AccountId: 011433970860
ContactId: 176f48d9-6c17-4527-8840-016edf9c1d9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 862609 ms
Total Talk Time (AGENT): 244055 ms
Total Talk Time (CUSTOMER): 232834 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/176f48d9-6c17-4527-8840-016edf9c1d9b_20250203T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]
[CUSTOMER][NEUTRAL] I'm calling about a dental bill.
[CUSTOMER][NEUTRAL] Uh, for my wife, we're on the same policy.
[CUSTOMER][NEUTRAL] Her name
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, you need more information to look up the, the record?
[AGENT][NEUTRAL] Yes, [PII], can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I can look it up with your social security number if you'd like to give me that and they'll pull it in for us.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Please, please, I'm sorry, I don't have it handy. Uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then for security reasons, I'll need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Email RE.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] And then, um, the cell phone number that we have on the policy for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. Thank you, sir.
[AGENT][NEUTRAL] All right, let me go ahead and look at the policy real quick.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I can tell you it's under my wife's name and the date of service is [PII].
[AGENT][NEUTRAL] OK. Is your wife there to give consent to discuss the claim, sir?
[CUSTOMER][NEUTRAL] Yeah, hold on.
[AGENT][POSITIVE] Yes, sir. Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] I'm on the uh phone with the dental insurance and uh you need to, uh, would you please.
[CUSTOMER][NEUTRAL] And I give me permission to discuss the case. Yes. Like hang on, here's my wife. I'm in for Roger Roger [PII]'s wife, and I give him permission to discuss my case, dental insurance.
[AGENT][POSITIVE] Thank you. Hi.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, Ms. [PII]. I appreciate your consent. Appreciate you. Thank you very much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, you're welcome and then what was the data service you gave me again? It was 12.
[CUSTOMER][NEUTRAL] 12 5 24.
[AGENT][NEUTRAL] OK, do you happen to have a claim number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, I'm sorry.
[AGENT][NEUTRAL] That's OK. That's OK. Let me pull it up. Yes, sir.
[CUSTOMER][NEUTRAL] Wait, wait, wait, wait, wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, this just has a date. It doesn't have a claim number.
[AGENT][NEUTRAL] OK, well, I only see one that was um uh submitted for deer, so I'm gonna pull that one up.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] And just verify with you, um, can you please give me the name of the doctor?
[CUSTOMER][NEUTRAL] Uh, Doctor [PII].
[AGENT][NEUTRAL] OK, got it, got it. All right, let me look at this claim for you real quick, Mr. [PII].
[AGENT][NEUTRAL] OK, so there are some remarks on the claim, why it was denied.
[AGENT][NEUTRAL] The first one being preventative services are limited to 1 per insured person per continuous six-month period.
[CUSTOMER][NEUTRAL] Right, that's, yeah, that's, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] And then, and then it also states that this policy does not provide benefits for any procedure or service not listed in the scheduled of covered dental services and procedures.
[AGENT][NEUTRAL] And then there's one more.
[CUSTOMER][NEUTRAL] And my my
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And the, the other one was the same. The other one, I'm sorry.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Go ahead and speak.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Uh, I'm only calling in reference to the, uh,
[CUSTOMER][NEGATIVE] And the part that was denied the uh for the 6 month uh requirement.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, the part that says preventative service are limited to 1 per insured person per continuous 6 month period.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] So the reason I'm calling is to throw myself on your mercy, and to see if you can give uh you're laughing, you're laughing.
[AGENT][NEUTRAL] Yeah, I thought it was cute. No, I thought it was cute that you said you're gonna throw yourself on my mercy.
[CUSTOMER][NEUTRAL] Well, I'm, I'm old school like that. Um,
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, as a one-time courtesy, uh,
[CUSTOMER][NEUTRAL] Uh, I have
[CUSTOMER][NEUTRAL] made a, made it a point to not let this happen again, between me and my wife. She, she had, was going in for another procedure, and they had
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] They, they said, what you want to get your cleaning at the same time, and she said, OK. Uh, not being, not being aware of the six-month rule. Um,
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, uh, and they, they, uh, I talked to them and they say, well, it's, it's not up to us to, to, uh, keep track of the six-month rule. Uh, so, so, uh, as, as, as a one-time courtesy, because, is it possible you could make an exception and, and cover this claim?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, I can, uh, send a request in to the dental examiners that you're asking for the one-time courtesy.
[AGENT][NEUTRAL] And um with your phone number and have somebody call you back and talk to you about it to see, you know what they decide.
[CUSTOMER][NEUTRAL] OK, that's fine. Uh, can you give me an approximate time frame and what, what area code number should I be looking for?
[AGENT][NEUTRAL] Yes, sir. Um,
[CUSTOMER][NEUTRAL] Will it be [PII]?
[AGENT][NEUTRAL] Yes sir and it'll, uh, it'll be [PII] number it'll be same number close to what you called um we are in a queue, so the numbers are sometimes they roll and they're different a little bit, but it'll be within a 24 hour period.
[CUSTOMER][NEUTRAL] Oh really?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, and if, if I'm not available to take the call, I can, that number, I, I can reach him.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Yeah. All right. Well, that's great.
[AGENT][NEUTRAL] Or you can just call the number back that you just called and let and let somebody know that you had a return call that you missed and we can transfer you on over to them either way.
[AGENT][NEUTRAL] So I'm gonna put you, mhm.
[CUSTOMER][NEUTRAL] Should I
[CUSTOMER][NEUTRAL] Should I uh make a note on my account number or a reference number for this conversation?
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] You could just say that you called on um [PII] and a request was sent to have somebody call you back. If you missed the call and just say I, I missed the the return call, can I please be transferred on over to the dental claims?
[AGENT][NEUTRAL] Department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm gonna put you on a brief hold real quick while I get that request sent in while we're on the phone together so it's gonna be a brief hold, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII]. This is [PII]. I'm sorry you had to hold for a little bit, but I've got that request in for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I should expect be expecting a phone call within 24 hours.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] All right. Well, uh, I appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, we appreciate you being an APL customer, Mr. [PII], and I hope you guys have a blessed day.
[CUSTOMER][POSITIVE] You too. Thank you very much.
[AGENT][POSITIVE] All right you take care bye bye.
[CUSTOMER][NEUTRAL] OK, bye-bye.