AccountId: 011433970860
ContactId: f6e5bee9-ebc0-4d26-ab62-50ca2d6cf61b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497079 ms
Total Talk Time (AGENT): 227888 ms
Total Talk Time (CUSTOMER): 184800 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/f6e5bee9-ebc0-4d26-ab62-50ca2d6cf61b_20250312T16:00_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], hi, this is [PII] at Wheeler Family Dentistry. I was looking to verify dental benefits.
[AGENT][NEUTRAL] OK, well, I can help you with the dental benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02595683.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I think she said [PII] right [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment, let me get the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is for dental, right? American Public Life?
[AGENT][NEUTRAL] And did
[AGENT][NEUTRAL] Yes, ma'am. This is a dental policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And did you need like a copy of the fax back or you have particular questions?
[CUSTOMER][NEUTRAL] Well, if I could get a fax back, but then I wanted, as I'm not familiar with this, this must be something new through the through the Beage new insurance that, um, so, um, I just wanna make sure one that we're in network.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um, the policy is on the Carrington PPO network. However, if your provider is not a Carrington provider, the benefits are still the same. The percentage offer being um a Carrington provider wouldn't be applied, but the benefits are the same. So there's no um.
[CUSTOMER][NEUTRAL] Can you check if I give you our Carrington?
[AGENT][NEUTRAL] Um, so we're not Carrington, but I do have the number for Carrington if you'd like to see if your providers in network.
[CUSTOMER][NEUTRAL] Oh OK, so y'all wouldn't know.
[AGENT][NEUTRAL] Right, like we don't have access to their list of providers.
[CUSTOMER][NEUTRAL] Oh, OK, hold on one second. Let me, let me, let me ask. Do you know where Carrington PPOs there too, she can't tell me that if we're in their network or not, but there's two different, you know, in-network or out of network.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] them
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So Aetna
[CUSTOMER][NEUTRAL] It's through Carrington.
[CUSTOMER][NEUTRAL] That's dynamite.
[CUSTOMER][NEUTRAL] Hm, do you have a number so I can find out to see?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the number to Carrington is 8002900-523.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I think we are, but we're not sure. Can you go ahead and give me like in network and then we'll, uh, if it's if we're not in network then I can call back?
[AGENT][NEUTRAL] So the, yes, so the benefits are the same. There's no in or out of network. It's all the same benefits. It's just if you are Carrington provider, they'll get like, I don't know if it's 5 or 10% off the bill. If you're not, you just won't get that 5 or 10%, but the benefits are the same.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the, the policy, um, like you want to go over the calendar year max deductible?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK. So the calendar year max is $500 per um insured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The deductible is $50 per insured up to $150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, deductible doesn't apply to preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy covers preventative and basic expenses. Preventative is covered at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiographs and FMX.
[AGENT][NEUTRAL] Basic expenses and basic restorative are all at 80%.
[CUSTOMER][NEUTRAL] So the FMX is basic.
[AGENT][NEUTRAL] Right. Well, it's in a category by itself.
[CUSTOMER][NEUTRAL] and any X-rays?
[CUSTOMER][NEUTRAL] Oh OK, um, preventative is just exams and cleaning.
[AGENT][NEUTRAL] Um, exams, bite wings, cleanings, fluoride, sealants, yeah, it's a list of things under preventative.
[CUSTOMER][NEUTRAL] OK, so like a PA, um, would be a preventative, like a PA exam, the 0220?
[AGENT][NEUTRAL] What's the
[AGENT][NEUTRAL] Hold on one second. That's under basic.
[CUSTOMER][NEUTRAL] OK, so X-rays is under the basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so there's no, no major coverage.
[AGENT][NEUTRAL] Right, Major for us is endodontic, perioontic, prosodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so D 7140, would that be major too?
[AGENT][NEUTRAL] 7140, um, for us is that's a basic simple extraction.
[CUSTOMER][NEUTRAL] These but the 70 to 10 would be major.
[AGENT][NEUTRAL] 7210, yes, because it's not on this list of codes.
[CUSTOMER][NEUTRAL] OK, OK, and no waiting period?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] No, there's no waiting period because major is not covered on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and has anything been used?
[AGENT][NEUTRAL] Uh, let's see. Hold on one moment.
[AGENT][NEUTRAL] Um, no, ma'am, he has not used any of the max or met the deductible yet.
[CUSTOMER][NEUTRAL] OK, so where do we send claims to?
[AGENT][NEUTRAL] Um, you can mail it, you can fax it, or you can send it electronically. Um, I can give you all three. It's also on the fax back, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] Do you want all three?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, so the payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright thanks.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's gonna go to American Public Life.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our fax number is [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] And yeah do say
[CUSTOMER][NEUTRAL] OK, I'm sorry, go ahead, fax number is [PII].
[AGENT][NEUTRAL] Mhm. 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's going to be attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And y'all do set assignment of benefits, right?
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] OK, OK, so that I can just call this number to find out if we're in network and then um.
[CUSTOMER][NEUTRAL] Can you send me a fax too for just what we went over?
[AGENT][NEUTRAL] Sure. Of course. What's a good fax number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 832
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Alrighty, so I'll go ahead and send this over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] All right, [PII], so thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.