AccountId: 011433970860
ContactId: 05e80730-592b-4f09-b95c-84a047294002
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 741590 ms
Total Talk Time (AGENT): 278477 ms
Total Talk Time (CUSTOMER): 305074 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/05e80730-592b-4f09-b95c-84a047294002_20250220T21:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, what did you say your first name is?
[AGENT][NEUTRAL] [PII], last initial [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Kind of cool. Um, and have never heard of that. That's why I was trying to get out of my mouth. Um.
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess I don't know, um, so I was just wondering if you could look up our benefits and let me know because I got the book here in front of me where I can find the information I need, um, because I'm not to make everybody do my work for me. I just, uh, um, I have to have implants.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um I think our insurance went into effect December. I just have to have one implant. It's uh a root canal gone bad from 20 years ago.
[AGENT][NEUTRAL] Uh, what's your policy, your name first and your policy number?
[CUSTOMER][NEUTRAL] Um, OK, the policy do do do certificate number.
[CUSTOMER][NEUTRAL] Is 02560623.
[CUSTOMER][NEUTRAL] And it's the policyholder's name is [PII], and my name is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well that at work. Give me one moment.
[AGENT][NEUTRAL] OK, and give me a moment.
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, well, under your dental policy, it does not cover implants.
[CUSTOMER][NEUTRAL] Not at all?
[AGENT][NEUTRAL] Not at all, no, ma'am. Uh, implants are implant crowns are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What about the X-rays and stuff, 3D X-rays?
[AGENT][NEUTRAL] Um, sure, about 3D X-ray, but let me look under your policy. Give me one moment.
[CUSTOMER][NEUTRAL] Can you hang on a second, I guess just tell this person I'll call him back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you there?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][MIXED] Yes ma'am, but 3D X-rays are not covered. Uh, you do have benefits for like panoramic X-rays or full mouth, bite wings, PAs, those are covered, uh, 3D X-rays are not covered under the plan.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, that's crazy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This one here, this booklet I have?
[CUSTOMER][NEUTRAL] It says uh dental insurance certificate.
[CUSTOMER][NEUTRAL] Certificate schedule of benefits and then.
[CUSTOMER][NEUTRAL] Endoonic expenses? Oh, that's after 12 months.
[AGENT][NEUTRAL] Uh, yeah, for major services, there is a twelve-month waiting period. Uh, since your policy that was in effective to [PII], major services will not be eligible to [PII] of this year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And then would the implant be able to be covered?
[AGENT][NEUTRAL] No, ma'am. Implants are just not covered under the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a different plan that it would be covered?
[AGENT][NEUTRAL] Well, none of our dental policies covered implants.
[CUSTOMER][NEUTRAL] Not even partial.
[AGENT][NEUTRAL] Um, partials are covered, dentures are covered, just uncovered implants, like actually.
[CUSTOMER][NEUTRAL] Oh, I mean partial, the partial payment.
[AGENT][NEUTRAL] Oh, no, ma'am. Uh, it doesn't cover implants at all. No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, this is radiograph FMX basic basic restoration major, endogenics.
[CUSTOMER][NEUTRAL] Um, repairs, oral surgery.
[CUSTOMER][NEUTRAL] Description of coverage and it says $50.
[AGENT][NEUTRAL] Uh, there's a $50 deductible on major services.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, I was wondering if I could get the money back because my husband paid $300 to get them X-rays.
[AGENT][NEUTRAL] Um, so he had X-rays performed.
[CUSTOMER][NEUTRAL] No, I did.
[AGENT][NEUTRAL] OK, was it for a 3D X-ray?
[CUSTOMER][NEUTRAL] I did. We made it.
[CUSTOMER][NEUTRAL] That's what they call them, but um, yeah, we had to go all the way to Lansing for them.
[AGENT][NEUTRAL] Um, you can contact the provider and request the billing that shows the data service, the, um, procedure codes, and the charges and submit that to us for review.
[CUSTOMER][NEUTRAL] Oh, OK, um, where do I send it?
[AGENT][NEUTRAL] Or the provider can submit it.
[AGENT][NEUTRAL] Um, our mail address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Well then.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEGATIVE] Wait a minute, you're too fast. I'm still at [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, what's
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] So I just send you.
[CUSTOMER][NEUTRAL] Is there a form I need to fill out to send with?
[AGENT][NEUTRAL] Uh, no, ma'am. We, we don't have claim forms for dental. You would just need to submit the billing, showing the codes and the amount of charge in the data service.
[CUSTOMER][NEUTRAL] What they did?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] All right. This is what I'm really having a hard time with right now. Um, so my dentist.
[CUSTOMER][NEUTRAL] Um, referred me to go to Lansing to get these X-rays cause apparently nobody in this area did them.
[CUSTOMER][NEUTRAL] Well, then I come back and she refers me to a doctor that's right down the road from her.
[CUSTOMER][NEUTRAL] And when I called them to try to get my appointment set up, he said, well, he's gonna need to do X-rays here, so he has his own. I'm like, well then, why did I even go all the way to Lansing?
[CUSTOMER][NEUTRAL] You know what I mean?
[AGENT][NEUTRAL] Yeah, so you had to go to another place and then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, that stinks. But yeah, like I said, you can submit the claim, so we can review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, as long as I have the codes and the date of service.
[AGENT][NEUTRAL] Uh, the close, data service, and amount of the charge. Yes, ma'am.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK, and do I need a copy of the um receipt they gave us then?
[AGENT][NEUTRAL] Uh, not the receipt, just the billing that has the codes. It has to have those what is called ADA codes, dental codes in order for us to process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Sounds like a plan. I just gotta get this going before I'm hurting again cause I, you know.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I asked for um antibiotics, and those have been out for a while and I know if I'm not careful, I'm gonna be in the same spot.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEGATIVE] Yeah, root canals in general hurt.
[AGENT][NEUTRAL] And antibiotics, yeah. Yes, ma'am, but and um if you like, I could also give her a fax number if you want to fax the claim to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, yeah, let's do that.
[AGENT][NEUTRAL] OK. Uh, it's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] And it'll come straight to our claims department.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right, I will.
[CUSTOMER][NEUTRAL] And then how long does it usually take to be, will you guys notify me if it's not or is or?
[AGENT][POSITIVE] Well, usually from the time a claim is received, it can take 7 to 10 business days. Uh, I will say with our dental, they are processed fairly quickly, um.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] They will send out an explanation of benefits or your husband, I don't know if he's set up on our online service center. We do have it to where he can set up on the online service center to view the policy.
[AGENT][NEUTRAL] As well as, uh, receive notification when a claim has been received, um, also when it's been processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Um, how do I, what's the website that I would, um.
[CUSTOMER][NEUTRAL] Have him do.
[AGENT][NEUTRAL] Uh, the website is secured. [PII].
[CUSTOMER][POSITIVE] They secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And also on the site, uh, once you set up, uh you'll be able to upload a claim as well instead of mail or fax it.
[CUSTOMER][POSITIVE] Oh, you know what? That would be so much nicer.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And be faster and.
[AGENT][POSITIVE] And quicker and you can, it'll give you um
[CUSTOMER][NEUTRAL] I, yeah, I.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] That's OK. Our, our male people are.
[CUSTOMER][NEGATIVE] They shouldn't have a job. I don't know.
[CUSTOMER][NEUTRAL] My, that's my thought. It's like.
[AGENT][NEUTRAL] I get that.
[CUSTOMER][NEUTRAL] Don't know, you know, they, my son's graduation pictures from college, they folded them up, they fit them into the mailbox.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEGATIVE] Yeah, and they never covered it, and that was like $400.
[AGENT][NEGATIVE] Oh, no, that is no good right there.
[CUSTOMER][NEGATIVE] No, and then my mail comes half open most of the time.
[AGENT][NEUTRAL] Yeah, I would say that, and also once he's set up on the site, it also um if you have a checking account, it does say that you can put in your direct deposit information, so instead of receiving a physical check, any payments can be sent electronically.
[CUSTOMER][POSITIVE] Oh nice. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Because if you're getting mail that's half uh half open, it's best to use that direct deposit information in there. Yes, ma'am.
[CUSTOMER][POSITIVE] That sounds good.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. OK, that sounds good. I appreciate, uh.
[CUSTOMER][POSITIVE] I appreciate your help thank you.
[AGENT][POSITIVE] Yes, ma'am. And is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] I don't think so. I think I'm pretty good.
[AGENT][POSITIVE] OK. Well, I thank you for calling APL. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Yes, ma'am. Bye.
[CUSTOMER][NEUTRAL] Bye bye.