AccountId: 011433970860
ContactId: ef186a36-0702-45a4-a74b-6eb466a590eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479570 ms
Total Talk Time (AGENT): 243976 ms
Total Talk Time (CUSTOMER): 96132 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/ef186a36-0702-45a4-a74b-6eb466a590eb_20250203T15:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in the customer service department. I've got an insured on the back line that's wanting to get some benefit details on his dental insurance, like what benefits he has and how many cleanings he can have per year.
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] 258
[CUSTOMER][NEUTRAL] 0767
[CUSTOMER][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] And his callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you did verify all the demographics.
[CUSTOMER][POSITIVE] Yes, everything is correct, and I'm emailing him temporary cards and ordering physical too.
[AGENT][NEUTRAL] Is this Tardarius?
[CUSTOMER][NEGATIVE] Ti [PII], yeah, I just didn't want to slaughter it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can transfer him.
[CUSTOMER][POSITIVE] All right, here he goes thank you and you have a good day.
[AGENT][POSITIVE] Thank you, same to you.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] uh, I was trying to see uh what my benefits are.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Benefit details.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm pulling that up for you now.
[AGENT][NEUTRAL] And is there a specific benefit that you're needing for me to verify?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] My dinner.
[AGENT][NEUTRAL] Is it for your preventative?
[CUSTOMER][NEUTRAL] I, I don't know what that mean.
[AGENT][NEUTRAL] So, what you get every year, you can normally get it like your cleanings, your whitening or any of that, your preventative expenses.
[CUSTOMER][NEUTRAL] I wanna know all of them, you know.
[AGENT][NEUTRAL] OK, so in regards to your benefits, verification of coverage does not guarantee the payment of the claim. For the calendar year you have up to $500. You do have a $50 deductible, but the $50 deductible is not included or applies to your preventative services.
[AGENT][NEUTRAL] If this policy is for a family, you will have up to the $150 but you only have the $50 deductible that you would have to pay out.
[AGENT][NEUTRAL] In regards to your preventative expenses, you do have up to 100% allowable for preventative services, which includes your cleaning, your cleaning you get once every 6 months.
[AGENT][NEUTRAL] Then you also have a radiograph, which is some X-rays, which that covers up to 80% of a label.
[AGENT][NEUTRAL] For your basic expenses, that's up to 80%.
[AGENT][NEUTRAL] And for your basic rest restorative expenses, that is up to 80%.
[AGENT][NEUTRAL] For your oral evaluate, go ahead.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] So I would have to pay
[CUSTOMER][NEUTRAL] So y'all cover up to
[CUSTOMER][NEUTRAL] 80% of like, if you gotta get work done in your mouth.
[AGENT][POSITIVE] Yes, it covers up to 80%.
[AGENT][NEUTRAL] But you do, we do have up to a maximum that we will pay out of the $500. Once that $500 is met, we will not pay anything else out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You do. I'm guessing.
[AGENT][NEUTRAL] OK. And so for your oral evaluation, you do have a total of 2 per 12 months. And then you also have the bite wing services, which you can only get that once per year.
[AGENT][NEGATIVE] And then your full mouth X-ray and panoramics, that is once every 5 years. Now, with this policy, orthodontic treatment is not covered.
[AGENT][NEUTRAL] Implant placement, removal and all related services are not covered either. It also shows that TMJ services are not covered under this policy, and then this policy does not have a missing tooth clause. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] But, so they, so they gotta take out to.
[CUSTOMER][NEUTRAL] It's not COVID.
[AGENT][NEUTRAL] If you have a missing tooth.
[AGENT][NEUTRAL] Already prior to the services it says it does not have a missing tooth clause, so if you have a missing tooth it's it's not saying that it's an exclusion.
[CUSTOMER][NEUTRAL] And I'm saying like if you gotta get a tooth pulled.
[AGENT][NEUTRAL] It's according to what they bill how they bill it then that is the way that we will be able to pull any of the codes up to see if that is covered up on your policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So you, you're trying to see if an extraction is covered?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So it looks like on here an extraction erupted tooth or exposed root.
[AGENT][NEUTRAL] It is covered under.
[AGENT][NEUTRAL] Your basic expenses, which is up to the 80%.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] All right. Oh, is it not like that? What I got? I got, I got medical benefits or something like that.
[AGENT][NEUTRAL] Let me see if you have medical with us.
[CUSTOMER][NEUTRAL] And all I've been on.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Now it does look like you do have medical, which is a limited benefit policy with us. It looks like it's an indemnity policy and so for that policy it does show that it is a limited benefit and if there's an amount that is left over after we make the payment, then it is your responsibility on that amount.
[AGENT][NEUTRAL] And were there specific benefit that you're needing to verify on that?
[CUSTOMER][NEGATIVE] That will never um
[CUSTOMER][NEUTRAL] But I'll be having to take
[CUSTOMER][NEUTRAL] Take my medicine, I better take a certain medicine so I did, how much it cover up.
[AGENT][NEUTRAL] Now, this is not in regards to prescription. This is for medical only.
[CUSTOMER][NEUTRAL] Oh, like going to the doctors again.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Checkups and stuff.
[AGENT][NEUTRAL] Yes. Now, your prescription, let me check to see if there's another number that you have to call in regards to your prescription.
[AGENT][NEUTRAL] So it looks like you would have to call Farmaville in regards to your prescription. Are you ready for that number?
[CUSTOMER][POSITIVE] Oh no, I'm good. I just see.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Well, I do wanna thank you so much for calling American Public Life. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.