AccountId: 011433970860
ContactId: 3e05d42d-0691-4634-bc6e-020f79156c1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549570 ms
Total Talk Time (AGENT): 287044 ms
Total Talk Time (CUSTOMER): 178339 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/3e05d42d-0691-4634-bc6e-020f79156c1b_20250121T18:34_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, I was calling, I submitted paperwork for my son's dentist to see about getting possibly reimbursed because it was over $6000 and I was just wanting to check on that claims.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Of course I could take a look at that claim for you. uh, what was your name?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry this was for [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. It's a policyholder.
[AGENT][NEUTRAL] OK, what was your name?
[CUSTOMER][NEUTRAL] To his employee. [PII], his wife.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes [PII].
[AGENT][NEUTRAL] All right, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] I don't have it on me at the moment. Uh, I am so sorry.
[AGENT][NEUTRAL] That's OK. uh, I can start using your social.
[CUSTOMER][NEUTRAL] Oh my goodness, I don't, mm, I got his date of birth. I don't know his social I I'm sorry, I'm not home at the moment.
[AGENT][NEUTRAL] Um, that's OK. All right. You did say it was [PII]?
[CUSTOMER][NEUTRAL] Can you look it up by?
[CUSTOMER][NEUTRAL] Yes, and it's [PII] is his birthday.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, and then we have, uh, myself and our two children, uh, [PII] and [PII]. I don't know if that helps you or not. Can you look it up.
[AGENT][NEUTRAL] It might, um, because the way I search it would either be through a social or just the name that doesn't allow me to put the date of birth so there might be a few different, uh, [PII] is all I'm kind of worried about.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, that's why I was giving you the, the names of who's on the policy to see if that might help.
[AGENT][NEUTRAL] Yeah. Could you give me another name? I'm sorry.
[CUSTOMER][NEUTRAL] Uh [PII], it's [PII]
[AGENT][NEUTRAL] Uh, let's try that. What state, uh, do y'all live in?
[CUSTOMER][NEUTRAL] [PII]. It's for [PII].
[AGENT][NEUTRAL] [PII]. OK, we've got quite a few [PII] as well.
[AGENT][NEUTRAL] We'll see.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, our son and daughter's on there as well.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I might have found you. What's the, what's your um full uh mailing address, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No guess not this was [PII].
[AGENT][NEUTRAL] Oh, here we are, I think.
[AGENT][NEUTRAL] You did say [PII]?
[CUSTOMER][NEUTRAL] Yes. [PII]. Yes.
[AGENT][NEUTRAL] OK, I think that sounds you.
[AGENT][NEUTRAL] Let's see. [PII], what was your date of birth?
[CUSTOMER][POSITIVE] OK. Perfect.
[CUSTOMER][NEUTRAL] It it's [PII].
[AGENT][NEUTRAL] OK, perfect. Yes. Um, let me see, this is actually the medical. Let me go to the dental here.
[AGENT][NEUTRAL] OK, I see you did already verify the address. Um, the only other thing I need to verify, [PII] is the uh email address we've got on file for you all. Looks like it is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] That's it. OK, thank you so much for verifying that. um, so before we go any further, did you want me to go ahead and give you this policy number so you've got it for your records?
[CUSTOMER][NEUTRAL] I've got it. I've got my card. I'm just not at home right now.
[AGENT][NEUTRAL] Oh, OK, sure, no worries. All right, so this claim was this for uh the.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was for [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] It was for, uh, he had dental work done.
[AGENT][NEUTRAL] All right. Give me just a moment here. Let's take a look.
[AGENT][NEUTRAL] Alright, and I'm sorry, do you know what the date of service was?
[CUSTOMER][NEUTRAL] Uh, it was in December. I don't remember the exact date. I'm so sorry when he had the dinner work done.
[AGENT][POSITIVE] No, that's all right.
[AGENT][NEUTRAL] What was the name of the provider?
[CUSTOMER][NEUTRAL] It was uh [PII].
[CUSTOMER][NEUTRAL] Um, it was, uh, oh my gosh, I'm sorry cause it's a new dentist too. It was something pediatrics. I do not remember the dentist's name, cause that's the first time we've been there. I apologize. But the policy uh for the amount was a little over $6000 I think 60,030, I'm mistaken.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] OK. All right. Bear with me just a moment. You did say it was in December though.
[CUSTOMER][POSITIVE] Yes, ma'am. I am so sorry. The [PII], the [PII], something like that, I think, I think it may be in [PII].
[AGENT][POSITIVE] No, that's all right.
[AGENT][NEUTRAL] OK. Bear with me just a moment.
[CUSTOMER][NEUTRAL] I've got so much going on. I don't even remember the dates.
[AGENT][POSITIVE] You are perfectly fine. OK. Let's take a look here.
[AGENT][NEUTRAL] Do you know the uh doctor's name at all? Is it, uh, let's see, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's right, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, let me see.
[AGENT][NEUTRAL] OK, I do believe I found this claim. So it looks like there were several procedures we were only able to pay on one, and it does look like that met the maximum for the calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For Samson
[CUSTOMER][NEGATIVE] Right, yeah, I paid, yeah, I had to pay out of pocket the 60,030 and they gave me that paper and tell me to submit it and said I might get reimbursed for it.
[AGENT][NEGATIVE] Well, if the calendar year maximum had been met, uh, we were unable to pay anything additional for that.
[AGENT][NEGATIVE] So the most, the only thing that we paid on this claim was the maximum amount we could at $13.60. So it looks like his maximum had been met prior to that, and I will say I don't see that I've received.
[AGENT][NEUTRAL] This looks like it came directly from the provider.
[CUSTOMER][NEUTRAL] For the 6000.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, cause they tell me I was submitted. That's why I submitted it myself.
[AGENT][NEUTRAL] Oh, let's take, let me see.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Let me check which plan this is.
[AGENT][NEUTRAL] Yes, OK, so for this plan, the benefit um total benefit amount per calendar year is $500 per insured.
[CUSTOMER][NEUTRAL] Oh, that's it. That's not very much at all.
[AGENT][NEUTRAL] Yes, and it
[AGENT][NEUTRAL] Again, it does look like it had been met uh prior to this claim.
[AGENT][NEUTRAL] So this plan also uh just so that you are aware, does not offer any kind of major coverage or major expenses. It is covers.
[CUSTOMER][NEGATIVE] So what do I need to do then, since it doesn't basically do anything, it's basically I'm paying for insurance that I'm still having to pay out of pocket.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Right, so this plan again it's, it's really only covers uh preventative and basic expenses. So if you wanted to see because we do offer different plans that have different coverages, but that would have to be through your employer or uh Lucas I guess uh if he's the policy holder um it would be through his employer um so I would have him get with them to see what other options are available that they offer.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] If we wanted to just drop, if we just want to drop the insurance, how would we do that?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, it would be through let's see, I think this is through, yes, so it's operated through they're called benefits in a card or BI. They're the ones that, um, essentially pay the premium on his behalf, so it would be through them, um, and I can give you that information if you'd like.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, give me one moment, let me get it.
[AGENT][NEUTRAL] Their phone number? OK, give me just a moment, let me get that.
[CUSTOMER][POSITIVE] OK, I'm ready whenever you are.
[AGENT][NEUTRAL] Yes, OK, just got it. Alright, so that phone number for them is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what was their name again?
[AGENT][POSITIVE] Benefits in a card.
[CUSTOMER][POSITIVE] OK, uh thank you.
[AGENT][POSITIVE] Yes, of course, is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Uh, no thank you.
[AGENT][POSITIVE] All right well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Thank you, bye bye.