AccountId: 011433970860
ContactId: 407b5106-0f1c-4d92-85d0-934dbc1bbc06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1482089 ms
Total Talk Time (AGENT): 507614 ms
Total Talk Time (CUSTOMER): 552231 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/407b5106-0f1c-4d92-85d0-934dbc1bbc06_20250508T16:06_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hey, [PII], I'm not sure if I called the right phone number. Uh, I had some issues going on where I got my teeth done. Uh, you know, 9 months later, they're saying that they didn't get paid or my insurance didn't cover it. I sent them EOBs 2 weeks later, another appointment 6 months earlier, they didn't get paid or something. I send them EOBs for that. Then they just got done reviewing them and now they're telling me I owe more money than before and that my insurance didn't cover anything, but.
[CUSTOMER][NEUTRAL] That's not what the EEOBs are saying, so I need to figure out what's going on and why.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, uh, I can look it up by your name or social.
[CUSTOMER][NEUTRAL] So so 011727489.
[CUSTOMER][NEUTRAL] And I need to figure out if the problem is the insurance company here or it's their company because either one something's getting changed.
[AGENT][NEUTRAL] OK, pulling that up. Give me one moment.
[AGENT][NEUTRAL] And what was your first and last name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and lastly a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, do you know what date that was for?
[CUSTOMER][NEUTRAL] Something in June and then something like in December or something like that.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So [PII], is that right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then there was one after that.
[CUSTOMER][NEUTRAL] Like immediately after that another appointment, so the next one after that a couple months later.
[AGENT][NEUTRAL] OK, I see one for [PII]. Let's see.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] And, and the, I, I don't know if this is your thing you can help answer, but why, why when I go in there and I'm told what I need and I say what I want to get, that they call the insurance company and verify what's approved and then it's really not approved. Why does that, why?
[CUSTOMER][NEGATIVE] Why am I being told that this is approved by insurance and it's not?
[AGENT][NEUTRAL] Well, your policy pays out a certain percentage for certain procedures, so we will say that it's covered up to that certain percentage. So let me pull up your policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] So I mean, we, we're gonna say yes, this is a covered benefit up to we'll pay 40% of it or 80% or whatever it pays so.
[CUSTOMER][NEUTRAL] But I mean, well, the, the place I get the teeth done, you know, they, they verify everything with the insurance company and then come back saying all this should be covered, you would only owe about this much.
[CUSTOMER][NEGATIVE] And it doesn't seem like that's really the case. I don't know. Maybe it's their end. I just don't understand how.
[CUSTOMER][NEGATIVE] If I buy a car for a certain price and then find out 3 weeks later, it's twice as much.
[CUSTOMER][NEGATIVE] It's not what I signed up for and B, I wouldn't have got the car in the first place.
[AGENT][NEUTRAL] Let me pull up the explanation of benefits on this claim real quick.
[CUSTOMER][NEGATIVE] Yeah, and the, the, the, the appointment you're looking at in June, they originally told me it was $12 per tooth covered. That paper says $50 per tooth, $55. And now I owe more money than before. I, I, I don't understand and I'm getting tired of dealing with this fucking headache.
[AGENT][NEUTRAL] OK, so it looks like you got periodontal services, so I can't answer why they're charging a different amount. When they call, we will clarify what the plan covers. Periodontal services are subject to a $50 deductible. The plan only pays 5 or 40%, so you're left with 60%.
[AGENT][NEUTRAL] So we pay $40 you pay $60 plus a $50 deductible.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You know, we typically fax them an outline of your policy.
[AGENT][NEUTRAL] Uh, let me see if I've got notes on that.
[CUSTOMER][NEUTRAL] So they told you one amount, you covered it and then they told you a different amount?
[AGENT][NEUTRAL] No, we don't ask for amounts. That's not how benefits typically work so they'll call in and they say, hey, we, we wanna check on this patient. uh, we're checking on periodontal services, um, what does the plan pay? We will say according to this plan, this plan pays 40%. We don't know what they're gonna charge. We have no idea until we get the claim.
[AGENT][NEUTRAL] So we're just giving a blanket statement of this plan pays this percentage.
[AGENT][NEUTRAL] They don't typically tell us the amounts that they're gonna bill. That's not typically how how it goes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Well, they tell me what about when I leave there, then, then 9 months later, I, I'm told I owed money. I prove that I don't because, you know, you guys and the ELBs, then 2 weeks later,
[CUSTOMER][NEUTRAL] They tell me, you know, something else happened. The same thing with a different appointment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] You know, oh, you owe money. No, I don't. Here's the proof. Two weeks later. Oh, you owe money for another appointment.
[CUSTOMER][NEGATIVE] No, I don't. Here's the proof. Oh, you owe more money than we thought you would before, even after proof.
[AGENT][NEUTRAL] Yeah, so I, I'm not sure where the breakdown is like for this, for instance, this policy or this data service we were billed $702 we paid the provider $28,080 so.
[CUSTOMER][NEUTRAL] Are you able to call and talk to them? They said they'd be willing to do a three-way.
[AGENT][NEUTRAL] Yeah, I mean, I, but like I said, I don't, I don't think it's uh I'm, I'm not sure where the breakdown is, but we pay 40%.
[CUSTOMER][NEGATIVE] I don't know either, because every time I do what I'm supposed to do, somehow I'm still owing money.
[AGENT][NEUTRAL] And I don't know if they're just going up typically some plans pay more on periodontal services. I'm not sure if maybe they quoted you a different amount initially, not taking into account. I'm not sure. I don't know what happened, so I just know.
[CUSTOMER][NEUTRAL] So can you call them?
[AGENT][NEUTRAL] Uh, yeah, hold on one moment.
[AGENT][NEUTRAL] Do you have their number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And so did, did they explain to you why the amount changed or what was their explanation?
[CUSTOMER][NEUTRAL] They said the EOBs didn't cover what they thought.
[CUSTOMER][NEGATIVE] Which doesn't make sense because they told me only $12 per tooth on the June.
[CUSTOMER][NEUTRAL] My appointment was covered. My EOBs say $50 per tooth for that was covered. And then, oh, you owe more than we thought after looking at the EOBs.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEGATIVE] What? You told me I just, even after paying out of, out of, even after paying before I left, after getting the procedure done, and then what they thought the insurance company you guys covered, they were telling me I still owed like 67 $800. I sent EOB's proving that way more was covered than you initially thought, and I still owe money somehow.
[AGENT][NEUTRAL] Yeah, I mean, I
[AGENT][NEUTRAL] Yeah, but it's not, they charged $126 per tooth and they and we paid $50 so that leaves the balance of $7560.
[AGENT][NEUTRAL] So I don't
[AGENT][NEUTRAL] I, I guess here's, so the thing is the day.
[CUSTOMER][NEGATIVE] I don't know, but we, I need to figure out what's at fault here because either I'm gonna drop the insurance company, you guys, because why, why am I paying, assuming, and then find out a year later, I owe money.
[AGENT][NEUTRAL] Yeah, I understand it.
[CUSTOMER][NEGATIVE] Or I'm gonna drop this dental insurance and anybody that uses them for billing. One of the two is getting changed. I'm not dealing with this ever again. So, I need to figure out what's going on.
[AGENT][NEUTRAL] Did you get
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Can you, can you stop yelling? Is that possible?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I would appreciate it if you'd stop yelling. That would be greatly appreciated.
[AGENT][NEUTRAL] OK, I, what I'm trying to explain to you is, it's there.
[AGENT][NEUTRAL] This is, this happens sometimes in the dental world or medical world. If they, at the end of the day, they have their bill charges, and it's highly unlikely that they're going to write off anything else. So I don't know again if they, I, I'm happy to make a three-way call, but I just want to prepare you that the end result is probably gonna be the these are the charges and this is your balance due. So,
[CUSTOMER][NEGATIVE] Well then whose fault is it that I was told that I only owed a certain amount and that's what I paid before leaving the office? Did the amount that I was getting covered changed by the insurance company or is it them?
[AGENT][NEUTRAL] They may
[AGENT][NEUTRAL] Like I said, when we verify benefits, we tell them it pays 40% and we send them that information. So I'm not sure where the breakdown lies. Again, at the end of the day, even if something was quoted incorrectly, they still have a right to bill you what the charges are.
[CUSTOMER][NEGATIVE] OK, so whose fault is it that I'm being told I only owe a certain amount and then 6 months to 9 months later, I'm being told that I still owe money. Whose fault is that? Is it the insurance company or is it just dental in place, the dental insurance thing or the, the teeth, whatever it is. The, the dentist?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I guess I can't
[AGENT][NEUTRAL] I, I don't, I don't know that and.
[CUSTOMER][NEUTRAL] Well, I need to figure that out because something's changing.
[AGENT][NEUTRAL] OK, so
[AGENT][MIXED] Like I said, I'm happy to get on a three-way call, but I'm, I'm not sure that you're gonna get the result that you're looking for because we.
[CUSTOMER][POSITIVE] No, I'll get the result I'm looking for because I'll find out where the problem is and then I'm gonna eliminate this problem.
[AGENT][NEUTRAL] OK, so are you, are you wanting to call the dental office or?
[CUSTOMER][NEGATIVE] Yeah, because apparently there's a miscom[PII] or something. Somewhere between finding out how much I owe and what I'm told in the long run doesn't, doesn't add up. So, I need to find out, is it the insurance company? Is it the dental place? Is it the dental billing thing? I need to figure out what's going on and where, where this make up of how much I owe and why I'm getting called half a year to 1 year later telling me I still owe money.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, hold on one moment.
[CUSTOMER][NEUTRAL] When I walk out of there thinking it's paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't want to keep dealing with this.
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you for calling RAB. If you know your party's extension, you may dial it now. Otherwise, please select from the following menu options. Press 1 to use our dial by name directory. Press 2 if you are calling to inquire about a recent charge on your bank statement.
[CUSTOMER][NEUTRAL] Press 3 if you would like to speak to a representative in our commercial sales department.
[CUSTOMER][NEUTRAL] Press 4 if you would like to speak to a representative in our medical sales department.
[CUSTOMER][NEUTRAL] For all other inquiries, please press 0 or stay on the line for the first.
[CUSTOMER][NEUTRAL] Please stay on the line while your call is transferred to the operator.
[CUSTOMER][POSITIVE] Good afternoon how may I help you?
[AGENT][NEUTRAL] Hi, um, I was trying to see if this is the right number to reach the office for Doctor [PII].
[CUSTOMER][NEUTRAL] Uh, no, we, we do the billing.
[AGENT][NEUTRAL] OK, so can you help with billing?
[CUSTOMER][NEUTRAL] This is not the doctor's office.
[CUSTOMER][NEUTRAL] Uh, yes, is this for medical or Jefferson Dental?
[AGENT][NEUTRAL] It's for dental, for Doctor [PII].
[CUSTOMER][NEUTRAL] OK, one moment, I'll get you to a representative.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Services please hold.
[AGENT][NEUTRAL] OK, I held 5 minutes, so I, I really can't hold longer to, to wait for someone, um, so I, I don't really know. I can send you a copy of what your plan policy processes and pays for, you know, so you have awareness of what it does. Another suggestion I can give to you is that.
[AGENT][NEUTRAL] Anytime you go to the dentist, you can request that they send in a pre-treatment estimate, so you know exactly what your out of pocket will be, um, because they'll
[CUSTOMER][NEGATIVE] That's what I thought they were doing because they would go, they would call the insurance company and then come back telling me this is what's covered and how much, this is what you'll owe after.
[AGENT][NEUTRAL] Well, they, they don't a pre-treatment estimate is basically like sending in a mock claim, so it'll give all the codes, we will respond back to them with the exact dollar amounts that we will pay versus us just saying they ask what is the policy, what percentage does it pay? We tell them what percentage it pays.
[AGENT][NEUTRAL] Now a
[CUSTOMER][NEUTRAL] So what end is being shady? Is it, is it the insurance company or is it them?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I, I mean, I, I, that classification of shady, I don't really know. I mean, again, I don't know, I can't answer for their office. If they called, they, it's entirely possible they got.
[AGENT][NEUTRAL] Wrong benefits or mixed up or what happened. I, I'm not sure. We quote our benefits based on your policy. And so I don't know. You said that the office told you they thought it was gonna be a different amount and then they, I mean, what did they say? I
[CUSTOMER][NEGATIVE] So what do I do? Do I call, get a hold of them and then call this company back?
[AGENT][NEUTRAL] Yeah, that would probably be better because we're we typically answer within less than a minute, so.
[CUSTOMER][NEUTRAL] I, I noticed that um.
[CUSTOMER][NEGATIVE] Yeah, they're not the best at answering their phones either great company, huh? um.
[CUSTOMER][NEUTRAL] How much do I pay
[CUSTOMER][NEUTRAL] How often for insurance, by the way?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, looks like your premium is $23 a month.
[CUSTOMER][NEUTRAL] No, that's really, I can't complain about that, I guess.
[AGENT][POSITIVE] Yeah, I mean that's a good premium, but yeah, I mean you're, you do have a plan that, you know, it pays 40% for periodontal services, um, you have a $1500 calendar maximum, that's pretty good.
[AGENT][NEGATIVE] Um, it pays 80% for a lot of basic services, so I mean it's just, you know, I unders I totally understand your frustration. I really do because it is frust.
[CUSTOMER][NEGATIVE] Yeah, it is, I get it's not fair on you either. I just hear, I know.
[AGENT][NEUTRAL] No, I, and I, I get it. I mean, no, you know, in this economy, nobody wants to be surprised about money, so, um, you know.
[CUSTOMER][NEGATIVE] It's not even that, you know, it's just, I'm told I'm walking out of there. This is what you owe. I pay it right then and there. And then 9 months later, I'm getting told I owe, you know, not, not even just like 50 $100. I'm getting told I owe 68 $900.
[AGENT][NEUTRAL] I, you know.
[CUSTOMER][NEUTRAL] You know, like that's
[AGENT][NEUTRAL] But do you want me to
[CUSTOMER][NEUTRAL] I know it's not your problem, but.
[AGENT][POSITIVE] No, I, I, I understand, but I'm here to help in any way I can.
[CUSTOMER][NEUTRAL] It's, it's not like whatever money, you know, like.
[AGENT][NEUTRAL] Oh, of course not, not $10 you know.
[CUSTOMER][NEUTRAL] Yeah, exactly. It's not even 100, you know.
[AGENT][POSITIVE] Right, no, I, I totally understand. Um, would it be helpful if I email you a copy of your policy just when you have some time just glance through that and that way it gives you a better understanding of exactly what to be prepared for just in case you run into this again and I'm, I'm happy we're happy to talk to them three way if you want to get them on the line and give us a call back we can definitely do that so.
[CUSTOMER][NEUTRAL] Yeah, it's just that they're they're so hard to get a hold of and I'm a truck driver so I work and run all day, you know, that's.
[CUSTOMER][NEUTRAL] A simple phone call with Bluetooth is one thing, but dealing with this is another.
[CUSTOMER][NEUTRAL] So, I don't know. I guess we'll just.
[CUSTOMER][NEUTRAL] I don't know. I guess we just have to talk to them again.
[CUSTOMER][NEGATIVE] And I asked them, can they send me something about what I owe? and they won't send me anything, so I, I don't, I don't really know how to go about this.
[AGENT][NEUTRAL] So I, I can.
[CUSTOMER][NEGATIVE] He's telling me I owe money, but I can't get a rundown of what and why.
[AGENT][NEUTRAL] Do you want me to send you your explanation of benefits or did you say you already have that?
[CUSTOMER][NEGATIVE] Both times they're saying they didn't get paid or they didn't get paid the amount that I was they were supposed to get paid. I sent them the EOBs.
[AGENT][NEUTRAL] OK, do you have?
[CUSTOMER][NEGATIVE] And it was for more money than they were telling me that they got paid for. So, they told me for the June appointment, they only got covered $12 per tooth for that, that one procedure. And on the EOBs, it's showing it was 50 $55 per tooth. And then they just called me and told me today, oh, you actually owe more money than we thought you owed before.
[AGENT][NEUTRAL] Yeah, it, it
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] They I mean they can't, so you know one thing like we received this claim for this dollar amount so if they're if they're changing the dollar amounts then they need to send us a corrected claim so we could potentially possibly pay more money so I'm not sure, you know, if that's the case then.
[CUSTOMER][NEGATIVE] I just asked them to send me something so I could send it to you guys or have a rundown of what's going on and why in numbers, and they just said we can't send it.
[AGENT][NEUTRAL] Now, I, I mean, I can.
[CUSTOMER][NEGATIVE] And it's kind of looking like pretty shady from them. They told me not all was covered. I proved more was covered than they thought.
[CUSTOMER][NEGATIVE] Two weeks later, oh, this other appointment after that, you know, uh, the, the one after June. Oh, well, the same thing happened to that. I send the EOBs for that one and then they come back 34 weeks later after I sent them that saying, yeah, we actually, you actually owe more money than we thought in the beginning.
[AGENT][NEUTRAL] Do you want me to send you the claim that they submitted? Would that help at all? So that gives what they charge.
[CUSTOMER][NEUTRAL] I, I don't even know what I need. I think, cause I've, I've sent what I was told what was covered. I sent what was actually covered, which is more than I thought.
[CUSTOMER][NEGATIVE] So somehow now they're trying to say I owe more money than originally.
[CUSTOMER][NEGATIVE] I, I, none of it makes any sense. None of it makes any sense.
[AGENT][NEUTRAL] Let me see if they cash the check too. Um, let's see.
[CUSTOMER][NEUTRAL] They cashed the check already too?
[AGENT][NEUTRAL] Uh, that's what I'm checking just to, just so you at least have that um information too, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cause it's funny, they, they can't remember when they got paid apparently or how much, but they always know how much I owe.
[AGENT][NEUTRAL] Right, let's see.
[AGENT][NEUTRAL] Uh, yeah, it looks like they cashed the payment for 28,080 on 32525.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Very water there.
[CUSTOMER][POSITIVE] How much thank you.
[CUSTOMER][POSITIVE] So they already got the, so they already basically got paid.
[AGENT][NEUTRAL] Yes, they have gotten paid the 28,080, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, I mean, that's good to know.
[CUSTOMER][NEUTRAL] I, I don't know. I guess I'm gonna have to call him back and then when I get a hold of them try to call you guys.
[AGENT][NEUTRAL] OK, well, we are open [PII] Central Standard [PII] Central Standard. So, um, we do operate a little bit outside the normal hours, so.
[CUSTOMER][POSITIVE] OK, alright, thank you for your help.
[AGENT][POSITIVE] OK, well I'm so sorry for your frustration and like I said, you know, get them on the line and we can we can try to figure something out so.
[CUSTOMER][NEUTRAL] Yes, it's not your fault.
[CUSTOMER][POSITIVE] Thank you, it's not your fault.
[AGENT][POSITIVE] OK. Well, I hope you have a, a decent day.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you. Bye.