AccountId: 011433970860
ContactId: 5a295f49-5c64-4063-a7c7-6a643ee3a88d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1718900 ms
Total Talk Time (AGENT): 486072 ms
Total Talk Time (CUSTOMER): 626142 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/5a295f49-5c64-4063-a7c7-6a643ee3a88d_20250505T14:14_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I have dental insurance with your company and my option is see that I am, that I have at this time. I'm a retiree with um Department of Health and Hospitals, and that's what was offered. I think you.
[CUSTOMER][NEUTRAL] had a change that occurred years ago, so then, um, all I was eligible for was option C under that. So, um, I'm interested in finding out what other options you'll have and what your premiums are and coverages.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I provide you with the policy number?
[AGENT][NEUTRAL] Uh, your name first and then your policy number, please.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My policy number is 603491.
[AGENT][NEUTRAL] And what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], what's your date of birth and your complete mailing address?
[CUSTOMER][NEUTRAL] [PII] is my date of birth and my address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you for that.
[CUSTOMER][NEUTRAL] And that's all lower case, of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you said that you're with the Department of Health and Hospitals. Uh, this is an individual policy that you have?
[CUSTOMER][NEGATIVE] That I am a return.
[CUSTOMER][NEUTRAL] Well, it's whatever I got whenever I started working for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, you know, 30 years before and plus. So that's what was offered, and that's what I took. And during all of this stuff, there was some kind of a change, I guess, with your company or coverages or something, and I was, I think, in a B and then I went to a C.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I'm interested in seeing your, your, um, what do you call your, your, your, the benefits, you know, the listing of benefits, um, uh, coverage services and all that. And the one I'm looking at says coverage type option C. So I'm interested in all your options.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] And premiums, etc.
[AGENT][NEUTRAL] Have you called about this before, like last year in 24?
[CUSTOMER][NEUTRAL] If I did, it was, uh, I y'all, y'all sent me a list of uh the coverage benefits.
[AGENT][NEUTRAL] OK, of your current policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was that a problem?
[AGENT][NEUTRAL] No, no, no, I'm just reading the notes and see where you want to basically verify just what you said this morning.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You wanted to know that well this says you wanted to know the difference in the premium and benefits of option B and C.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Is that all, all options that you have, just B and C?
[AGENT][NEUTRAL] Uh huh, so I'm looking, so currently you have option C.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold um I may have to transfer the call because I can see where you've switched between, have you had um option A before?
[CUSTOMER][NEGATIVE] I don't think so. The card that I have shows B and then I slashed through it, like I corrected it myself and put a C, like they'll never sent me a card. I just had to update it myself. So I don't know anything about anything else.
[AGENT][NEUTRAL] Yeah, maybe you were employed at this time, but from [PII] you had family coverage and it shows option A.
[AGENT][NEUTRAL] And then effective [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] To [PII], it changed to couple coverage and you had option B.
[CUSTOMER][NEUTRAL] I did have two children that matured, you know, they were out of uh age category, you know. Mhm.
[AGENT][NEUTRAL] Right, the dependent age. Mhm. Mhm.
[AGENT][NEUTRAL] And then I show.
[CUSTOMER][NEUTRAL] And my husband and myself is still on it.
[AGENT][NEUTRAL] Mhm. And then I show option C from.
[AGENT][NEUTRAL] Uh, [PII] and this is the policy that you are currently on.
[CUSTOMER][NEUTRAL] When did the, uh, the sea auction begin?
[AGENT][NEUTRAL] Your option C.
[AGENT][NEUTRAL] Um, the effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Current to current.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I want, why did it change anyway, I guess y'all, y'all, your system, your policies are changing my I guess, or was that because of something?
[AGENT][NEUTRAL] Mhm. Did you request a change?
[CUSTOMER][NEGATIVE] No, I would, I want, I don't know why I would change, requested a change because the only thing I would have is my children, you know, aged out and I don't know why I would have wanted, uh, still the, the best coverage that I could have had. I guess according to the premium, y'all had to change and I didn't want to change my premium perhaps and that's why it ended in C, I don't know.
[AGENT][NEUTRAL] OK, give me one
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][MIXED] Although my coverage is helpful, it's not beneficial. And my dentist evidently is not in y'all's PPO or your whatever, however you call it.
[AGENT][POSITIVE] Yeah, there's actually not a network affiliated with this policy, so it's really provider of choice.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, but that's who I've always used.
[AGENT][NEUTRAL] Yeah, so meaning that your doctor doesn't have to be contracted with a network. There is no network for the policy that you have.
[CUSTOMER][NEUTRAL] So, but you'll cover it, cover it.
[AGENT][POSITIVE] Mhm. We'll still provide a benefit, yes.
[CUSTOMER][NEUTRAL] But that's what I'm just trying to find out what the, you know, I'm comparing it to, trying to compare it to something else and seeing what's beneficial to us. It seems like the older I get, the worse my mouth gets, of course. And um I'm just trying to find something that'll be helpful. I mean, yeah, we've got teeth that are exploding and cats that are popping off like I'm eating rocks. I don't know what my problem is. I've got a partial upper, uh, um, and my husband had
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] A full set up or, but, you know, still, we're just trying to find something beneficial to us and seeing if maybe I can contact my, uh, state office and, and upgrade my dental insurance with y'all or something. I just wanted to see what y'all have to offer instead of me losing y'all, you know, I, um, or keeping y'all, you know, and it's, it's just costing me an arm and a leg to, um, get my mouth worked on.
[AGENT][NEUTRAL] Right, so you in the past had option A, B, and C.
[AGENT][NEUTRAL] So you've had the options that are available.
[CUSTOMER][NEUTRAL] Well, I don't know why I, it, I, I went from B to C, because maybe your premiums went up and I wanted to keep my premiums the same, maybe. And so that's why I ended up C. I don't know.
[CUSTOMER][NEUTRAL] I don't know how that happened.
[AGENT][NEUTRAL] Yeah, your option A, your premiums are $52 option B $53 and then option C it's $57.50.
[CUSTOMER][POSITIVE] And you see I'm paying more and and which is the better coverage.
[CUSTOMER][NEUTRAL] I guess see out of all that?
[AGENT][NEUTRAL] Let me take a look at the schedule of benefits. I think that they're relatively, let's see what the differences may be.
[CUSTOMER][NEUTRAL] Tell me the premiums for A, B, and C again, please.
[AGENT][NEUTRAL] $52 for A, $53 for B.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What, what did you say? It, it was a school.
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][NEUTRAL] Yeah, it's, it's a little difficulty. A is how much?
[AGENT][NEUTRAL] 52
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] B
[AGENT][NEUTRAL] 53
[CUSTOMER][NEUTRAL] Oh, OK, good. And, and see what am I paying?
[AGENT][NEUTRAL] $57.50.
[CUSTOMER][NEGATIVE] Yeah, you see, I'm paying the higher of the 3. You think my coverage would be um substantial.
[CUSTOMER][NEUTRAL] would be the best, she is the best for y'all?
[AGENT][NEUTRAL] So for um I'm looking at the schedule A uh the calendar year max was 1000.
[AGENT][NEUTRAL] Uh, calendar year deductible per covered person 50.
[AGENT][NEUTRAL] And under this policy, it paid a certain dollar amount for a procedure, a cover code.
[AGENT][NEUTRAL] So I'm gonna move over to Schedule B.
[AGENT][NEUTRAL] Uh, Schedule B, the calendar maximum and deductible is the same.
[AGENT][NEUTRAL] Uh, likewise, the policy pays a certain benefit for a procedure code which appears to be a little higher benefit amount than A.
[AGENT][NEUTRAL] And that may be why, and let me look at C.
[AGENT][NEUTRAL] Option C, uh, the calendar year max and your deductible is the same.
[AGENT][NEUTRAL] Um, and it looks like your benefit amount is less.
[CUSTOMER][NEUTRAL] See, is that the less of them all.
[AGENT][NEUTRAL] Looking at the benefit amount section.
[CUSTOMER][NEUTRAL] Even though my premiums higher than A.
[AGENT][NEUTRAL] Yeah, I'm just reviewing the schedules.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So when you're speaking of the 100, that was the deductible and then the 50, that was.
[AGENT][POSITIVE] 1000 is the, yeah, but 50 is the deductible. You're correct. You're correct.
[CUSTOMER][NEUTRAL] I mean 1000.
[CUSTOMER][NEUTRAL] And the, and then the, the uh other one, the $50 that was the service fee.
[AGENT][NEUTRAL] The $50 is your calendar year deductible. $1000 is the calendar year maximum.
[CUSTOMER][NEUTRAL] Oh, max, yeah, deductible max.
[AGENT][NEUTRAL] Um, and, and, and that's the same for each of the policies, but when it comes to the benefits.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So I'm looking at option A versus option B.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Still there?
[AGENT][NEUTRAL] Yeah, I'm still here.
[CUSTOMER][NEUTRAL] OK, it's OK. I'll just checking.
[AGENT][NEUTRAL] Just checking, I'm looking at the both of them.
[AGENT][NEUTRAL] So between option A and option B.
[AGENT][NEUTRAL] I mean, I'm sorry A and option C. Option C has the greater benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then I'm gonna compare option C to option B.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, the greater benefit as far as how much, uh, the policy will pay.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] So on the restorative services which would be like your crowns.
[AGENT][NEUTRAL] Um, option C.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Has a better benefit than option B.
[AGENT][NEUTRAL] Whereas for your.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And A as well, right? C is, sounds like it's still the best. They, they're just telling me that, you know, and I can, I can see my bill when I have my services that they're telling me my insurance is not very good at all. I've been having y'all forever, but, um, uh, that's why I was contacting to see if there's anything better than just the auction is what I was wanting to know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And I, I'd rather not go to a different dentist. I've been using them forever since I moved to the [PII] area over 30-something years ago.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I was just trying to keep everything simple and the same without changing to some other kind of insurance company, but um the pre the premiums would be higher over there and I don't know what the coverages would be. I'm assuming it would be good too, but I mean, it would, you know, whatever it is, but you're the only best option that you have is C.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look at another option. There is an option D.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So option D your preventive services, the benefit is higher on option D.
[AGENT][NEUTRAL] Um, let's see, diagnostic, which is basically your X-rays when they do panels and bite wing X-rays.
[AGENT][NEUTRAL] Option D.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Um, has a higher benefit for that category. And then for restorative such as fillings that you may have.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It looks like option D benefit that we pay is a little is somewhat higher.
[AGENT][NEUTRAL] Uh, restorative services, which is major.
[AGENT][NEUTRAL] Um, it looks like option D pays a higher benefit.
[AGENT][NEUTRAL] Not vastly higher, but it's higher.
[AGENT][NEUTRAL] And then let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For like your crowns and bridges.
[AGENT][NEUTRAL] Your peronal and endodontics, the uh option D looks like it pays a little more.
[AGENT][NEUTRAL] As well as for the.
[CUSTOMER][NEUTRAL] What's the pre
[AGENT][NEUTRAL] Yeah, I'll have to get you over to a different area to discuss that. I'm just comparing the two schedule benefits.
[AGENT][NEUTRAL] And looking at the benefit amount.
[CUSTOMER][NEUTRAL] Oh, I know, but can
[CUSTOMER][NEUTRAL] Can you, oh, can you give me the um um premium?
[AGENT][NEUTRAL] I'll have to transfer you to a different area for the premium amount.
[CUSTOMER][NEUTRAL] 00, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what's the difficulty in um um changing from uh uh a C to a D? I mean, what do I do? Just contact my state office?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know, the cust well this is an individual plan now you're no longer with an employer group because you pay for it yourself, don't you?
[CUSTOMER][NEGATIVE] I it's taken out of my chat. It's taken out of my, my pension.
[AGENT][NEUTRAL] Right, so you pay it.
[AGENT][NEUTRAL] OK, so yeah, um, and so um I can get you over to uh our customer service team, uh they could discuss the difference in the premium amounts.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what the process is if you can transfer over to the option B, I don't know if you can or not, um, that's not saying yes you can or no you can't, but that area will be able to clarify that for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, option 2.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And they're gonna be able to send me the um uh what do you what do you call that list?
[AGENT][NEUTRAL] The schedule of benefits?
[CUSTOMER][NEUTRAL] Benefit list.
[CUSTOMER][NEUTRAL] Schedule benefit.
[CUSTOMER][NEUTRAL] They're gonna be able to send me the new schedule of benefits for G?
[AGENT][NEUTRAL] If they say that you can switch over, you can request a copy of it, yes.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] And once if if they say that you can, um, the team, the customer care team, which is who I I'm with, we can, we can send get you a schedule of benefits, uh, that's something that we could do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me connect you.
[AGENT][NEUTRAL] And then I'll let them know the reason for your call and then we can proceed from there, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] in customer service. How may I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good [PII] how are you?
[AGENT][POSITIVE] I am good. Um.
[AGENT][NEUTRAL] All these emails. I have an insured on the phone. Let me give you her policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That number is 603-491 uh Roxanne.
[AGENT][NEUTRAL] And in looking at her history, it appears that she's changed from option B to C and so on and so forth. She's now wanting to perhaps change to option D.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And she also wants to know what would be the difference in the premiums. I think that's the benefit that may pay out the highest on services.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I will have to find.
[CUSTOMER][NEUTRAL] About the premium.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I'll have to find the premium. Hold on just a second.
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't know if it's gonna work like this, uh.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I don't know if I'm gonna be able to look it up like this. I was hoping that I could, but.
[CUSTOMER][NEUTRAL] Oh, red muffins.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do do.
[CUSTOMER][NEGATIVE] My computer is going so slow today.
[AGENT][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] It's like, go away, it is Monday and I don't wanna be here.
[CUSTOMER][NEUTRAL] That's what my computer's saying.
[CUSTOMER][NEGATIVE] OK, I can't pull it up that way either. Well, how the heck am I supposed to check the premium?
[CUSTOMER][NEUTRAL] Without actually changing it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Ok let me do it this way.
[CUSTOMER][NEUTRAL] Darn it.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was trying to go through another way because I was in the middle of making changes on the policy, so now I have to make a note.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I look at the policy again 603.
[CUSTOMER][NEUTRAL] 491.
[CUSTOMER][NEUTRAL] Hopefully, it will let me try to add that benefit and tell me what the premium is.
[CUSTOMER][NEUTRAL] Because I've checked the rate table and it's not showing up there, OK.
[CUSTOMER][NEUTRAL] 7280.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] And uh she'll have to do an application for 71 alrighty [PII] go ahead and transfer her and I'll tell her the premium and um send her an application for to apply for the option D.
[AGENT][NEUTRAL] OK, and then she wanted a copy of the schedule and I told her that we need to confirm whether she can switch and she can and then once it's set up, then we can send her a schedule of benefits that she would like.
[AGENT][NEUTRAL] That's just
[CUSTOMER][NEUTRAL] Yeah, now I can send her a um a brochure for that. I think we have a brochure for this one, yes, I think so hold on.
[AGENT][NEUTRAL] Oh, for Schedule D?
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] Important documents original APL docs.
[CUSTOMER][NEUTRAL] What's the dental.
[CUSTOMER][NEUTRAL] OK, I know I had it.
[CUSTOMER][NEUTRAL] OK, brochure.
[CUSTOMER][NEUTRAL] Select dental to.
[CUSTOMER][NEUTRAL] OK. This one that I have.
[CUSTOMER][NEUTRAL] Yeah, it had, OK, so I could have checked this for the premium. It has, um, each schedule listed on here and the different premium type, but yeah, I can send send her this brochure and it shows her what's covered by the plan that she chooses, yeah, mhm.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That's cool.
[AGENT][POSITIVE] Wonderful.
[AGENT][POSITIVE] Wonderful. Yay.
[CUSTOMER][POSITIVE] Yay, yup.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so did you wanna transfer her over or?
[AGENT][POSITIVE] Yes, I will get her transferred over.
[AGENT][POSITIVE] Here she comes. Thank you, memory.
[CUSTOMER][NEUTRAL] OK. And has she been verified?
[AGENT][NEUTRAL] I, she has been verified. Did you need her phone number?
[CUSTOMER][NEUTRAL] Uh, yeah. Is it the same in the system?
[AGENT][NEUTRAL] It's the one that shows up on the CCP.
[CUSTOMER][NEUTRAL] OK, the [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alrighty you can go ahead and transfer her over. I'll take care of it.
[AGENT][POSITIVE] OK, thank, thank you so much. Here she comes.