AccountId: 011433970860
ContactId: 4f27dd8a-6195-4bac-bb87-03ceb5c127c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1423430 ms
Total Talk Time (AGENT): 506949 ms
Total Talk Time (CUSTOMER): 690641 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/4f27dd8a-6195-4bac-bb87-03ceb5c127c4_20250430T14:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATS. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Uh, yes, I was calling, uh, the last few, few times me and my wife went to the dentist, uh, for some reason they can't, uh, it's not paying on my account, you know, I've been going to this dentist for 14 years and so I don't know what is happening where I don't know if it's on their end or.
[CUSTOMER][NEUTRAL] Uh, the insurance in, but they told me to call you guys.
[AGENT][POSITIVE] OK. Well, I can definitely um assist with the policy. May I have your name and a good contact number just in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK, my name is [PII], uh, my uh contact number is [PII].
[CUSTOMER][NEUTRAL] And my policy number is.
[CUSTOMER][NEUTRAL] 00703855
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, now I have you here, Mr. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII]. My uh mailing address is [PII].
[CUSTOMER][NEUTRAL] And my email should be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, and so is the, is, would this be this last claim here from February for you or is it your, your wife or one of the children?
[CUSTOMER][NEUTRAL] Uh, uh, the last claim from February is, is me and uh uh it's for me, yes, and then uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then also my wife, they said her last claim didn't pay, I think.
[CUSTOMER][NEUTRAL] Today, today, it wouldn't go through. She went to the dentist today.
[CUSTOMER][NEUTRAL] And that may not be on your file yet, so I don't, I don't know.
[AGENT][NEGATIVE] So the only, so for, for the one for you for February, so we're paying out on your claims. This one was denied because preventative services are once every 6 months, so it's just less than 6 months, so we can't pay out.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, uh, OK, um.
[AGENT][NEUTRAL] But for, but the other claim, let me see if I.
[CUSTOMER][NEUTRAL] It it's something, well, well we know I knew that because I was paying out of my pocket at first when I was doing them, uh, in the other times, but it's something, some reason they say it's not, not paying. I don't, I don't know. I don't know if it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me look through these claims just to see if I can.
[AGENT][NEGATIVE] Because for the most part, we have been paying. There are a few here that are denied, but they're denied for the time, or like this one here was the, what is this? Hold on one second.
[AGENT][NEUTRAL] Outside of the ones that were denied because it hasn't been enough time lapse, the only other denial reason is the policy doesn't provide benefits for any procedure not or service not listed on your covered dental services. So this is from back in [PII], um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have no idea how to say this last name, [PII].
[AGENT][NEUTRAL] Um, but that's the name of the dentist, but whatever this code is 00170 is not a covered code on your policy, so we couldn't pay out on that.
[CUSTOMER][NEUTRAL] Mm, I, I don't know.
[CUSTOMER][NEUTRAL] Yeah, I, I, uh, yeah, I, I had a dental implant put in, but I paid that out of my pocket so I don't know if that would have anything to do with it and uh.
[CUSTOMER][NEUTRAL] Just trying to figure out, you know, make sure we.
[CUSTOMER][POSITIVE] Got everything uh done properly because uh.
[CUSTOMER][NEGATIVE] You know, I just don't want the bills to build up on me.
[AGENT][NEUTRAL] Right, and you're paying for the service. So, of course, we wanted to
[AGENT][NEUTRAL] Um, pay out for you. So I'm just looking through you and Mrs. [PII]'s claims. For the most part, they are paid out. The the the the one for her hasn't populated for the recent one, yeah, it's just showing [PII]. So when they file that claim, we'll go ahead and process the new one. But
[CUSTOMER][NEUTRAL] No, she
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But they, they said they tried to file it today and it wouldn't go through.
[AGENT][NEUTRAL] How
[CUSTOMER][NEUTRAL] She went to the dentist today. I, I don't, I don't know what to, they, they, they may have changed some things in the office and I think they have, I don't know if that would have anything to do with it, but they said they tried to file it today and it wouldn't go through.
[CUSTOMER][NEUTRAL] That's why we're calling.
[AGENT][NEUTRAL] I don't know what
[AGENT][NEUTRAL] I don't know what they mean by that. So if it's not going through, then that to me just from what I'm hearing, I would then
[AGENT][POSITIVE] The best thing to do, let's do this. Give them our phone number and your, they already have your um your your policy ID card so that we can provide them with a breakdown of your benefits, so they that will hopefully eliminate them from doing services and the time hasn't passed and they'll then have a list so they know the whatever they're trying to do is not covered or is covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It seemed like that's what they would have done in the beginning instead of having us do this, but they wanted us to call because if you have the information and you know what you filing it's easier for you to call the, the insurance company than me because you know all the codes and everything but.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] But you know nowadays people don't wanna do the work so but I, I will call them back and see if we can get that, get them to do that and I will give them your number.
[AGENT][NEUTRAL] Do you want
[AGENT][NEUTRAL] OK, do you want to
[CUSTOMER][NEUTRAL] Or, or you can call them.
[AGENT][NEUTRAL] Yeah, I was gonna say, do you want me to um like call them on, I can't call them by myself, but you can, I can call them with you because I I'll then be a third party, but if you're on the line with me, then that changes things. So I can call them and try to see what's going on.
[CUSTOMER][NEUTRAL] Either way, however.
[CUSTOMER][NEUTRAL] OK, let me, let me, let me.
[CUSTOMER][NEUTRAL] Oh well, I would appreciate it, but.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So how would we do that if I need to be on the line with you?
[AGENT][NEUTRAL] Um, if you want me to call, just, uh, just let me know their number and I'll call them on the other line and then put us all together or if you want to call them on the other line and whatever is easier.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK, here, here it is, here it is. I'll let you, I'll let you do it. Here's the number [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And do you mind if I place you on just a brief hold while I call on the other line?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Dental care at East Sanditch Center. To get you the best team member, please select from the following menu. If you are considering becoming a new patient, please press 1. If you are an existing patient, please press 2. For all other questions for our office team, please press 3.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality and training purposes.
[AGENT][NEUTRAL] The Corbin.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] OK, I'll just make sure you're here with me, OK.
[CUSTOMER][NEUTRAL] Your call is important to us. Please hold for the next available team member.
[CUSTOMER][POSITIVE] Thank you for your patience. All of our team members are assisting other callers. If you'd like to leave a message, please press one. Otherwise, please hold and your call will be answered in the order it was received.
[CUSTOMER][NEUTRAL] Hello this is [PII]. May I have your first and your last name?
[AGENT][NEUTRAL] Hey [PII], my name is [PII], first initial [PII]. I'm calling from an insurance, uh, insurance company, but they're on the line as well. Do you need the patient's name?
[CUSTOMER][NEUTRAL] Uh, yes, please.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Uh, yes, it's
[AGENT][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] You said [PII] is his last name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me pull up his chart real quick.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, I don't see his name listed here.
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK, date of birth right here. OK, I have his chart here and how may I help you today?
[AGENT][NEUTRAL] All right, so there's a few things. Um, Mrs. [PII], um, her first name is [PII]. She just came in today and they tried, uh, I guess, to submit the claim, but they told her and Mr. [PII] that they couldn't send it through. So I'm trying to see what information y'all have if I need to give y'all updated information, and then to see if y'all need a copy of the fax back.
[AGENT][NEUTRAL] Because, uh, we're paying out for the most part, but there are some claims for like Mr. [PII] that were, like, for example, pro fees, it was less than 6 months, so it was denied. Um, there's another 11 of the codes, I think it was 00170 is not covered on his policy. So I'm wondering if you all have their facts back to know what's covered and what's not in the time frame so that we can avoid the denied claims.
[CUSTOMER][NEUTRAL] OK, so I'm not in billing they have a whole different chart for claims for this, and I don't have access to it so um the claim number anything like that, the fax, um, I don't have that information but I can have billing give you a call directly that way they can go over this and get that handled, um, but they would have to call you back because I'm not able to transfer.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] So this wouldn't be billing. This is the office staff, so that y'all can look at their facts back and see what codes are covered so that you know what you can.
[CUSTOMER][NEUTRAL] I'm not in office patient services. um, I'm not in office today, um, but I can like have.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, that's different than billing, OK.
[CUSTOMER][POSITIVE] Right, right, so I wouldn't, I mean I can have billing give you a call directly that way they can get this handled for you.
[AGENT][NEUTRAL] But I don't need to talk to billing. Who in, so you're not in the office. Is there a number for the office then, because that's who I thought I was calling.
[CUSTOMER][NEUTRAL] It would be the same number, the [PII]. You just press option 3 and it gets you to someone from the office.
[AGENT][POSITIVE] Alright, that's what I need to do. OK, thank you so much. Can you transfer me or do I need to call back?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, unfortunately I can't transfer. I'm so sorry.
[AGENT][POSITIVE] It's OK. No, that's fine. I'll call back. Thank you very much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK. Hello, Mr. and Mrs. [PII].
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Hey, yeah, she was trying to pass me the billing and I'm like, no, I don't need billing, I mean who's in the office. So let me call the office. Um, they didn't have any on their prompts, just say like one if you're new or two if you're an existing patient, so I just put 2 because y'all go there, but their automated system didn't really specify that. So I'm sorry about that. I'm gonna call them on the other line and use number 3.
[CUSTOMER][NEUTRAL] She said, she said it should be 3, but uh you know, press 3, but I like you say it would have made sense to existing patient, but I'm patient if you got time I'm I'm here.
[AGENT][NEUTRAL] I got time today because I don't want y'all have to keep going through this.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][NEUTRAL] Alright, hold on one moment. You're welcome. I'm going to call them on the other line and I'm going to use 3 this time. So hopefully we can get you some resolution. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Dental Care at East Sanditch Center. To get you the best team member, please select from the following menu.
[CUSTOMER][NEUTRAL] If you are considering becoming a new patient, please press 1. If you are an existing patient, please press 2. For all other questions for our office, your call may be recorded for quality and training purposes.
[CUSTOMER][NEGATIVE] They don't care the center.
[AGENT][NEUTRAL] Hey, my name is [PII]. I'm calling from APL. I have a, we have a mutual patient that I'm trying to assist. Um his name is [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I have the date of birth if you need it.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] Alright, give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII]. My name is [PII]. I'm calling from APL. Um we have a mutual patient that I'm trying to help. His name is [PII], and his wife [PII]. Um I have the policyholder's date of birth if you need it.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][POSITIVE] Oh sweetheart, let's see.
[CUSTOMER][NEUTRAL] What we needing today dear?
[AGENT][NEUTRAL] Alright, so we're paying the claims out for the most part, but there's some claims that were um denied for like example, proceeds, it was like less than the 6 months, so it was denied and then there's like a code, I think it was 00170, that's not on their policy. So I'm trying to see if y'all have a copy of the fax that to know what's covered and what's not in the frequencies. If not, I can send you all the copy so that we can try to avoid these denials, but also Mrs. [PII], um,
[AGENT][NEUTRAL] Came in today and I get it that y'all were trying to file the claim and told her that it wouldn't go through. So I'm trying to see if y'all just what information y'all have to file the claim with us and just go over it with you if you need to update or what, what the issue is so we can get Mrs. [PII] taken care of also.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so my office manager is not here. She's, she is um gonna be out into tomorrow. This is something that she's gonna have to handle because I'm not sure how to handle that um I'm not sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't remember.
[CUSTOMER][NEUTRAL] Let me see if I can get the chart pulled back up.
[AGENT][NEUTRAL] So basically, I'm just asking if y'all need a copy of the fax back, I can fax it to y'all and then
[AGENT][NEUTRAL] What claims information you have for us, I can confirm it for you, that's all. I don't need the office manager.
[CUSTOMER][NEUTRAL] OK, I can I can try to take all that information. I don't know where I would put it unless I just put it on a sticky note and put it on her desk because I don't, I don't know where she would put that information. I can just take it on a sticky note if I have to let me see.
[AGENT][NEUTRAL] Or can we see who assisted them, whoever was trying to process it.
[AGENT][NEUTRAL] I'm just trying to see if y'all have the correct claims information, so y'all don't have any issues filing the claim.
[CUSTOMER][NEUTRAL] So we have the fax. I mean we have the fax back we have the fax back here we got it in February of this year.
[CUSTOMER][NEUTRAL] Um, and who she spoke with was just was just the person who was checking out, which was me, and I don't, I don't do any of that. I just literally batched the claim and then the insurance people on the back end do the rest, um, what information on like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What information are you, are you gonna give that way so I can kind of see if it matches.
[AGENT][NEUTRAL] Alright, so if y'all have the facts back, then y'all are able to see what codes are covered, so we hopefully won't get any more claims that are that have codes that aren't on here. And then I don't know, you said that it couldn't go through. So do you have the claims like the mailing address, the payer ID, the fax number, what didn't go through?
[CUSTOMER][NEUTRAL] OK, I'm not sure why I'm not sure why she's saying it. I said it didn't go through. I, I don't recall telling her it didn't go through. Well, my, my I'm on here and my wife is right here she just left the dentist's office and she said they tried to put it through and I can get her on here and they told her told her to call the uh call my insurance so that's why we call because it it wouldn't go through and I can get her on the line she just left from up there. [PII], come here right quick.
[CUSTOMER][NEUTRAL] Now what did they say it looks like my office.
[CUSTOMER][NEUTRAL] Come in.
[CUSTOMER][NEGATIVE] Oh, showing that you owe 125 and uh for the last time you yes sir because there was a balance because Mr. [PII] is it looked like on our on my ledger when I was checking her out it looked like the insurance didn't pay for your cleaning from [PII]. Yes, I was paying, I was typically paying.
[CUSTOMER][NEGATIVE] I was coming in every 3 months and I would charge my insurance for 6 months and then I pay out of my pocket but you guys went corporate and the price went up and I told him, well, I'm gonna stop coming in. I'm just gonna come in on them when my insurance will pay every 6 months and I told him I'll pay whatever is due.
[CUSTOMER][NEUTRAL] Uh, because the price went up when, when you guys went corporate, so I don't, and I stopped that. So if I owe the 125, I'll pay that. That's no problem, but I just wanna make sure that my wife was taken care of today when I stretched it out. I changed it because it was last month or something. I stretched it out for 6 months and she didn't have to pay that. Yeah, and she stretched hers out for 6 months so she wouldn't have to pay.
[CUSTOMER][NEUTRAL] So, uh, uh, so that our insurance would cover our clean. So that's all I'm showing on the account. I'm not sure why insurance was like I understand why insurance was called because I told her to call but for you but for her she should be fine. I mean we have the fax back and all the details that are in the fax back there. So you're saying the 125 that is always is for the last time I came in and when I found out it was you guys went corporate and and so how much how much is due on that?
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Exactly, because I, I can pay that. It is 125. 80 is what your balance is.
[CUSTOMER][NEUTRAL] OK, well, we'll get that taken care of because I was lacking understanding.
[CUSTOMER][NEUTRAL] No, you're OK and then just I wanted her, I didn't want her to have to pay the balance unless she wanted to call the insurance to figure out why, but that explains why because of your cleaning, so that makes sense but well your wife should be fine because we've got, like I said we've got the fax back and all the information is in the system.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, well, now I got some clarity because I thought it just didn't go through today and she owes some money, but it was it was so if it don't, yes, uh huh yes sir because all I do is I batch it. I don't know if it goes through or not same day we won't know that we have to send them out to the insurance to know, but yeah, yours is just your portion, not your wife's. Hers is will be sent out today.
[CUSTOMER][POSITIVE] OK, well I got it I got it. I understand now thank you so much.
[CUSTOMER][POSITIVE] You're welcome honey.
[AGENT][POSITIVE] All right, thank you very much. I appreciate you.
[CUSTOMER][POSITIVE] And and thank you for your help.
[AGENT][POSITIVE] You're welcome. Hold on one moment, Mr. [PII]. All right, well, thank you. Have a good day.
[CUSTOMER][POSITIVE] Yes, mhm, you're welcome.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Alright, Mr. Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so y'all good?
[CUSTOMER][NEUTRAL] I think we're good. I was lacking understanding because my wife came in and she was saying that we, that they told her to call the insurance and so uh I thought her, her whatever she filed today didn't go through because they was telling her to call the insurance.
[AGENT][NEUTRAL] And they should
[AGENT][NEGATIVE] And they should have explained it.
[AGENT][NEUTRAL] Mhm, and they should have explained it to her like they did. Exactly. So as long as you have everything you need, so once you take care of that balance, then it will be an even a clean slate and then that 6 months, every 6 months, your cleanings will be covered by the policy.
[CUSTOMER][NEGATIVE] Yeah, they should have explained it better.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] See, they, they changed the whole office, and I'm gonna say this and I'm gonna let you go. I know you're busy, but I used to pay $50 in between cleanings so I would get an extra cleaning every 3 months. And then I came in the last time and they, I went to the office and they said, no, you owe such and such. I said, What? Yeah, well, well, we went corporate and, and this is the price for corporate. I said, Well, counselor, I don't wanna do them anymore, you know, and I paid when I was in the office, so I don't know how I'm really behind, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I paid that day for what I did that day, so but I, I will, I will take care of that and that's why uh it's like it is because they changed the whole system, but, but anyway, thank you for your help at least now I understand what's going on.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're very welcome, Mr. [PII]. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, no, that's it.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL. I hope you and Mrs. [PII] have a great day.
[CUSTOMER][NEUTRAL] Alright alright bye bye.
[AGENT][NEUTRAL] Bye bye.