AccountId: 011433970860
ContactId: ef87a180-68cc-47cc-b7f8-640e63eb7dc3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514217 ms
Total Talk Time (AGENT): 209528 ms
Total Talk Time (CUSTOMER): 181209 ms
Interruptions: 7
Overall Sentiment: AGENT=-0.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/ef87a180-68cc-47cc-b7f8-640e63eb7dc3_20250624T13:10_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify benefits for a patient.
[AGENT][POSITIVE] Sure, I can assist you with benefits. May I have your name?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. Alright, and may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's Aspen dental. What kind of opportunities and challenges.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It's 02641157.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it is the [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. You need this benefit information given to you verbally or faxed over to.
[CUSTOMER][NEUTRAL] Uh, verbally please.
[AGENT][NEUTRAL] OK, you have a specific question or you need a full breakdown?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, specific questions, what was the effective date?
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Alright. Effective date on the policy is [PII]. And you just ask them at the moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Perfect, uh, what was the group name and group number?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] There's like.
[AGENT][NEUTRAL] The group name is Superior.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Skilled trades.
[AGENT][NEUTRAL] LLC.
[CUSTOMER][NEUTRAL] And then um what was.
[AGENT][NEUTRAL] The group number is 7.
[CUSTOMER][NEUTRAL] What was the group name?
[CUSTOMER][NEUTRAL] Yeah um.
[AGENT][NEUTRAL] Superior Skill Tras LLC.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect and then what was the group number?
[AGENT][NEUTRAL] 70101.
[CUSTOMER][NEUTRAL] Perfect. And then what was the name of the insurance? Is it under Carrington?
[AGENT][NEUTRAL] No, this is uh APL. It's gonna be on the APL or American Public Life.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now if you're looking for the network, um, if the provider participates with Carrington they can use their fee schedule but it is not required.
[CUSTOMER][NEUTRAL] And you said it was is this considered like a PPO plan?
[AGENT][NEUTRAL] Um, this is not a PPO and HMO. Uh, if the provider participates with Carrington, they can use their PPPO schedule, but it is not required, so it is more like a commercial plan.
[CUSTOMER][NEUTRAL] You said it was called American Public Life.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What was the claims address?
[AGENT][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII]. We also have a payer ID if you need it.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Perfect. What was?
[CUSTOMER][NEUTRAL] Uh, yes, what was the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then are you able to verify if our providers in network or not?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] OK, um, what was the deductible and does it apply to basic and major?
[AGENT][NEUTRAL] OK, deductible is $50 per insured or $150 per family, and deductible does not apply to preventatives.
[CUSTOMER][POSITIVE] Perfect. What was the maximum and has only been used year to date?
[AGENT][NEUTRAL] OK, let me check on that for you. One moment.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] but I
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] For your denture yesterday the 52.8.
[AGENT][POSITIVE] OK, this one has a benefit of 750 per year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Pretty good
[AGENT][NEGATIVE] And nothing has been made or used for 2025.
[CUSTOMER][POSITIVE] Perfect. I mean it's.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Perfect, is there any ortho coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Perfect. Do you have the group coverages for preventative basic and major?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we have preventative is cover 100%. Radiograph FMX is covered at 80%.
[AGENT][NEGATIVE] Basic expense and basic restorative expenses cover at 80%. With this one there's no major service. So and the periodontics process repair surgeries are not covered under this one.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] It's just basic.
[CUSTOMER][NEUTRAL] I'm sorry, you cut out at the end. You said no endedontics, periodontics, or oral surgery? Like you guys swing for the fences with the signature.
[AGENT][POSITIVE] Correct, there's no major service.
[AGENT][NEUTRAL] Just a basic policy.
[CUSTOMER][NEUTRAL] Is the code what is the code 7140 covered under? 39% for signature 27% for.
[AGENT][NEUTRAL] 71.0. That's the simple extraction, right, let me double check.
[CUSTOMER][NEUTRAL] Do you want
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For the
[AGENT][NEUTRAL] That's that's gonna be under the basic.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And then is there any crown bridge implant or denture coverage?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And then are there any waiting periods?
[AGENT][NEUTRAL] Not on.
[CUSTOMER][NEUTRAL] Do you have the frequencies for exams, cleanings, and X-rays?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for cleanings, we have once every 6 months. Oral evaluation is 2 for 12 month period. But when this once per 12 month period. Fu m x-rays and panels are once every 5 years.
[CUSTOMER][POSITIVE] Perfect. What about for period auto maintenance code 4910? I know that period isn't covered, but sometimes the maintenance is not covered.
[AGENT][NEGATIVE] Not covered.
[AGENT][NEGATIVE] That one is not.
[CUSTOMER][NEUTRAL] Is there does the missing tooth cloth apply?
[AGENT][NEGATIVE] Not for this one because it's only basic.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Are there any downgrades on this plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Perfect, do you mind if I have a reference number for this?
[AGENT][NEUTRAL] We don't have reference numbers, Miss [PII]. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Uh, what was your name?
[AGENT][NEUTRAL] My name is. That's [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alright thank you so very much I really do appreciate you.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Mm