AccountId: 011433970860
ContactId: d6789026-a07b-4a1a-9e55-4a48dea92a8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636679 ms
Total Talk Time (AGENT): 336202 ms
Total Talk Time (CUSTOMER): 329266 ms
Interruptions: 18
Overall Sentiment: AGENT=0.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/d6789026-a07b-4a1a-9e55-4a48dea92a8d_20250401T18:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling to confirm benefits for one of our patients.
[AGENT][NEUTRAL] OK, [PII], are you needing benefit information only or do you also need eligibility?
[CUSTOMER][NEUTRAL] Eligibility as well.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with both things, [PII], and what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Our callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 025796997
[AGENT][NEUTRAL] OK, thank you [PII]. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What type of policy are you calling on today?
[CUSTOMER][NEUTRAL] Dental, please.
[AGENT][NEUTRAL] OK. And also on our dental policies, [PII], I have a fax back of the member's benefits that I can send to you and anything not on the fax back means it would not be covered under the plan also.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] That would be lovely and I just have a couple other things to go over that is just absolutely marvelous.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, sure. That's.
[AGENT][NEUTRAL] Certainly will. I'll be happy to send that over to you. So, first off, any information I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] So their name is [PII] and last name is [PII]
[AGENT][NEUTRAL] Mhm. Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was like.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Beautiful front line.
[CUSTOMER][NEUTRAL] Two cars
[CUSTOMER][NEUTRAL] Where you've got a
[CUSTOMER][POSITIVE] It's not a bad option.
[AGENT][NEUTRAL] OK, so again, he is the subscriber on this dental plan and it is active effective [PII].
[AGENT][NEUTRAL] And what type of information, um, you said you needed some additional information also. There's no history on file for him.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh great well that's good news. What is the group name of this plan?
[AGENT][NEUTRAL] OK, his employer's name is Universal Trucking.
[AGENT][NEUTRAL] United Road.
[CUSTOMER][NEUTRAL] United Road ROAD?
[AGENT][POSITIVE] Already, that is correct.
[CUSTOMER][POSITIVE] Great, and is this a family plan or is this a sole plan?
[AGENT][NEUTRAL] This is family. This is uh family.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Fantastic. Now the insurance, uh, he gave me the group number, I believe, let me just make sure it's still the same. I have 16703.
[AGENT][NEUTRAL] Do you need the, do you need the group number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] Great and his member ID is 02579697 correct? Fantastic. Now the actual name for the insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct. Mhm.
[AGENT][NEUTRAL] Is American Public Life.
[CUSTOMER][NEUTRAL] dedicated rooms for
[CUSTOMER][NEUTRAL] large
[CUSTOMER][NEUTRAL] Found it here we go and the plan product name is it just American Public Life, is that the name of the product itself?
[AGENT][NEUTRAL] Public life, yes.
[AGENT][NEUTRAL] Uh, yes, and this is not a, and that is also on the fax back along with our payer ID and claims fax number.
[CUSTOMER][POSITIVE] Great and the mailing address?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you still want me to give it to you verbally?
[CUSTOMER][NEUTRAL] Yeah, what is the um is this the [PII] or the [PII] address?
[AGENT][NEUTRAL] It's, uh, the [PII], if it's [PII], that no longer exists.
[CUSTOMER][NEUTRAL] Uh huh, so the [PII], OK, I'll tell them.
[AGENT][NEUTRAL] So that needs to be removed.
[AGENT][NEUTRAL] 248,950 and [PII] City is our, which is what is also on his ID card.
[CUSTOMER][POSITIVE] Perfect. OK, and the payer ID is the [PII]?
[AGENT][NEUTRAL] That is the correct address.
[AGENT][POSITIVE] Alright, take the word, that is correct.
[CUSTOMER][NEUTRAL] Great, now my next question is, let's see, is there a deductible on this plan?
[AGENT][NEUTRAL] There he is. It's a $50 calendar year deductible that is also that information is on his fax back.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] $50 per covered insured up to $150 per family, and a $1500 calendar year maximum benefit.
[CUSTOMER][NEUTRAL] OK, I just have to go.
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] For coverage services.
[CUSTOMER][NEUTRAL] Great, great, and no benefits on file and is this calendar year plan or a contract year and it starts [PII]?
[AGENT][NEUTRAL] Calendar.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And the effective date on his policy is [PII]. No.
[CUSTOMER][POSITIVE] Great, is there or coverage on this plan?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] Well, OK.
[AGENT][NEUTRAL] And that's stated on the fax back as well.
[CUSTOMER][NEUTRAL] OK, so there's no ortho coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, just making sure of all this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, but I do have to go through this because I do have the notes here for me to close out my window. Um, if you can tell me about the group coverage for uh diagnostic and preventive, is it by fee schedule or is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Based on a percentage percentage of the UCR of the service region covered services are based on a percentage.
[CUSTOMER][NEUTRAL] At a percentage rate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Great and it's UCR?
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, diagnostic and preventive is 100?
[AGENT][NEUTRAL] Preventative is 100, radiographs, FMX and basic. Basic restorative major and I'm sorry, let me start that over. Preventative is 100% of UCR. Radiographs, FMX is in basic and basic restorative is 80% of UCR.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] yeah the places are open.
[CUSTOMER][POSITIVE] Great, OK.
[AGENT][NEUTRAL] Major endoperontic, prosthodontic, and oral surgery is 40% of UCR with a 12-month waiting period on those five categories.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] And that's all on the facts back as well.
[CUSTOMER][NEUTRAL] Great, yeah, if you could fax it over to me I won't keep you on this then because you're gonna answer every question I have. OK, our fax number is 401.
[AGENT][NEUTRAL] Yeah, no, you're fine.
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] OK. Give me one second. Alright, 1 2nd. Let me pull that. Does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] No, no, no, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So grab, we, we can grab it here.
[AGENT][NEUTRAL] Now, I don't know, um, on here, there is also a dependent child with the exact same name as him. Obviously, date of birth is different, but neither have a middle initial, so just um since you had asked the level of coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, thank you. I definitely appreciate that.
[AGENT][NEUTRAL] OK, and the fax number again?
[CUSTOMER][NEUTRAL] 401.
[CUSTOMER][NEUTRAL] 519
[CUSTOMER][NEUTRAL] 7558
[AGENT][NEUTRAL] I'm so sorry, but [PII], your voice faded out. I could barely hear you. Could you, uh-huh.
[CUSTOMER][NEGATIVE] I never like.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and I'm just gonna repeat it back to make sure I heard you correctly. [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, well, I have just sent that to you then.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So provided there's not any type of technical mishaps you should be receiving that within just the next few minutes and then I did wanna tell you that if you all end up filing a claim with us, [PII], once it's been processed, we do have a portal in which you should be able to check claim status and our portal website is located at secured.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Great secure [PII].
[AGENT][NEUTRAL] OK. Secured has a D on it.
[AGENT][POSITIVE] So it's secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Great, OK, I have it now. Thank you so much and one last question, are implants covered under this.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh right, well, you are certainly welcome. Yes.
[CUSTOMER][NEUTRAL] Are implants covered under this plan?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, they are not. Implant placement, removal and all related services are not covered.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Wonderful and in your information it has the replacement um information correct your.
[CUSTOMER][NEUTRAL] You're um.
[CUSTOMER][NEUTRAL] Let me just see here.
[CUSTOMER][POSITIVE] The frequency limitations are in there too, OK? True in the email fantastic thank you so much for your time all right.
[AGENT][NEUTRAL] Oh, yes. All of that's in there. Yes. Sure.
[AGENT][NEUTRAL] Yes, on this fax back. You're welcome. Yes. On the fax pack, it breaks it down into the different categories. It's gonna give you the procedure codes, the service, and then the right column has limitation and on the very last page of the fax back is the fax back is 8 pages. It gives you the um what the limitation, you know.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I see the future.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] Limitations are with whatever alphabetic code was beside it.
[CUSTOMER][NEUTRAL] OK, and is there a missing
[AGENT][NEUTRAL] Mm.
[CUSTOMER][MIXED] Great, a missing tooth claws.
[AGENT][NEUTRAL] Yes, there is.
[AGENT][NEUTRAL] There he is. It
[CUSTOMER][POSITIVE] Perfect. OK. All right. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. So again, is there anything else? Yes, ma'am, you too. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] All right have a great one.
[CUSTOMER][NEUTRAL] No, I'm letting you go.
[AGENT][POSITIVE] Well, you're fine, [PII]. I've enjoyed talking with you. Yes, ma'am, and thank you for calling ATL. Have a wonderful rest of your day.
[CUSTOMER][POSITIVE] No, you're good to go thank you.
[CUSTOMER][NEUTRAL] Same bye bye.
[CUSTOMER][POSITIVE] You got it.
[AGENT][POSITIVE] Thanks. Bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.