AccountId: 011433970860
ContactId: 31e0c6ec-1f72-4b1e-a11a-c6ef1d4ee391
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 852150 ms
Total Talk Time (AGENT): 234095 ms
Total Talk Time (CUSTOMER): 294073 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/31e0c6ec-1f72-4b1e-a11a-c6ef1d4ee391_20250130T15:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] How are you? My name is [PII]. Um, I just had a few questions. Um, uh, I don't, I, I don't know if you can pull up my account. I no longer have an account. I believe it's been termed, but.
[CUSTOMER][NEGATIVE] At the time, when my, when my account was active, I went to the dentist and um I was notified that when they process my claim that they said that my claim was turned and it will not, and that you guys will not uh support that claim, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I was just trying to get more information on that only because if I only went because I and it was verified that I was covered at the time and of my appointment so I don't understand how it's not being um.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK. I can check on that for you, Mr. [PII]. May I have a callback number just in case we get disconnected and the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, OK, so I'm at work currently. I do not have the policy number. Um, I was just notified only a couple of minutes ago by my dentist.
[CUSTOMER][NEUTRAL] Um, about this, um, I can give you a callback number, uh.
[CUSTOMER][NEUTRAL] Or if you need to look up my account I can give you some further information about that.
[AGENT][NEUTRAL] Go ahead and spell your last name and your first name and and let me have that callback number, Mr. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] First name [PII]
[AGENT][NEUTRAL] OK, give me just a second. Go ahead and spell it out one more time, a little bit slower because I need to write it down.
[CUSTOMER][NEUTRAL] Call back.
[CUSTOMER][NEUTRAL] Alright, [PII] is the last name. It is [PII]
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] is the first name [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what mhm.
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Oh no, oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Take it as a shortcut that cost and time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Who's your, who was your employer? Who's your employer?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, at the time I was, uh, BG staffing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be a minute. I'm waiting on the group to pull up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's gonna be a few more minutes because it's a large group.
[AGENT][NEUTRAL] Still waiting on the group to upload one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I think it will be a lot faster if you provide the social because it's taking a long time to unload all the names on the group.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and let's see.
[AGENT][NEUTRAL] May I have the mailing address on file for verification?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] right down to.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we was notified from BG staffing that your last day was [PII], which that's the day that we have terminated the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how was it then on June that it was verified that I still had.
[CUSTOMER][NEUTRAL] Um, coverage.
[AGENT][NEUTRAL] It had not been reported.
[AGENT][NEUTRAL] We need to wait for the employers to report if you leave work or if you're not longer with them, then we go ahead and cancel the policies.
[CUSTOMER][NEUTRAL] We out here.
[CUSTOMER][NEUTRAL] But if I was covered and it was verified, shouldn't it still be covered if that day it was processed? I get that the day that you guys got it to process the claim, it may not have been any, any longer, but that day that it was verified and I went, I was covered.
[AGENT][NEUTRAL] The policy was active. Now, um, we was notified after the fact that the the policy needed to be terminated. Uh, when we give out our benefits, we also include the the disclaimer which indicates that it's not a guarantee of payment that's also on the paperwork and that's something that we mentioned in the calls every time due to the fact that this is an employer that is reporting to us if the policy is gonna continue or not.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So at the time that you call more than likely the policy was still active because we did not receive that report, it was too early for the report to get to us, but once we received the report, the account became inactive.
[CUSTOMER][NEUTRAL] So how does that directly fall on me then if
[CUSTOMER][NEUTRAL] If at the time it was double verified that I had covered, I mean, I would, I wouldn't, I wouldn't have, I wouldn't have, you know, set the appointment or, or, or went under the impression that I was covered on the insurance if I wasn't.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Was you still working at that time?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, yeah, I called to verify the insurance before I went, um, because I was between assignments at the time, um, I called to verify.
[CUSTOMER][NEUTRAL] Um, the coverage, I still had it and um, so I went to the dentist. Um, and the dentist verified that I had coverage. I paid the co-pay and I was allowed to be seen. Um, now they're saying that I need to update information. Now I no longer have American Public Life, um, as I have another insurance company, but at the time when I did have that insurance, that claim was processed under.
[CUSTOMER][NEUTRAL] Under the validation that I was actively covered.
[CUSTOMER][NEUTRAL] So at this point in time I don't understand how the balance of I believe it was 2202 or something like that.
[CUSTOMER][NEUTRAL] Um, is owed to me if I was covered at the time of service.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Based on what I got here and we record everything um.
[AGENT][NEUTRAL] We send the schedule of benefits to Ms. [PII], the provider, the dental provider, um, and then the schedule is indicated that um it's not a guarantee of payment. Um, that's the only thing I see on 65, which is around the time that you have the service done.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And like I said before, we were um reported after that that the policy needed to be terminated because you were no longer with that group.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right. So with that being said, I was covered at the time of service. So how am I, but you see what I'm saying, because it was, it was reported to you, it seemed like it was reported to you late or whatever the case was.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] How did that fall on, on, on, on my own if I was, if I verified that I was covered at the time and so the dentist's office. Now I get that when you got the report and you had to report it at that point in time, I wasn't covered, but I, but I was when I got seen and I, it was verified. I don't understand how I would be stuck with the copay app.
[AGENT][NEUTRAL] Again, Mr. [PII], I can only give you information about the policy and based on this information, the policy was terminated [PII], which is when you stopped working with BG staffing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Um, I can get somebody to review this information and give you a call back, but that's all the information I have in the system, and that's the reason of the denial of that claim. It's because you stopped working and it was reported that the policy needed to be terminated on [PII]. The service was done after.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That date of service.
[CUSTOMER][POSITIVE] OK, if you could have somebody call me back, that would be great.
[AGENT][NEUTRAL] OK, so let me go ahead and send this to escalation for AM. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the phone number you provided to me is the, the number that they can reach you on? [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Any time or do you have any specific time?
[CUSTOMER][POSITIVE] Any time is fine.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, so I went ahead and um put all the information in and send it over for um another department that's the one that takes care of the claims to review and give you a call back, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.