AccountId: 011433970860
ContactId: 6264a8d2-ffd6-4b16-b586-4689687c6cfa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392100 ms
Total Talk Time (AGENT): 124675 ms
Total Talk Time (CUSTOMER): 206768 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/6264a8d2-ffd6-4b16-b586-4689687c6cfa_20250122T20:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in group billing. How are you doing?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Good, I'm doing well, thank you. Um, I have an insured on the line. Her name is [PII] and her policy number is 606741.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, she was actually just transferred by Angel over to me about a letter she received, so I helped her with that, um, but it sounds like she might have some questions about claims. Uh, she said that she had some dental work done and was, um, understanding that she should have been reimbursed after she paid out of pocket, so I'm not sure, um, I told her that you guys could let her know if we received any claim information, um.
[CUSTOMER][NEUTRAL] To kind of go over that with her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I got her pulled up. You can send her over.
[CUSTOMER][POSITIVE] OK, thank you so much here she comes.
[AGENT][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am, is there a way possible if I give you a policy number if you can pull up and see if any claims have been sent in.
[AGENT][NEUTRAL] Um, yes, ma'am. What's your policy number?
[CUSTOMER][NEUTRAL] Oh, let me get back over there.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] I went looking for a receipt.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00606741
[AGENT][NEUTRAL] OK, thank you. Now, please verify your name and date of birth.
[CUSTOMER][NEUTRAL] Yes, ma'am, [PII], [PII].
[AGENT][NEUTRAL] OK, and please verify your mailing address and your email address to make sure we have the correct info on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges for the claim you're calling about?
[CUSTOMER][NEUTRAL] And that's what I thought I didn't have. I'd have to go and probably go to the dental place and get it.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Your ex
[CUSTOMER][NEUTRAL] I've had like
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've had like 3 types of dental work done. One was a root canal, and then one was a um an implant, and then 2 cleanings.
[CUSTOMER][NEGATIVE] And I was told when I had to do the root canal and all that stuff that I had to pay for everything up front, which is over $2000 and that they would turn it in and then y'all would cut me a check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But what y'all paid. But I haven't received anything back from them.
[CUSTOMER][NEUTRAL] So I didn't know if the check was coming here to my address or did y'all cut a check and it goes to.
[CUSTOMER][NEUTRAL] entity.
[AGENT][NEUTRAL] OK. What's, what's the date of service or around what time so I can see if they filed a claim with us? I would need the date of service in order to pull that up.
[CUSTOMER][NEUTRAL] The business that did it.
[CUSTOMER][NEUTRAL] Yeah, I'll, I'll probably have to, I'll have to go get that. I'm, I'm thinking maybe.
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] OK, I do show claims on file for [PII] and I'm showing that the provider was paid for all of these claims, but to give you the exact information that you need for sure, um, I would need the date of service and the provider's information.
[CUSTOMER][NEUTRAL] So when I, this plan, I don't ever use it. And then I decided to use it.
[CUSTOMER][NEUTRAL] When I
[CUSTOMER][NEUTRAL] Do this.
[CUSTOMER][NEUTRAL] And they turned it in. Y'all cut them a check for what I paid.
[CUSTOMER][NEUTRAL] Is that how that works?
[AGENT][NEUTRAL] Yeah, we, we cut a check to whoever files the claim and according to the documentation we have on file, the provider filed the claim, so that's who received the check.
[CUSTOMER][NEGATIVE] Oh, that's just not right. Don't get me. OK. So I'm double out of pocket and I have to go to the provider to get my difference back?
[AGENT][NEUTRAL] Um, if you've already paid them and if we're talking about the same service, like I said, you would, um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, we, we are, we are.
[CUSTOMER][NEUTRAL] Because I, I've been to that provider 3 times.
[CUSTOMER][NEGATIVE] And I have not received a single check back and I've had to pay for everything up front.
[AGENT][NEUTRAL] You know, well, when they filed the claim, um, we had no clue, ma'am. All we can go by is what we received and according to what we received.
[CUSTOMER][NEUTRAL] So can I ask you
[CUSTOMER][NEUTRAL] They're gonna ask you something. When they file a claim, I'm trying to figure out how this works. When they file a claim,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, did they, uh, I guess it's that type of number what they claim.
[CUSTOMER][NEUTRAL] I don't know. OK.
[CUSTOMER][NEGATIVE] They should be only claiming what y'all charge.
[AGENT][NEUTRAL] Well, they're claiming what they charge. Yes, ma'am.
[AGENT][NEUTRAL] And if you, and if your policy covers that benefit, then, then we pay it.
[AGENT][NEUTRAL] If it's covered under, right, if it's covered under your policy. Yes, ma'am.
[CUSTOMER][NEUTRAL] And then y'all pay it.
[CUSTOMER][NEUTRAL] Right. And it was covered under the policy.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] But I wind up having to pay for everything up front because they said I had to pay for everything up front and then y'all would issue a check.
[AGENT][NEUTRAL] Yeah, the check was issued and it once again.
[CUSTOMER][NEUTRAL] So y'all don't require payment up front?
[CUSTOMER][NEUTRAL] You don't require payment up front or is that?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, because you're paying the provider. That's between you and the provider.
[CUSTOMER][NEUTRAL] OK, well, I
[AGENT][NEUTRAL] Oh yeah, it sounds like they were paid twice because um like I said, according to the claim that we received um the, the payment that it came directly from them, so that's who we paid.
[CUSTOMER][NEUTRAL] OK, well, um, I'm, I'm gonna go back up there and get my dates and stuff and then give y'all a call because something doesn't sound right and it sounds like somehow the middle person here which is me is getting screwed out of payments so um yeah I appreciate that so I'll um get the dates.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And then give you a call back.
[AGENT][NEUTRAL] Uh, yes, ma'am. We're here at [PII] central time. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Mhm. Thank you.