AccountId: 011433970860
ContactId: 191a08e5-b42e-48b6-8e27-5049ff42ea8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468179 ms
Total Talk Time (AGENT): 114983 ms
Total Talk Time (CUSTOMER): 188226 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/191a08e5-b42e-48b6-8e27-5049ff42ea8c_20250321T16:30_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] Yeah, I'm good. Um, my name is [PII], and I was actually trying to see exactly um what was going on my, my dental, my dental bill because I've been, I don't know, I guess I've been, I switched to this insurance and I went and got my teeth cleaned, and they pretty much told me like, like I guess my coverage.
[CUSTOMER][NEUTRAL] Doesn't, they don't, y'all don't cover my I guess my cleanings until like after 12 months or something like that. I wasn't aware of that.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with your benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] Um, policy number is 02554423.
[AGENT][NEUTRAL] OK, thank you. Now, please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. Now, please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Uh email address is [PII]
[CUSTOMER][NEUTRAL] [PII] and my um mailing address is [PII].
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Hola, [PII].
[AGENT][NEUTRAL] OK. And I'm showing that you don't have an email address on file. Would you like to add one?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what email address would you like to add?
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] The number 2.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], so [PII].
[AGENT][NEUTRAL] OK, I got your email address added.
[AGENT][NEUTRAL] OK, one moment. I am showing one claim on file that paid out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what date of service, um.
[AGENT][NEUTRAL] The climate you're speaking about what date of service.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Think it was like [PII]?
[CUSTOMER][NEUTRAL] And they pretty much said I still got a balance. Like I still got a balance of 175 or something like that talking about we call and they said that they don't.
[CUSTOMER][NEUTRAL] They don't accept inferior queens or something like that up until 12 months or something like that. I was like, what?
[AGENT][NEUTRAL] OK, one moment. Cause I do show.
[CUSTOMER][NEUTRAL] They was like they said something like they got in touch with y'all.
[AGENT][NEUTRAL] Yeah, I do show where the claim partially paid. We paid out $149 and let's see the portion that denied one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sir. Thanks for your patience. Um, yes, sir, there are 3 portions of your cleaning that's not covered under your policy, and that's why the claim denied, that portion of the claim denied.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] What portion of the claim then? I thought I was just getting a regular scheduled maintenance routine clean. What, what, what portion of it did I?
[AGENT][NEUTRAL] Um, where there are certain codes on the claim that's not, that's not included in the fee schedule.
[AGENT][NEUTRAL] So there were certain portions of the cleaning that was not, that's not listed on our fee schedule. Therefore, those portions that I.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they don't cover until after 12 months?
[AGENT][POSITIVE] That's correct. Yes, sir.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So a portion of the queen is is is is covered.
[CUSTOMER][NEUTRAL] And what, so I just wanna know after 12 months, is it covered 100%?
[AGENT][NEUTRAL] Yes, sir, that additional portion. Yes, sir, that will be covered at 100% after 12 months of enrollment.
[CUSTOMER][NEUTRAL] Oh, how long have I been involved with y'all now?
[AGENT][NEUTRAL] OK. With this particular policy, I'm showing [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] And how long is it? Is it [PII], so 6 months?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, 6 months. OK, so they pretty much told me my next one I would have to pay out of pocket too. Like I, I guess a portion of it would be covered, but then the other portion I'd have to pay for.
[AGENT][NEUTRAL] Um, if you get the same cleaning that you got this time, then the full, um, cleaning should be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, a normal doctor, and that's what I was trying to ask them like what, why don't, why am I not just getting a normal queen?
[CUSTOMER][NEUTRAL] What kind of what, what kind of clean are they giving me?
[AGENT][NEUTRAL] Yeah, you would need to discuss that with the provider.
[CUSTOMER][NEUTRAL] 000, I'm sorry, I thought it was on there like they said something about an Imperial Imperial queen or something like that.
[CUSTOMER][NEUTRAL] OK, alright, well, OK, I, I'll, I'll, I'll figure, I'll figure everything out, but because they said I got a, they said I have a balance of like 175 so I'm gonna pay it but I'm gonna um.
[CUSTOMER][POSITIVE] Next time I go I'm gonna see exactly like what clean that I can get like what clean does my insurance cover, and that's the one that I wanna get like I don't really wanna, you know, yeah, OK, OK, well I was just I was just checking. thank you so much I appreciate it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] All right.