AccountId: 011433970860
ContactId: 5deed210-742c-4e2a-b511-8a16ad53a4be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496540 ms
Total Talk Time (AGENT): 232278 ms
Total Talk Time (CUSTOMER): 140869 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/5deed210-742c-4e2a-b511-8a16ad53a4be_20250519T19:48_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII]. I was calling to see exactly what this plan covers that I have.
[AGENT][NEUTRAL] OK, Ms. [PII], so you're needing to get benefit information on your policy, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] Policy number is 02.
[CUSTOMER][NEUTRAL] 588
[CUSTOMER][NEUTRAL] 336.
[AGENT][NEUTRAL] What's the last number you said 6. I was having some trouble hearing you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so Ms. [PII] so any information that I provide for you today will be a verification of benefits and not a guarantee of payment, and I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And lastly your email address, please.
[CUSTOMER][NEGATIVE] I didn't understand you.
[AGENT][NEUTRAL] Yes, ma'am. I'm having some trouble hearing you. What is your email address?
[CUSTOMER][NEUTRAL] My email address be [PII].
[AGENT][NEUTRAL] OK, thank you. So this policy number that you gave to me is your dental policy. So you're needing information on your dental policy?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I went to the dentist a few weeks ago and I had to end up paying.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment for me to get your benefit information pulled up please.
[AGENT][NEUTRAL] OK, so on this general policy that you have, miss, um,
[AGENT][NEUTRAL] Ms. [PII], you have a calendar year maximum benefit of $500 for covered services with a $50 calendar year deductible.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And this policy has benefits for preventative and basic expenses. It does not cover any type of major service or periodontics, any, any endodontics. It is strictly just for preventative and basic.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] So what is the percentages?
[AGENT][NEUTRAL] Preventative
[AGENT][NEUTRAL] is covered at 100% of the allowable charge.
[CUSTOMER][NEUTRAL] So what is that exactly?
[AGENT][NEUTRAL] That is for a cleaning, an an oral evaluation is considered preventative.
[AGENT][NEUTRAL] Uh, bite wing X-rays would fall under preventative.
[AGENT][NEUTRAL] Again, your cleaning.
[AGENT][NEUTRAL] Would fall under that.
[CUSTOMER][NEGATIVE] So I, there's no way I can't recover the money that I paid.
[AGENT][NEUTRAL] Now, your are you, are you referring to your premium payments or you're talking about what you paid to the dentist?
[CUSTOMER][NEUTRAL] What I paid to the dishes.
[AGENT][NEUTRAL] OK, I let me see if we've received a claim for you.
[AGENT][NEUTRAL] So as of now, Ms. [PII], your dental office has not filed a claim with us for you.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So you weren't listening. Uh, he said that he couldn't not file a claim, but I could, and I have all the necessary papers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm going to email you a user guide for our portal, Miss [PII], that explains how you can set up your profile and you can actually submit your claim.
[AGENT][NEUTRAL] You can upload it if you have a computer and you're able to do that, you can upload your claims information directly into your portal for our review. If you're not able to do that, you can either fax in the claim or you can mail it.
[AGENT][NEUTRAL] And I could give you
[CUSTOMER][NEUTRAL] Mail it on the back of the card?
[AGENT][NEUTRAL] Ma'am?
[CUSTOMER][NEUTRAL] Mail it to the number that's on the back of the card with Oklahoma City on.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. That is where you would mail it.
[AGENT][NEUTRAL] And you can put attention claims department.
[CUSTOMER][NEUTRAL] So in other words, this is not really insurance.
[AGENT][NEUTRAL] Yes, ma'am, this policy
[CUSTOMER][NEGATIVE] There's nothing that's gonna help.
[AGENT][NEUTRAL] Now this plan again, it only has benefits for basic and preventative.
[AGENT][NEUTRAL] Expenses.
[CUSTOMER][NEGATIVE] But see, it didn't say that at the end of year, but now I know this so I will not accept it again because.
[CUSTOMER][NEUTRAL] Who just needs the basics. Nobody.
[CUSTOMER][NEUTRAL] I'm not even a [PII], [PII]. Don't need the basics.
[CUSTOMER][NEGATIVE] So in other words, y'all gonna take my money for the rest of the year.
[CUSTOMER][NEGATIVE] Claim that I cannot use that is just useless.
[AGENT][NEUTRAL] Now you can contact benefits and a card who is who handles your deductions of premium and if that is who you, if you're wanting to cancel your coverage, I can give you their phone number if you don't have it and I can also connect you with one of their representatives.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, you can give me the number to connect me as well.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So this is preventative. It's not anything that I have paid for. It's really no use in faxing anything is in, is it? Because I had a tooth extraction. It cost me $212.
[AGENT][NEUTRAL] We would just have to.
[CUSTOMER][NEUTRAL] And that is
[AGENT][NEUTRAL] We would have to receive your claim. We can't process claims over the phone, this last day, so we would just have to receive the claim to review it.
[CUSTOMER][NEUTRAL] But you just told me what it covered and didn't.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there any way you can mail me anything definitely so I can have to say that.
[CUSTOMER][NEUTRAL] What you do cover and what you do not cover.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. In that portal, I emailed you the user guide and in your portal, there's actually a copy of your policy information with all of your benefits. And then also, you have access to your ID cards there as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I