AccountId: 011433970860
ContactId: 1c8f1659-250b-4dbb-82be-f516bcf2866e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306179 ms
Total Talk Time (AGENT): 141427 ms
Total Talk Time (CUSTOMER): 144615 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/1c8f1659-250b-4dbb-82be-f516bcf2866e_20250318T13:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, this is [PII], uh, insured with [PII]. Uh, if I give you my numbers of question, can you look up my policy and answer my question?
[AGENT][POSITIVE] It would be my pleasure to assist you, Ms. [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] 00613354
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And this is on your dental policy? All right. What's the claim number?
[CUSTOMER][NEUTRAL] I have a claim number.
[CUSTOMER][NEUTRAL] I have a claim number.
[CUSTOMER][NEUTRAL] 3572445
[AGENT][POSITIVE] All right. Thank you for [PII].
[CUSTOMER][NEUTRAL] Mm, let's see, where's the date on this? I'm sure it is, yeah.
[AGENT][NEUTRAL] Looks like data services.
[AGENT][NEUTRAL] All right, and how can I help you, Ms. [PII]?
[CUSTOMER][NEUTRAL] I want to know why the uh X-rays were not covered. They were uh first of all, we didn't understand that you don't do separate calendar years. It's like a a year or the 6 months continual, not based on years, is that correct?
[AGENT][NEUTRAL] For the frequencies, yes, ma'am. So, like if your X-rays are every 6 months, it does not mean every 6 months within 1 year. So if you have it in say November.
[CUSTOMER][NEUTRAL] The way I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Of one year, it will go into the next year for that time frame.
[CUSTOMER][NEGATIVE] Well, when I was at the dentist, they told me it had been over a year since I had X-rays. So I had them on [PII] and then nothing was covered. So that's why I don't understand why nothing was covered on the X-rays.
[AGENT][NEUTRAL] Mhm. So for the X-rays that was applied to your deductible, to the, you know, there's a deductible on your policy of $50. So that benefit amount was applied to your deductible.
[CUSTOMER][NEUTRAL] Yes, but that's, that's, um, way more than that. I had bite wings for 99 and
[CUSTOMER][NEUTRAL] What was the other thing prophylaxis for 120 is that not?
[AGENT][NEUTRAL] So that's your cleaning. Mhm.
[CUSTOMER][NEUTRAL] Oh, that's my claim. OK. So, so why was nothing covered on either one?
[AGENT][NEUTRAL] Yeah, and so
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So for the prophylaxis, that is limited to 1 insured per continuous 6 months. So looks like you had that within the previous 6 months for the propus. Let me check that. Yeah, that was on 9.
[CUSTOMER][POSITIVE] Yes, that's right, that's right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I go more often than that due to the way my mouth is. I have to go more often than 6 months. OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] But so they pay it says paid nothing. It doesn't even say it paid anything. That's because you said of that 38 was, was went towards my deductible and then 59 went towards my deductible?
[CUSTOMER][NEUTRAL] It says schedule 31, 38, and 59.
[AGENT][NEUTRAL] Mhm, let me get that EOV pulled up so I can look and see exactly what you're looking at.
[AGENT][NEUTRAL] So with your um prophylaxis, the cleaning, that was
[AGENT][NEGATIVE] The 6 months hadn't passed, so that one was denied.
[AGENT][NEUTRAL] The um
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] By wings. Yeah, that was within your 6 month.
[CUSTOMER][NEUTRAL] X-ray
[AGENT][NEUTRAL] That um time period hadn't.
[AGENT][NEUTRAL] Let's see, that was applied to your deductible. I apologize.
[CUSTOMER][NEUTRAL] Yes, but I had
[CUSTOMER][NEUTRAL] Yeah, but that, but X-rays aren't cleaning. So in other words, if I hadn't had X-rays in a whole year, you still wouldn't pay for X-rays?
[AGENT][NEUTRAL] Well, if your deductible had been met, then it, it would have been paid $38.
[AGENT][NEUTRAL] But because that deductible for [PII] has not been met, that $38 benefit was applied to your deductible. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for my
[CUSTOMER][NEUTRAL] OK, alright, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Does that kind of make sense?
[CUSTOMER][POSITIVE] OK, thank
[CUSTOMER][NEUTRAL] Yeah, I mean it's
[AGENT][NEUTRAL] I understand.
[CUSTOMER][MIXED] It's pretty pitiful. Yeah. OK. All right, thank you for your.
[AGENT][NEUTRAL] Yeah, it would be better if it was paid, right?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Well, I mean, I see 000 so I knew it was over a year since I had X-rays.
[AGENT][NEUTRAL] And it was just applied to your deductible.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, alright, how much deductible do I have left to fulfill?
[AGENT][NEUTRAL] Should be your deductible is $50. Let me check and see.
[AGENT][NEUTRAL] You have $12 of your deductible remaining.
[CUSTOMER][POSITIVE] OK. All right, thank you. I appreciate it. Bye.
[AGENT][POSITIVE] Yes, it's been my pleasure, Ms. [PII]. Thank you.