh, sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And should I put attention to [PII]?
[CUSTOMER][NEUTRAL] Um, sure, if you'd like.
[AGENT][NEUTRAL] OK. Well, I'm sending you over the fax back now. And did you have any other questions about the policy?
[CUSTOMER][NEUTRAL] Uh, no, that was it.
[AGENT][POSITIVE] OK. Well, um, you should be receiving this shortly. I am literally about to press in right now and um well, I hope you have a good day.
[CUSTOMER][POSITIVE] Alright, thank you, you too.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.