AccountId: 011433970860
ContactId: e91c7f24-74b7-46b9-95f6-e05117b7a6dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 835159 ms
Total Talk Time (AGENT): 328146 ms
Total Talk Time (CUSTOMER): 326414 ms
Interruptions: 9
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/e91c7f24-74b7-46b9-95f6-e05117b7a6dc_20250506T20:58_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I just, oh shoot, I just, please.
[CUSTOMER][NEUTRAL] OK, sorry. Hi, can you hear me?
[AGENT][NEUTRAL] Hello.
[AGENT][POSITIVE] I can. Yes, ma'am. How can I help you today?
[CUSTOMER][NEUTRAL] OK, I, sorry, I just had to these for a second. It was OK, it went up. OK, um, I just need to, I, I'm on the website. I'm trying to find a dental provider that I can, uh, we can go to, um, on the website. Do I have to log in and create an account, or can I just look at the providers?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, so you're trying to find out how to locate a network provider for the type of policy you have with us, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yep.
[AGENT][NEUTRAL] OK, yes ma'am, I can direct you, but I'll first need to pull up your policy information and verify some things with you for security so I can see the type of plan you have, and then we can go from there. Alright, so first off.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I tried to create it. I tried to create a login account, but it says like social security number or member ID and not policy number, and all I have is the policy number.
[CUSTOMER][NEUTRAL] So I don't know what.
[AGENT][NEUTRAL] OK. So first off, who am I speaking? OK, so I can try and help you. Who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] My name's [PII], but I'm not the policy holder.
[AGENT][NEUTRAL] So that's why you're not gonna, OK. So, [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you, and the policy number?
[CUSTOMER][NEUTRAL] It is 00753470.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] He just needs a root canal, so I, I just need to find a root canal doctor because he needs, he's at the dentist right now and he needs a root canal, and I don't know how to figure out where he can go, you know, with his insurance, so.
[AGENT][NEUTRAL] OK. So what I'm gonna need to do is I'll have to verify some things with you first for security, and then I'll explain a couple of things to you, OK? So, what is his name again and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And his home mailing address, please?
[CUSTOMER][NEUTRAL] Um, I think it's [PII].
[AGENT][NEUTRAL] Thank you. And the, his phone number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Now we do have something else on file for him.
[CUSTOMER][NEUTRAL] Oh really? Oh, that's been his number for 5 years.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Mhm. OK. Well, we were provided another phone number for him for his enrollment.
[CUSTOMER][NEUTRAL] OK, yeah, I think he enrolled in like [PII], so I think it's been a long time so but he's had that number at least 5 years at least or more.
[AGENT][NEUTRAL] OK. So what is the last 4 of his social?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I don't remember. I'll have to ask him.
[CUSTOMER][NEUTRAL] He's at the dentist right now. Just a sec, let me check him.
[AGENT][NEUTRAL] And [PII], do you spell your first name [PII]?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And then how do you spell your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Now, [PII], I will be, I'm gonna go ahead and just let you know that I'm gonna be very limited as to what I can tell you without his authorization to speak to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For sure, yeah, I just, I just thought it'd be I could look up, um, yeah, I just, how, OK, how can I tell him to see who you guys cover for root canals then.
[AGENT][NEGATIVE] Because you're not covered.
[AGENT][NEUTRAL] Is there a way you can conference him in to authorize me to speak to you? Otherwise, he can, we are here until [PII] central time.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me see if I can add him.
[CUSTOMER][NEUTRAL] He's like at the dentist, so I don't know what they're.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh wait, how do I.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK [PII], are you there? Yeah.
[CUSTOMER][NEUTRAL] OK, I have the lady from your insurance on here. She just wants you to say that it's OK.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Yes, it's OK to give any information to [PII].
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] Yes, so it will be, Mr. [PII], that'll be for this one phone call only, but with your authorization, I can do that. If you'll verify the last four of your social for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then what is your current, what is your phone number? Because the phone number that [PII] gave me for you was not what we have on file.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, now what that is not the phone number that we have. What is an old phone number that we could possibly have for you or?
[AGENT][NEUTRAL] A different phone number.
[CUSTOMER][NEUTRAL] The only other number that I can think of is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] This one ended in a [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] No. Maybe they got it mixed up because it's a weird number [PII] and then [PII].
[AGENT][NEUTRAL] No, it's nowhere close to yeah.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Well, it's changed now. I mean, I just called in on it. My, my cell phone number has been the same for years.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then I do need to add an email address on file for you. What email address would you like for me to add, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII]. Is that correct?
[AGENT][NEUTRAL] Was that correct, Mr. [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] OK, alright, so I'll be happy to speak to [PII], um, and answer any questions that I can for this phone call and I'm also going to email you a.
[AGENT][NEUTRAL] User guide
[AGENT][NEUTRAL] That will explain how you can profile in our portal where you can also have access to your information online as well, OK?
[AGENT][NEUTRAL] And that email that I'm gonna send to you will come from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] OK, well, thank you very much um for giving me this verbal authorization for today.
[CUSTOMER][POSITIVE] Thank you I appreciate it bye bye.
[AGENT][POSITIVE] All right, you're very welcome. Bye bye.
[AGENT][NEUTRAL] OK, [PII], are you still there?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, alright, so, um, on this policy, this is not a network plan so he may go to any, he may choose any provider, this is not a network.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Plan that he has.
[CUSTOMER][NEUTRAL] So is that, um, is there like, I, I guess like, um,
[CUSTOMER][NEUTRAL] Uh, it's when I called, the code that I did was like 3350 was like the, it was like endo endodonics or root canal, I guess I should say that interchangeable, but root canal on a molar.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then she told me that it that you guys cover $124 of it.
[AGENT][NEUTRAL] OK, so give me just one second. OK, give me more.
[CUSTOMER][NEUTRAL] It's what she said, but I know you can't guarantee it and all that stuff, but I just, I just thought, I just thought that that was like extremely low for like a root canal, you know, cause they're like $1000.
[AGENT][NEGATIVE] Oh, no, wait, yeah, I can't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and this plan does pay specific benefit amounts for certain coverage services.
[CUSTOMER][NEUTRAL] So I, I
[AGENT][NEUTRAL] So if you'll give me just one moment to send him, finish sending him this email that I told him I was gonna.
[CUSTOMER][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And um I can look that code up for you that you lost, but give me just a second.
[AGENT][NEUTRAL] OK, and what was the code, Mellie, that you had?
[CUSTOMER][NEUTRAL] Um, I'm just going off my memory because I wrote it on a different paper, but it was like 33,350 I think. It's for a root canal on a molar.
[AGENT][NEUTRAL] 30
[AGENT][NEUTRAL] Right, but, OK, I can look for that code number, but, you know, if that's not the right code number, um.
[AGENT][NEUTRAL] And the provider
[CUSTOMER][NEUTRAL] You know, I think
[CUSTOMER][NEUTRAL] Yeah, I think what she was, I think it was the wrong code. I think it was for the the restoration that goes on top of the end though, so like they do a root canal and and they'll fill it up with a filling, and I think that's the code she gave me because I'm like.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] You know it, or maybe, I don't know, maybe $124 for.
[AGENT][NEGATIVE] OK, cause I can't, the 3350 didn't even pull up as being covered under his plan. So I don't know if that's not a valid code or, you know.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, it's, he wrote it on.
[CUSTOMER][NEUTRAL] We were like just driving in the car and I wrote it on a paper, so I'm literally just going off my memory of what she told me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But um but it's, but so can you see um.
[CUSTOMER][NEUTRAL] So there's not like you guys don't have like his policy doesn't say like 50% root canal, 50% crowns.
[AGENT][NEUTRAL] No, this is not the type of plan. No. He has, again, it pays specific benefit amounts for certain covered services. It's not based on percentages.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Can you look up a root canal on a roller?
[CUSTOMER][NEUTRAL] I know there's like lots of codes. I was, I worked in a dental office for like 20 years, so.
[AGENT][NEUTRAL] If you can give me, yeah. Yeah, you would have, I would have to have the.
[CUSTOMER][NEUTRAL] I don't know the code for that.
[AGENT][NEUTRAL] Right. And there are multiple different, because there's different types of root canals.
[AGENT][NEUTRAL] So it could range anywhere from, you know, a $283 benefit to a $446 just based on, you know, but you said it's for a molar.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes. Yeah.
[AGENT][NEUTRAL] Now, for code 3330, that is root canal molar excluding the final restoration. The benefit is 446.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] Oh, OK, that sounds more right. OK, that's what I was expecting. I was expecting around 400 or so. So that's OK, so good. So as long as he, so he doesn't have to go in network, that's, that's good.
[AGENT][NEGATIVE] Yeah, there's not a network plan for this.
[CUSTOMER][NEUTRAL] And then they'll bill for that.
[CUSTOMER][NEUTRAL] And then the restoration will be like obviously a different code cause, cause they'll put a little filling on top, you know, that'll be just, that's actually like an accrual on a molar, adult molar crual would be that one, but that one's not, I mean that's like 200 bucks total. So I'm sure you guys pay like, you know, $70 or something, I would, I would assume.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] But, OK, all right, well, that's good to know. I'll just have him go to the guy I like them and the honest I like.
[CUSTOMER][NEUTRAL] And it it doesn't matter where he goes.
[AGENT][NEUTRAL] You're correct. He's, this is not a network plan, so he, he's not in a specific, you know, he doesn't have to use specific network doctors for maximum benefits.
[CUSTOMER][POSITIVE] OK. Awesome. I think that is all I needed to know.
[AGENT][POSITIVE] OK, well, if that is all I can help you with, um, thank you again for calling APL and I hope that you have a very nice rest of your day today.
[CUSTOMER][POSITIVE] You too, thank you so much.
[AGENT][NEUTRAL] All right.