AccountId: 011433970860
ContactId: ca87117b-b5f6-44b4-ab29-41c858aba877
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734559 ms
Total Talk Time (AGENT): 297761 ms
Total Talk Time (CUSTOMER): 168984 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/ca87117b-b5f6-44b4-ab29-41c858aba877_20250127T22:26_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I'm sorry, what is your name?
[AGENT][NEUTRAL] Oh, it's [PII]
[CUSTOMER][NEUTRAL] I wanted to get a complete verbal breakdown of benefits.
[AGENT][POSITIVE] OK, you needed a breakdown of benefits. I can help you with that today and can I have your name and a good call back number please?
[CUSTOMER][NEUTRAL] Of course my name is [PII]. Callback number is [PII].
[AGENT][POSITIVE] Perfect and.
[AGENT][NEUTRAL] Miss [PII], do you have the policy number handy?
[CUSTOMER][NEUTRAL] I do actually um on the card is it the one that says um policy certification or cert or 02147862.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect and let me get that pulled up for you.
[AGENT][NEUTRAL] Thank you for your patience and would you be able to verify the member's first and last name for me please and date of birth?
[CUSTOMER][NEUTRAL] Of course, yes, um, one second, sorry.
[CUSTOMER][NEUTRAL] Sorry, I'm sorry, I'm barely pulling out the patient. I have like other patients on my desk. OK, [PII] and it's [PII].
[AGENT][POSITIVE] Thank you very much. um I do see [PII] here he's current and active with us with an effective date of.
[AGENT][NEUTRAL] [PII] and then let me pull up his benefit information. I do have the option to send a fax back if that's something what you're wanting, but I can also do verbal if you prefer.
[CUSTOMER][NEUTRAL] Can I do both? Can I ask you for a fax back and then maybe like a few questions that I have in regards to just to make sure like they get answered because I've, I don't think I've ever seen a fax back. I'm not sure what will actually be included in it from you guys.
[AGENT][POSITIVE] OK, yeah, absolutely I can definitely send you that fax back. um, it's gonna have his benefit information, his calendar year maximum, his deductible, what percent everything's paid at and every single code he is approved for.
[CUSTOMER][NEUTRAL] OK, um, any waiting periods or missing?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Any waiting periods are missing tooth clock?
[AGENT][NEUTRAL] Um, he's only covered for basic, so he does not have any waiting periods and he does not have.
[AGENT][NEGATIVE] And I was gonna say he's only, I'm so sorry, my brain just stopped working. Uh, he does have a missing tooth claw, yes.
[CUSTOMER][NEUTRAL] OK, and then so he, it doesn't cover major?
[AGENT][NEGATIVE] No, there is no major coverage for his policy.
[CUSTOMER][NEUTRAL] Preventative?
[AGENT][NEUTRAL] Um, it is just preventative and basic, yes, and basic restorative.
[CUSTOMER][NEUTRAL] OK, how about per oral surgery or endo?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And basic is covered at 1% and preventative is covered at 10%.
[AGENT][NEUTRAL] Uh, yeah, preventative is covered at 100% of allowable and then the.
[AGENT][NEUTRAL] Basic is covered at 80%.
[CUSTOMER][NEUTRAL] OK, what's the group name and group number?
[AGENT][POSITIVE] Yes, that's an excellent question. Let me get that for you.
[AGENT][NEUTRAL] And the.
[AGENT][NEUTRAL] The group name is Partners.
[AGENT][NEUTRAL] Personnel management.
[AGENT][NEUTRAL] Partners personnel management sorry.
[CUSTOMER][NEUTRAL] In regards to the group number, which one would that be? That's 70087?
[AGENT][POSITIVE] Yes, I'm so sorry. I didn't even mean to space on not giving that to you.
[CUSTOMER][NEUTRAL] No, it's OK and the fee schedule please.
[AGENT][NEUTRAL] Alright, yeah, so the fee schedule is going to be based off of the um Carrington PPO network fee schedule. however, utilization of a provider within the Carrington network is not required.
[CUSTOMER][NEUTRAL] OK, and then the coordination of benefits?
[AGENT][NEUTRAL] Um, we do not coordinate benefits.
[CUSTOMER][NEUTRAL] OK, and then just wanna verify, so this insurance is called American Public Life, correct? Or would it be in [PII]? OK, got it.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] American Public, OK, and then can I know if there's any history on file?
[AGENT][NEUTRAL] Yeah, I can definitely look that up for you and then real quick, Ms. [PII], do you have a, a fax number I can send that to?
[CUSTOMER][NEUTRAL] Yes, it's going to be [PII].
[AGENT][NEUTRAL] Alright, [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Alright, I'm gonna send on that so it should be coming your way soon and then let me get that history pulled up.
[AGENT][NEGATIVE] I, I am, come on. I don't think I'm showing any history, but I just wanna make sure it's not just stuck and not loading.
[AGENT][NEGATIVE] Oh yeah, it's definitely gonna be stuck.
[AGENT][NEUTRAL] Alright, so what I'm looking at here is.
[AGENT][NEUTRAL] His last services with us that would impact his frequencies is his bite wings which are once every 12 month period and the last time he had them was 3-13-2024.
[AGENT][NEUTRAL] Um, and then let me check his FMX andpanos for you.
[AGENT][NEUTRAL] OK 1 2nd.
[AGENT][NEUTRAL] I'm not showing any history for.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Complete series.
[AGENT][NEUTRAL] For the FMX or the panel?
[AGENT][NEUTRAL] On him, so I don't have any history on that.
[AGENT][NEUTRAL] So it looks like yeah the only one that would be impacting is that bite wing which is once every.
[AGENT][NEUTRAL] 12 months and it was last done in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, can I just ask you a few quotes, please?
[AGENT][POSITIVE] Yeah, absolutely, 1 2nd.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What codes would you like to look at today?
[CUSTOMER][NEUTRAL] Um, I would like to first, uh, well, I would like to see 43 41 60 1060 57, 6065.
[AGENT][POSITIVE] OK, and I'm so sorry, can we go one at a time?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah yeah no worries, you can do that sorry about that.
[AGENT][NEUTRAL] OK, no, no worries, um, so you said 4.
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] 341. I do not show that's a covered procedure for this policy.
[CUSTOMER][NEUTRAL] OK, OK, how about for um.
[CUSTOMER][NEUTRAL] How about for uh 6010?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and then how about for 6057?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 6065.
[AGENT][NEUTRAL] No, I'm sorry.
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEUTRAL] 7953? No.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] 7:40.
[AGENT][POSITIVE] No, I'm so sorry.
[CUSTOMER][NEUTRAL] It's OK 2950.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] 2954.
[AGENT][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] Um 3221.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] 2392.
[AGENT][NEUTRAL] 2 2392 is covered under basic restorative. It has two limitations. Let me read them to you. Uh, the first one is replaced only if existing for 24 months, and then the next one is a maximum 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] And you said that one is at 80%, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and then let's see.
[CUSTOMER][NEUTRAL] How about for um.
[CUSTOMER][NEUTRAL] 4249.
[AGENT][NEUTRAL] 4249. No, ma'am.
[CUSTOMER][NEUTRAL] And the 9944.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you that was all I needed um I'm sure he has no ortho coverage neither, correct?
[AGENT][POSITIVE] Correct, no wor though.
[CUSTOMER][NEUTRAL] OK, I'll just wait for the fax. I mean, but just in case I don't receive it, can I just get the max and the deductible please?
[AGENT][NEUTRAL] Yeah, absolutely. The calendar year maximum is $500 per year. The deductible is $50 per person. He does have a family deductible of $150 but it's an individual plan, and then his his preventative services will not apply to his deductible.
[CUSTOMER][NEUTRAL] OK and then the.
[CUSTOMER][NEUTRAL] OK, I see, and then.
[CUSTOMER][NEUTRAL] Anything used?
[AGENT][NEUTRAL] Uh, not for this calendar year, no.
[CUSTOMER][POSITIVE] OK, thank you so much for your help Ali have a great rest of your day.
[AGENT][POSITIVE] Yeah, it's my pleasure thank you so much for calling APL you take care.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Mm bye.