AccountId: 011433970860
ContactId: 44755661-15b7-4c1c-870e-e1874efbd78c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440850 ms
Total Talk Time (AGENT): 174011 ms
Total Talk Time (CUSTOMER): 94198 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/44755661-15b7-4c1c-870e-e1874efbd78c_20250116T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. Um, I had a procedure done, oh, this was back in November, uh, and I'm getting a bill for my insurance company for $79 and they're I called them and they said that.
[CUSTOMER][NEGATIVE] You know we didn't pay enough for.
[CUSTOMER][NEUTRAL] Whatever, but I'm trying to figure out what the amount of the claim was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, we will definitely take a look at that claim, uh, [PII], really quick, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Um, that's OK. I can start using your social.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII] and that's in [PII].
[AGENT][POSITIVE] Alright, thank you so much for verifying that information, [PII]. Alright, and this was for your dental?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's take a look.
[AGENT][NEUTRAL] Do you happen to remember um uh you said this was in November?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know the exact date by chance? or kind of sort of?
[CUSTOMER][NEUTRAL] Well I, I think it was [PII] or something like that.
[AGENT][NEUTRAL] First. OK. Give me just a moment, let me do some searching here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was the provider, was it [PII]?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] That's what I've got as the provider.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, but I do have this as [PII]. Uh, let's take a look.
[AGENT][NEUTRAL] All right, so for this claim, [PII].
[AGENT][NEUTRAL] Looks like the total charges were $2,524. We paid a benefit of $770.
[AGENT][NEUTRAL] So if they're billing you for 79, I'm not sure that this is the correct claim.
[CUSTOMER][NEUTRAL] 2,524 was the bill. It's what they.
[AGENT][NEUTRAL] Was it? OK.
[AGENT][NEUTRAL] So we did pay the full amount for everything except for a portion did go towards your deductible, which was, uh, I think this policy has a $50 deductible.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But otherwise, we paid uh as much as the benefits would allow.
[CUSTOMER][NEUTRAL] Which would be
[AGENT][NEUTRAL] We paid a total benefit of $770.
[CUSTOMER][NEUTRAL] That's weird and they the bill was 2524.
[AGENT][NEUTRAL] That's the total charges we've got.
[CUSTOMER][NEGATIVE] Doesn't make sense.
[AGENT][NEUTRAL] Let's see, option D. Give me just a moment. I'm gonna get your
[AGENT][NEUTRAL] Policy pulled up here.
[AGENT][NEUTRAL] OK, so yes, deductible was $50 which a portion of that went towards.
[AGENT][NEUTRAL] And let me take a look at these.
[AGENT][NEUTRAL] Procedure codes.
[AGENT][NEUTRAL] OK, so this was a crown.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And the root canal, OK.
[AGENT][NEUTRAL] OK, yeah, this information is accurate um we paid the maximum amount per procedure uh per your policy. The only one, of course that was not paid completely was the one that went towards your deductible.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So instead of the we paid 383 towards the actual crown.
[AGENT][NEUTRAL] As the remaining $50 went to the deductible.
[CUSTOMER][NEUTRAL] Why the $79? I don't know.
[AGENT][NEUTRAL] That is a bit odd um if you'd like you can have them give us a call might be a bit easier.
[AGENT][POSITIVE] We could take a look and speak with them they can they're more than welcome to give us a call if they've got any questions.
[CUSTOMER][NEUTRAL] Do what?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, it's very puzzling. Yeah, that's an odd amount, you know.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEGATIVE] Why I'm getting this bill now and it's like it was done in November and I'm just getting this now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, we received it right after, uh, looks like we got it [PII] was when we received the claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I don't know what to do with this well.
[CUSTOMER][NEGATIVE] Not gonna pay it unless I know for sure I owe this. I don't know.
[AGENT][NEUTRAL] I understand like I said if you want to have them give us a call we can make sure that they have all the correct information you never know there's always that human error so we can make sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK, thanks.
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thanks a lot.
[AGENT][POSITIVE] All right well thanks for giving us a call yes ma'am. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, bye bye.