AccountId: 011433970860
ContactId: 3f631311-542a-495b-8436-e37ae1b313c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500880 ms
Total Talk Time (AGENT): 206920 ms
Total Talk Time (CUSTOMER): 167007 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/3f631311-542a-495b-8436-e37ae1b313c2_20250328T16:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, um, my name is [PII]. Um, I'm with Western Flyer Express and um.
[CUSTOMER][NEUTRAL] I had a, I did a um dental.
[CUSTOMER][NEUTRAL] Appointment
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they're saying that a claim wasn't. I paid my end my obligation part of it and.
[CUSTOMER][NEUTRAL] And now they're saying it's still a um a claim due.
[AGENT][NEUTRAL] OK, so, um, did the provider file a claim with us and we just need to check on that, is that right? Or were you needing assistance getting that claim filed?
[CUSTOMER][NEUTRAL] Um, yeah, they, they claimed it, but it, it was denied they say.
[AGENT][NEUTRAL] OK, OK, so we can get that claim pulled up and we can get some clarification on that um first if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Start with a 6
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, policy 02304455.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] All right, and I'm just gonna verify some information really quick. [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] It's um [PII], but I had the work done in um [PII].
[AGENT][NEUTRAL] That's fine. I just needed your home address. That's just to verify what we have. Um, last thing I need is the email address we've got on file for you. Looks like it's a [PII] account.
[CUSTOMER][NEUTRAL] message.
[CUSTOMER][NEUTRAL] Uh, yes, [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying that information. OK, let's take a look. I do see a few different claims um do you happen to know the date of service uh when you went for treatment there?
[CUSTOMER][NEUTRAL] Uh, [PII], um.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] [PII] and [PII], yes.
[AGENT][NEUTRAL] The [PII] and [PII], OK.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this, uh, is it SC Smiles LLC?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's um it was with Aspen Dental, but I'm not sure who they use like on the other end, Aspen Dental.
[AGENT][NEUTRAL] Oh, OK, I do see a claim from uh [PII], um, it just says SC smiles, um, and we did pay that benefit, um, we paid a benefit of $648.
[AGENT][NEUTRAL] And then give me just a moment. Let me see, there was another one after here.
[AGENT][NEUTRAL] There was another one for uh [PII] and we paid that benefit of $328.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then here's uh OK there's another for [PII] uh we paid $524.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So there were, uh-huh.
[CUSTOMER][NEUTRAL] But when, before they, um, this.
[CUSTOMER][NEUTRAL] They told me my end when they had before I got what you call they told me my end was 963 um and um that everything else was covered so I, I paid the other end, the 963.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But now they're saying it's a balance of 700.
[AGENT][NEUTRAL] Mm, I don't know. I would have them give us a call, uh, if that's easier just so we can make sure that that's accurate. Uh, there are a couple of procedures we were unable to make a payment on, um, but they were, let's see, this one was like $20 there was another for $20 just they just weren't covered procedures under your policy, so I'm not quite sure what they're bill amount to you would have been. I just do see that we did make uh payments on what we could.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So do they need, she said they need to reach out to y'all?
[AGENT][POSITIVE] It just so that there's if there's clarification that's needed if it doesn't sound right to you um we can absolutely do that to make sure that that information is accurate.
[CUSTOMER][NEUTRAL] OK, because yeah, I'm not.
[CUSTOMER][NEUTRAL] Uh, I'm not sure what the total, I think the total bill was like 3500 or more.
[AGENT][NEUTRAL] Yeah, um, and that was for all of these dates of service, is that right? Is it the [PII], [PII], and [PII]?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, for the um
[CUSTOMER][NEUTRAL] Well, for the whole bill, I think, yeah.
[AGENT][NEUTRAL] OK, I can quickly kinda add um what we paid just so we can kinda get an idea for that. Give me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for those 3 claims, the total benefit amount that we paid for those 3 dates of service was $1500 even, so that was the benefit amount that we paid.
[CUSTOMER][NEUTRAL] 1600? OK.
[AGENT][NEUTRAL] 15, 1500.
[CUSTOMER][NEUTRAL] 15, OK, and I paid the 963.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So will it be paid when I make my last um.
[CUSTOMER][NEUTRAL] Like I have one more visit and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Will, will it be paid then the the last part, the remaining part $700 they say?
[CUSTOMER][NEUTRAL] Are y'all.
[AGENT][NEUTRAL] Um, it depends on when they send that information to us, so they were the ones who filed that claim with us, so whenever they send us that information we can get that processed.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] So it is covered up to everything. Everything was covered to.
[CUSTOMER][NEUTRAL] Up to that 963 that I had to pay.
[CUSTOMER][NEUTRAL] I mean 3000 was covered.
[AGENT][NEUTRAL] Yeah, so there were some, um, again there were a couple of procedures that were not covered under this policy, and then of course for some of them we pay a percentage, um, so for example one of them, uh, the dollar amount that they charged was $345 the benefit amount we paid was $118 for that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, we definitely need some clarification because I'm OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So I got one more visit and.
[CUSTOMER][NEUTRAL] So um.
[CUSTOMER][NEUTRAL] Have them call y'all.
[AGENT][POSITIVE] Yeah, that's perfectly fine and we can touch base.
[CUSTOMER][POSITIVE] OK, and then we get some clarification. Alright, that's what I need to know and I have them, I have them call y'all.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sounds good. Did you have any other questions for me at the moment, [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Uh, that'll work right there.
[AGENT][POSITIVE] Alright well I appreciate you calling. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.