AccountId: 011433970860
ContactId: f2a6d466-ad04-48ae-b733-b84bc95da5d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 656539 ms
Total Talk Time (AGENT): 302918 ms
Total Talk Time (CUSTOMER): 176403 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/f2a6d466-ad04-48ae-b733-b84bc95da5d2_20250319T17:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Lines. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII]. I believe I spoke to you earlier. I am calling because I was able to get in touch with the dental department, um, the patients spoke and we were like on a three way, um, phone call, but I am yet to receive the fax.
[AGENT][NEUTRAL] OK, let me get the
[CUSTOMER][NEUTRAL] Of the patients benefits.
[AGENT][NEUTRAL] OK, let me get the policy number.
[CUSTOMER][NEUTRAL] OK, it is 02506636.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, patient, so the insurance is under [PII], but the patron is [PII], his wife.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you could verify her date of birth.
[CUSTOMER][NEUTRAL] Her date of birth? Yes, it is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for verifying the account, so I show you.
[AGENT][NEUTRAL] Call today, spoke with [PII], and then [PII].
[AGENT][NEUTRAL] Uh, it looks like VEV was supposed to fax the, yeah, I don't show I spoke with you, but let me see.
[CUSTOMER][NEUTRAL] Yeah, I've spoken to several people today.
[AGENT][NEUTRAL] And she was faxing over a copy of the benefits.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] I spoke with you briefly um and then you transferred me you said it was a different administrator.
[AGENT][NEUTRAL] 80, OK, um.
[AGENT][NEUTRAL] Um, oh my gosh, um.
[AGENT][NEUTRAL] OK. I can't even think. I'm sorry. OK, I do remember. Yeah, OK. So when that come, did you give a different policy number at the time?
[CUSTOMER][NEUTRAL] It's OK. Yeah, yeah, cause I was, yeah.
[CUSTOMER][NEUTRAL] Um, no, I gave the same policy number, but whenever the customer, the patient called and we were like with, you know, it was 3 of us on the phone, the lady provided me with the dental policy number because all I have here was his medical card and that's what helped me, um, get his benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get it pulled.
[CUSTOMER][POSITIVE] But I went like in a whole circle like I spoke to all these people and went right back to.
[AGENT][NEGATIVE] Yeah, cause the me OK, cause if it's the medical policy, it wouldn't even let me pull up.
[AGENT][NEUTRAL] Any information so.
[AGENT][NEUTRAL] Uh, it'll just go to the other administrator, but now that we're in a dental policy, let me pull up the benefits.
[CUSTOMER][NEUTRAL] Yeah, it's for dental, yes ma'am.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And his his folder should be there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it not
[CUSTOMER][NEUTRAL] OK all right mhm.
[AGENT][POSITIVE] Effective.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK. Now, would the fax be going to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I have [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. Now, it's, it's sent.
[AGENT][NEUTRAL] Um, let me see if EV put anything in the notes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and sure call [PII].
[AGENT][NEUTRAL] Oh, the insurer call with provider on the.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] My Carina to verify benefits and policy info.
[AGENT][NEUTRAL] Provided correct policy number and faxed benefits to office. OK.
[CUSTOMER][NEGATIVE] Right, and we still haven't received it. I'm not sure it's been over half an hour, I know for a fact, um.
[AGENT][NEUTRAL] She doesn't.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me, uh, let me at least.
[AGENT][NEUTRAL] If you don't mind holding, let me at least get the notification because I've sent it. So let me uh get the notification that it's sending.
[CUSTOMER][NEUTRAL] OK all right
[AGENT][NEUTRAL] OK, hold one moment. OK, thank you.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. I apologize for the wait. So I just, I did receive the notification that it's sending fax to, to you. So it is sending, are you getting?
[CUSTOMER][NEUTRAL] Um, I, the machine isn't saying anything, um, but it probably takes a bit before it gets here. Um, could you give me like a brief summary of her benefits though that way at least have that until it comes in.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, mhm, let's see, let me get it back.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, uh, let's see, please advise verifying benefits is not guaranteed payment. Uh, her policy with us has been active since [PII]. It is still current, uh, currently active, um, so it looks like this policy's calendar year maximum is $1500 per person.
[AGENT][NEUTRAL] Uh, she does have a $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] It looks like for her preventative expenses, they pay at 100% of the UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, radiographs are 80%, basic expenses are 80%.
[AGENT][NEUTRAL] Uh, basic restorative expenses are at 80%. All major expenses pay at 40%.
[AGENT][NEUTRAL] Uh, endodontic expenses, 40%.
[AGENT][NEUTRAL] Uh, periodontic expenses 40%.
[AGENT][NEUTRAL] Uh, Hoodontic repair expenses are, uh, considered major, paid at 40%, and oral surgery is paid at 40%.
[AGENT][NEUTRAL] Um, so as far as the frequencies, uh, proffe, cleanings are once every 6 months.
[AGENT][NEUTRAL] Um, the exams 2 per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bite wings.
[AGENT][NEUTRAL] Uh once per 12 month period.
[AGENT][NEUTRAL] Full mouth X-rays and panoramics are once every 5 years.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Crowns and bridges are once every 7 years per tooth.
[AGENT][NEUTRAL] And partials and dentures are once every 5 years.
[AGENT][NEUTRAL] Did you have additional questions?
[CUSTOMER][NEUTRAL] I think that is it, um.
[CUSTOMER][NEUTRAL] Yeah I think that's all the information I need. Can I get a reference number please?
[AGENT][NEUTRAL] Yes, to reference our call, you will use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] [PII]. OK, alright.
[AGENT][POSITIVE] OK. You have a wonderful day and thank you for calling American Public Life. Are you, have you received?
[AGENT][NEUTRAL] Uh, it's a machine.
[CUSTOMER][NEGATIVE] No, it's still not. I, no, we still haven't received it. I haven't, no, the.
[AGENT][NEUTRAL] And it's 985.
[AGENT][NEUTRAL] 796.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] 8501.
[CUSTOMER][POSITIVE] Correct, it is, yes, that's it.
[AGENT][NEUTRAL] OK. I
[CUSTOMER][NEUTRAL] If not with this information it's OK, but can you provide me with the payer ID? I forgot to ask for that to make sure we send it in the correct person.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, yes, the payer ID is 64, I'm sorry, 60801.
[CUSTOMER][NEUTRAL] And what's the payer name?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK, I think that's it, hopefully the fax comes in.
[AGENT][NEUTRAL] OK, let me get your callback number is [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, correct, that is correct.
[AGENT][NEUTRAL] OK. I will, uh, if I get anything that says it's trying and then it's abandoned, I'll give you a call back and let you know for some reason.
[AGENT][NEUTRAL] It's not going through, but right now it's showing that it's [PII]. OK.
[CUSTOMER][POSITIVE] OK, sounds good then yeah.
[CUSTOMER][POSITIVE] OK, well thank you so much, [PII].
[AGENT][POSITIVE] You're welcome. You have a wonderful day, [PII]. Thank you for calling APO.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright you too good bye.
[AGENT][NEUTRAL] Bye bye.