AccountId: 011433970860
ContactId: c07a03f1-5b9d-4ec4-bcf8-6d9ff3dee50f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734349 ms
Total Talk Time (AGENT): 189651 ms
Total Talk Time (CUSTOMER): 158580 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/c07a03f1-5b9d-4ec4-bcf8-6d9ff3dee50f_20250428T15:01_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Get the
[CUSTOMER][NEUTRAL] in for delivery.
[CUSTOMER][NEUTRAL] Hey there, uh, this is [PII]. I'm calling from an out of network dental office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Trying to get a breakdown of benefits from a patient.
[AGENT][NEUTRAL] OK, sure. I can assist you with the fax pack of benefits, Miss [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, it looks like it is.
[CUSTOMER][NEUTRAL] 02617141.
[AGENT][NEUTRAL] OK, let me try that one moment.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Pretty much
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Perfect. Thank you, Miss [PII]. All right. And uh so you say you need a benefit breakdown and you need this information to give to you fax or by uh verbal?
[CUSTOMER][NEUTRAL] Um, uh, prob, can you do both? Can I ask you some questions verbally and then you send a fax.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK, is can they can the patients see an out of network dentist so y'all pay the provider?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and do we send the claims to American Public Life Insurance, not through [PII].
[AGENT][NEUTRAL] Correct, it goes to American Public Life.
[CUSTOMER][NEUTRAL] OK, and so the group number is 70056?
[AGENT][POSITIVE] Yeah, that is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, and I gave you the right ID number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And are you showing the employer or the group name as MAU Workforce Solutions?
[AGENT][NEUTRAL] Mm, let me pull that information and yes, it is.
[CUSTOMER][NEUTRAL] OK, is there a waiting period or a missing tooth cloth on the plan?
[AGENT][NEGATIVE] Not for this one because this one is just a um basic. It doesn't have any major service on this one.
[CUSTOMER][NEUTRAL] OK, so there's no waiting period or OK, because you don't have those options. OK, so pre preventive and.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Basic, but there's no waiting period.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, um, what's the, uh, does it cover 100% for out of network on preventive?
[AGENT][NEUTRAL] Yes, let me give you the benefits, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. So for preventative, they cover 100%. Radiograph FMX is covered at 80% and then basic expense and basic restorative expense is 80%.
[CUSTOMER][NEUTRAL] OK, you said and you said the X-rays is covered at 100%.
[AGENT][NEUTRAL] The only thing we cover 100% is, will be the right wings. If it's any radiograph or FMX it's gonna be 80%.
[CUSTOMER][NEUTRAL] What's the frequency that shares on a FMX and PAM?
[AGENT][NEUTRAL] OK. So for that one, we have limited to one X-ray procedure and any combination of 210, 277, or 330 per 5-year period.
[CUSTOMER][NEUTRAL] OK, and what is covered under basic that fillings in the perio simple surgical extraction.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, yes. Uh, and the Imperial are not covered. It's just simple extraction and it's gonna be just fillings. So fillings, simple extractions and X-rays, those are gonna be on their basic. Um, there is no major service. Major service includes endodontics, periodontics, prosthodontic repair or surgery, cramps and bridges, so those are not covered.
[CUSTOMER][NEUTRAL] What about a surgical extraction like a 70 to 10?
[AGENT][NEUTRAL] That's a major, so it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just fillings and simple extractions.
[AGENT][NEUTRAL] Mm right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can they get to, is it a calendar year plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what is the deductible and the maximum?
[AGENT][NEUTRAL] OK. So this one has a $500 maximum with the $50 deductible and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Do you need the frequencies?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK. So for the, let's see, uh, cleanings, proffe is once every 6 months. Oral evaluation is 2 for 12-month period.
[AGENT][NEUTRAL] B wings is once per 12-month period.
[AGENT][NEUTRAL] And then the full mile x-rays and panels is once every 5 years.
[CUSTOMER][NEUTRAL] OK, so you have to wait 6 months plus a day to get the cleaning.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright perfect yeah if you could um if I could get a reference number for the call and.
[AGENT][NEUTRAL] OK. We don't have a reference number so you can use my name in the estate if you will. Do you need the spelling of my name?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that's [PII].
[AGENT][NEUTRAL] And what is the fax number so I can send this fax over to you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you right now?
[CUSTOMER][POSITIVE] OK, yeah, sure, thank you.
[AGENT][POSITIVE] OK, thank you. You're welcome. 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][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that's all.
[AGENT][POSITIVE] OK, well, thank you for calling ATL. Have a good week, Miss [PII].
[CUSTOMER][POSITIVE] You too thank you uh huh bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.