AccountId: 011433970860
ContactId: 081b8b4d-e086-4476-b1db-272a6e7dbe11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381690 ms
Total Talk Time (AGENT): 186331 ms
Total Talk Time (CUSTOMER): 199484 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/081b8b4d-e086-4476-b1db-272a6e7dbe11_20250114T15:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][POSITIVE] They sounded OK at first.
[AGENT][NEUTRAL] Well, I have bronchitis, so I could be better, but I'm all right.
[CUSTOMER][NEUTRAL] I hope he's sleep.
[AGENT][NEUTRAL] What you got?
[CUSTOMER][NEUTRAL] So, I have a um insured on the other line. I was gonna send a hub, but he's trying to call the dentist. He needs help with his explanation of benefits, trying to see why he um has patient responsibility this time versus the other claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Trying to see if um
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] If they sent us over something that was different so that he can call them and and get it rectified.
[AGENT][NEUTRAL] OK, who do I have?
[CUSTOMER][NEUTRAL] Um, Bostic Basil, the sorry, the policy number is 160.
[CUSTOMER][NEUTRAL] 3081.
[AGENT][NEUTRAL] And I have basil on my line.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then it's for that claim, um 3542515.
[AGENT][NEUTRAL] Say that one more time, 354.
[CUSTOMER][NEUTRAL] Mhm. 2515.
[AGENT][NEUTRAL] What data service is it for? do you know?
[CUSTOMER][NEUTRAL] Please, hold on one second.
[CUSTOMER][NEUTRAL] Data service.
[AGENT][NEUTRAL] Um, yeah, deductible applied. That's why. Go ahead.
[CUSTOMER][NEUTRAL] And I went over that with them. I don't even see the data of service on.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is 12 6.
[AGENT][NEUTRAL] It's 12 6.
[CUSTOMER][NEGATIVE] OK. Um, uh, my arm base is stuck on page two, and I'm like, where I can't even.
[AGENT][NEGATIVE] Oh, I know at my own base, I can't even deal with that. It's so slow. I can't deal with that. No.
[CUSTOMER][NEUTRAL] I'm sorry, it just popped up. I see it now. It was stuck. I'm sorry.
[AGENT][NEUTRAL] That's OK, no problem, but go ahead and give it to me. I'll take it.
[CUSTOMER][NEUTRAL] OK, and can you say your name one more time?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You met me, remember?
[CUSTOMER][NEUTRAL] I do, but you were coughing in the beginning, so I didn't know said let say or just say, so I just want to make sure.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEGATIVE] Yeah, oh, I know it. Yeah, this cough is never, never leaving, I don't think.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] I hope you feel you got some well, I'll send you a message.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, send it on, girl.
[CUSTOMER][NEUTRAL] All right. OK. Hold on one moment.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hello Mr. [PII]. Yes ma'am.
[CUSTOMER][POSITIVE] Hey, um, thank you so much for holding. I have [PII] on the line and she's going to be assisting you with your claim, um, more in detail, OK?
[CUSTOMER][POSITIVE] OK, thank you. You're very welcome.
[AGENT][NEUTRAL] All right, Mr. [PII], this is [PII] over in the dental department. How can I help you today? She was explaining you had a question about your data service 126-2024 dental claim. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what can I help answer for you?
[CUSTOMER][NEUTRAL] Well, normally.
[CUSTOMER][NEGATIVE] I haven't been paying anything or I pay a $20 deductible.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And I've seen this dentist already once this year, but on that I didn't pay anything um on the deductible the first time I've seen him because
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You know she was saying that I have a $50 deductible I hadn't met yet.
[AGENT][NEUTRAL] Right, that is correct. You do have a $50 deductible except of course for your preventative, um, but when, uh, your dentist filed a couple of your codes now that don't fall under your, uh, wellness, then you do have that $50 deductible. So it looks like let's say $32.18 looks like that $50 deductible came out of one of your claims on [PII], yeah.
[CUSTOMER][NEUTRAL] OK, so in other words, he did, he did additional stuff that he should that normally he wouldn't do.
[AGENT][NEUTRAL] I'm not saying not normally, the dentist can do, of course, what they choose to do, but it does not fall under your routine, um, that would pay 100%, correct.
[CUSTOMER][NEUTRAL] On preventive.
[CUSTOMER][NEUTRAL] Yeah, and that was X-rays, wasn't it?
[AGENT][NEUTRAL] Yes, it was for x-rays.
[CUSTOMER][NEUTRAL] Yeah, see, I asked her about that when she was taking them.
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][NEGATIVE] I said that um I said that now you're not doing anything extra that's gonna cost me. No.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] But she did because
[AGENT][NEUTRAL] Yeah, because that is applying towards your deductible here, yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright, well, they, they're saying that I owe $54.
[AGENT][NEUTRAL] 54. 0, so we paid $8. Let's see, let me see if there's anything else that didn't pay. Yeah, there's a $4 over they charged over a reasonable customer on a back wing. We charged you $89. The allowable was 87.
[CUSTOMER][NEGATIVE] But I shouldn't.
[AGENT][NEUTRAL] It's 2 more.
[CUSTOMER][NEUTRAL] OK, they charged me too much in a bike lane.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Just over an RNC, I mean they can charge you what they want, but it's over our customer limit.
[AGENT][NEUTRAL] Yeah, so that's probably why. Mhm, yep.
[CUSTOMER][NEUTRAL] Right, and they and and yeah and then.
[CUSTOMER][NEUTRAL] Yeah, and they know what and they know what your limit is, don't they?
[AGENT][NEUTRAL] Uh, yes, sir, they do.
[CUSTOMER][NEUTRAL] Yeah, see, I, that's
[AGENT][NEUTRAL] They know what their limit is too, so.
[AGENT][NEUTRAL] Yeah, they can kind of charge what they want, yeah.
[CUSTOMER][NEUTRAL] Yeah, I see, well see the thing is, well, well, see, the thing is they just moved to another bigger office.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And say I was, you know,
[AGENT][POSITIVE] Got you. Yeah.
[CUSTOMER][NEUTRAL] And that that's the reason why I was questioning it, because they, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They just, they just moved. And usually, when doctors move, they need more money.
[AGENT][NEUTRAL] Yeah, I understand that. Definite put some red flags up don't it, Mr. [PII], but is that all I can help answer for you today?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yes, ma'am. So in other words, they did extra X-rays that you wouldn't gonna pay that you don't normally pay for because it wasn't prevented.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] And they over and they overcharged me on on one thing about $4 on the bike wing.
[AGENT][POSITIVE] Yeah, just over a reasonable customer.
[CUSTOMER][MIXED] By $4 for me only thing OK well they.
[CUSTOMER][NEUTRAL] Yeah, well, that, that's good then. I, I appreciate you doing that because that way when I call him here in just a minute I can explain to them why I'm not paying them $54.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] Yeah, OK. Yes, sir. Well, well, yes, sir, Mr. [PII], and thank you for calling APL and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][POSITIVE] Alright thank you ma'am.
[CUSTOMER][NEUTRAL] Alright, you too, you too, bye.
[AGENT][POSITIVE] Thank you, sir. Bye bye.