AccountId: 011433970860
ContactId: 4c9b5650-8838-449f-8525-2d09640b7fa1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 771919 ms
Total Talk Time (AGENT): 231226 ms
Total Talk Time (CUSTOMER): 250284 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/4c9b5650-8838-449f-8525-2d09640b7fa1_20250618T14:34_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was wondering, um, OK, so my husband had some dental work done and it's like they're not paying the whole claim.
[CUSTOMER][NEUTRAL] Um, and as part of it was done in 24 and the rest of it finished up in 25.
[CUSTOMER][NEUTRAL] So we're trying to find out why they're not covering more.
[AGENT][NEUTRAL] OK, um, who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yeah, let's see, policy number is 01471302.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] And is the claim on behalf of your husband?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Because you guys covered mine.
[AGENT][NEUTRAL] And do we have
[AGENT][NEUTRAL] Mhm. Do you have um permission from him for us to, is he near you so I can get permission from him to speak with you on his behalf?
[CUSTOMER][NEUTRAL] Um, if I have to, we can call him, but, um, back when we um got rid of our medical, they were supposed to put me on there for as a person to talk to.
[AGENT][NEUTRAL] Alright, let me see if that happens.
[AGENT][NEUTRAL] And did you fill out the third party authorization form?
[CUSTOMER][NEGATIVE] I don't believe they had us do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't believe they had us do that because that was a few years ago, but that we took the medical off.
[AGENT][NEUTRAL] Um, because typically we can do it over the phone, but it only works, uh, it's only for one time authorization if you want it completely, um, we would have to, excuse me, get you to fill out a third party authorization form which I can, um.
[AGENT][NEUTRAL] Email to you
[CUSTOMER][NEUTRAL] OK, can, can I call him and?
[AGENT][POSITIVE] Yeah, you can do that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, see if I can call him and add him.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me try to call him one more time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess I'm gonna have to call him and then call you guys back because.
[CUSTOMER][NEGATIVE] He's not answering his phone.
[AGENT][NEUTRAL] OK, um, in the meantime.
[CUSTOMER][NEGATIVE] But I, you may not be able to answer this.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] As I say, in the meantime, um, if we have an email on file, I have an email on file. Would you like me to send you that form?
[CUSTOMER][NEUTRAL] Uh, you can, but then what do I have to send it to him or something? I don't know how that works. He's a truck driver, so he's in another state at the moment.
[AGENT][NEUTRAL] OK, yeah, he will need to fill it out um if you want you can send it, you can download it and send it to his phone and he might be able to um.
[AGENT][NEUTRAL] Do it there, but he will need to sign it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But at least that way you all will have it just in case.
[CUSTOMER][NEUTRAL] OK, well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, um, like I said, you may not be able to answer this question, but.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] When you have teeth pulled like in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But don't get your dentists till [PII], but you have to pay upfront to the dentist.
[CUSTOMER][NEUTRAL] How do they break that down to where you're getting.
[CUSTOMER][NEUTRAL] Coverage for both years.
[AGENT][NEUTRAL] Um, let me look into your policy.
[CUSTOMER][NEUTRAL] Because we had to pay the dentist up front before they would do the work.
[CUSTOMER][NEGATIVE] And so I noticed the bills that we sent to you guys for the claim, it shows everything being done in 24 and that's not the case.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] Alright, let me look.
[AGENT][NEUTRAL] Now the policy shows dentures and partials are allotted once every 5 years.
[CUSTOMER][NEUTRAL] OK, so this is his first time getting dentures.
[AGENT][NEUTRAL] I don't.
[AGENT][NEUTRAL] The first time.
[AGENT][NEUTRAL] But probably.
[CUSTOMER][NEGATIVE] Yeah, but see, like I said, the dentist made us pay everything upfront, but it doesn't work like that. We, he's been waiting like months.
[AGENT][NEGATIVE] Yeah, they shouldn't have had to.
[AGENT][NEUTRAL] To do that, did you all um get the itemized receipt and everything showing that you paid up front and put in the dental claim?
[CUSTOMER][NEUTRAL] Uh, I believe it says that it's been paid because I sent the paperwork in already. They have received the paperwork and there's like two claims on there, but one claim they're not wanting to pay.
[CUSTOMER][NEGATIVE] And they're paying the other one for 1500 and from what I read, it's, that's the max for a year or something.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm thinking maybe we're gonna have to get the dentist to redo the dentures because technically he still don't have them.
[AGENT][NEUTRAL] He still doesn't have them.
[CUSTOMER][NEUTRAL] He still doesn't have his permanent. No, he still doesn't have his permanent. He's not getting them until the [PII] or something like that, [PII], [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, and this all started like a year ago.
[AGENT][NEUTRAL] Yeah, I would call, I would ask them to get you, I would, I would ask them to get you a uh an itemized receipt with the procedure codes and the dates that each of them happened, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because it shows everything was done in 24.
[AGENT][NEUTRAL] It could be that you reached your
[AGENT][NEUTRAL] Yeah, cause then it would be not because of the dentures it because, because you reached your calendar year maximum, depending on when it was.
[CUSTOMER][NEUTRAL] Yeah, see, that's what I'm thinking because they didn't put a different date for the dentures.
[AGENT][NEUTRAL] For each one.
[CUSTOMER][NEUTRAL] Yeah, like the teeth that got pulled, you know, they um put, they have that on the paperwork and stuff.
[CUSTOMER][NEGATIVE] But they have it down as the dentures getting done in 24, and they did not.
[CUSTOMER][NEGATIVE] That did not happen.
[AGENT][POSITIVE] Yeah, I would get with your dentist and see um why they build it that way.
[AGENT][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, if you have that itemized receipt, uh.
[AGENT][NEUTRAL] Turn that in as well and if um
[AGENT][NEUTRAL] Need be, they can always call us and we can verify benefits with them as well and give them a a copy.
[CUSTOMER][NEUTRAL] Yeah, because the papers that I'm looking at because I made copies before I sent them into you guys.
[CUSTOMER][NEUTRAL] And it says that the balance is 0 we paid in full.
[AGENT][NEUTRAL] Yeah, and so that's why you'll need an itemized receipt. Yeah, you'll need the itemized receipt that shows everything, and I would I would ask them why they if some of it was done this year, why they billed it for last year. I would ask them um.
[CUSTOMER][NEGATIVE] We just didn't get the work done in full.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, because I feel like they shouldn't have put the dentures on this because he hasn't even got the permit yet.
[AGENT][NEUTRAL] Yeah, and I would talk to them about it and then say if they need to, they can always call us um to verify. But yeah, I would see what, what their reasoning is behind that, and they might have a reasoning for it that that we're not able to see because I'm not a, I'm not a dental provider. I don't know why they would do that um just because I'm unaware. So I would ask them why and see if they can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If uh if they can bill you for what you got done this year, um, instead of lumping it all into last year, um, so I would ask them their reasoning behind that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK alright well I appreciate your time thank you so much.
[AGENT][NEUTRAL] Well, any time, and let me go ahead and get that email sent out to you as well um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][NEUTRAL] All right, and I just sent that out to you, so hopefully you'll get it, um, you'll get it from [PII] [PII] [PII]. If you don't see it in your email in about 5 to 10 minutes, uh, check your spam. Um, otherwise you can also find it on our website as well, but at least this way you'll have it, um, for convenience to where you can email it to him and see if he can get it back to you somehow.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that works. I appreciate everything.
[AGENT][NEUTRAL] Anytime. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. You did great. Thank you so much.
[AGENT][POSITIVE] Great. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thanks bye.