AccountId: 011433970860
ContactId: 46a0da23-ba08-4fb6-92ff-bb70d6d19ed7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324420 ms
Total Talk Time (AGENT): 109817 ms
Total Talk Time (CUSTOMER): 145362 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/46a0da23-ba08-4fb6-92ff-bb70d6d19ed7_20250506T19:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer service. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. I have an insured on the line. She is calling, uh, she's a little confused about her dental benefits. She's saying that she's having some issues getting some claims paid, I guess.
[AGENT][NEUTRAL] OK, you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 259.
[CUSTOMER][NEUTRAL] 6197
[AGENT][NEUTRAL] OK, for [PII].
[CUSTOMER][NEUTRAL] Yes, and she's calling. She said she submitted she has claims for her and her daughter.
[CUSTOMER][NEUTRAL] Um, so I was like, OK, well I'll get somebody to, you know, look and see why those aren't being paid, and she's like, oh, so you see it's not being paid, and I was like, I, I thought that's what you were calling for. I apologize. She said, well, I'm just confused and I'm like, OK, well, I'll get somebody to look at your benefits for you and see what's going on. I see claims an M track for her and her daughter, but I can't see if they were denied or they just didn't pay or what. So I don't know how to look at all that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] But she's been verified and the phone number on the account is her callback number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect. Thank you so much.
[CUSTOMER][POSITIVE] All right, thank you, [PII], here she comes.
[AGENT][NEUTRAL] Hi, this is [PII] on the care team. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII] too. I, I just, I don't understand what's going on with my insurance. Um, I, my daughter and I went to the dentist and had our teeth cleaned and a checkup and X-rays and um
[CUSTOMER][NEGATIVE] I, I, I, this is not covering it. I'm getting these letters. I just don't understand why I wouldn't cover it.
[AGENT][NEUTRAL] Um, it looks like, let's see.
[AGENT][NEUTRAL] We're just waiting on confirmation from the employer that you're eligible for benefits. So once we receive that.
[CUSTOMER][NEUTRAL] Well, I was when I was, when I was there, I was eligible, but I'm not working there anymore, but when I, at the time of my appointment, I was working there.
[AGENT][NEUTRAL] OK, yeah, it looks like, so this was for
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I ended my contract.
[CUSTOMER][NEUTRAL] Yeah, I did my job on um for.
[CUSTOMER][NEUTRAL] 25 on [PII].
[CUSTOMER][NEUTRAL] I so.
[AGENT][NEUTRAL] Yeah, we, we've got
[CUSTOMER][NEUTRAL] I, I wouldn't, I mean.
[AGENT][NEUTRAL] We have that in the system um but we we haven't received that confirmation from the employer, so that's what we're waiting on. Once we receive it, we'll send the claims through, but we've reached out twice and haven't gotten confirmation.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so it's just I'm, it's nothing bad on my, I just have to wait then, right? I mean, it's not.
[AGENT][NEUTRAL] Yeah, it's not that you're not covered, it's just we're, we're just waiting on that confirmation for eligibility. So once that's received, it'll go through for processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and what do you cover it all since it's the standard stuff, what's the coverage? I just wanna.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Because I have you on the phone.
[AGENT][NEUTRAL] up the benefits. Hold on one moment.
[AGENT][NEUTRAL] Um, anything I quote is not a guarantee of payment. It's a basic outline of your policy.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it looks like for
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Uh let's see, so.
[AGENT][NEUTRAL] Did she had, she had a cleaning, it looks like, or an exam and a cleaning?
[CUSTOMER][NEUTRAL] Yeah, we both have the same thing cleaning and exam.
[AGENT][NEUTRAL] OK, so cleaning and exams under your policy pay 100% and there's a 500% maximum payout per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How about the X-ray?
[AGENT][NEUTRAL] Um, X-ray.
[AGENT][NEUTRAL] Um, X-ray, you have a $50 deductible you have to meet first, and then it pays 80%.
[CUSTOMER][NEUTRAL] OK, so I'll probably owe a little bit of money for the X-rays, right?
[AGENT][NEUTRAL] Yes, they'd be subject to that $50 and then pay at 80%.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I pay 80% and you pay 80%.
[AGENT][NEUTRAL] We pay 80%.
[CUSTOMER][NEUTRAL] OK, so who do I pay that to the dentist? They'll figure it out once you work out the claim.
[AGENT][NEUTRAL] Yeah, once the claims process and we send payment then anything that's left over, they should balance they'll bill you for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK. Anything else I can help with?
[CUSTOMER][NEUTRAL] No, that's it. Thank you. OK, bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day.