AccountId: 011433970860
ContactId: 669411d8-73da-4f72-b284-42db108fff72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 889429 ms
Total Talk Time (AGENT): 274496 ms
Total Talk Time (CUSTOMER): 218821 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/669411d8-73da-4f72-b284-42db108fff72_20250226T19:01_UTC.wav
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[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I have a problem with the uh the, the dental foline for [PII] we.
[AGENT][NEUTRAL] Do you have a policy number so I can assist you?
[CUSTOMER][NEUTRAL] Um, I see.
[CUSTOMER][NEUTRAL] 02280546.
[AGENT][NEUTRAL] And what's your name?
[CUSTOMER][NEUTRAL] Uh, [PII] Last name [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You, and the date of birth?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your name?
[CUSTOMER][NEUTRAL] Uh, this is [PII].
[AGENT][NEUTRAL] And [PII], who are you, the provider or insurer spouse?
[CUSTOMER][NEUTRAL] No, I'm the mother.
[AGENT][NEUTRAL] OK, so did [PII] give us permission to speak with you?
[CUSTOMER][NEUTRAL] Yes, it's
[AGENT][NEUTRAL] Have you called APL to give us that permission?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] Have he called here to APL to give us permission to speak with his mother?
[AGENT][NEUTRAL] Cause I don't see that here anywhere.
[CUSTOMER][NEUTRAL] Uh, he's right here. You can, you can talk to him. He's right here. Hold on.
[AGENT][POSITIVE] Yes, please. I will have to speak with them first, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] healthy.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hey, [PII], how are you doing?
[AGENT][NEUTRAL] Could you verify your full name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] And that's fine.
[CUSTOMER][NEUTRAL] And yes, [PII] [PII] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you repeat that number again for me please?
[CUSTOMER][NEUTRAL] Uh, my birthday?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], what is your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the email address that we have on file for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you're calling to give APL permission to speak with your mother on behalf of your policy and claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your mother's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me one moment, I'm putting this in notes.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] Could you provide me with the spelling of your mother's last name?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, first name, last name is [PII].
[AGENT][NEUTRAL] I can barely hear you.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] That's your mother's last name, correct?
[CUSTOMER][NEUTRAL] Yes, it's the same as mine.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I can speak with your mother now.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello [PII], so you say you were calling in regards to a claim for your son [PII]. What is the date of service?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] No, no, uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What day did you go to the dentist? What? Uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm not showing a claim on file for.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It shows that there was no payments made on the claim is because the records indicated that the premium for the service date.
[AGENT][NEGATIVE] There was no premium received for that service date, therefore,
[AGENT][NEGATIVE] No benefits were allowable.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] He, he didn't pay, uh, that's what he told me. I asked him, he, he, they, they, they take out his paycheck, the people, the uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The weekly uh payroll?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, may I place you
[CUSTOMER][NEUTRAL] Yeah, I, I.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Hold on, I have to, you can talk to him. Maybe he said.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have to be a one on one.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So your premium is taken out weekly. Um, so for that week was the premium taken out?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, may I place you guys on a brief hold?
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] Thank you. Let me do some research. I'll get right back with you. Hold one moment. 867.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] On hold
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding [PII]. So it looked like there was no premium paid for that week, so you may wanna reach out to your your employer to verify that, but as of right now in our system it doesn't show that a premium was received.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] So therefore, you wasn't eligible for anything.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mm, there should have.
[CUSTOMER][NEUTRAL] For the week of the
[AGENT][NEGATIVE] Unfortunately, we don't.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, how come I got 2 sheets for the
[CUSTOMER][NEUTRAL] Uh, insurance company, one that has like the price for the.
[CUSTOMER][NEUTRAL] Oral examination and one that says.
[CUSTOMER][NEUTRAL] $0.
[AGENT][NEUTRAL] So I'm not sure what your how the employer deducting it, but as of in our system, there's nothing being taken. There was not a premium received for that week.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So you may wanna reach out to your benefit coordinator at your employer to verify that information.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think I received 2,
[CUSTOMER][NEUTRAL] Explanation of benefits from the insurance company, one that has.
[CUSTOMER][NEUTRAL] Uh, I guess my patient responsibility as
[CUSTOMER][NEUTRAL] 244 and one that has 0 on it for the same claim, I think.
[AGENT][NEUTRAL] So, um.
[AGENT][NEGATIVE] It shows 0 because we didn't make a payment.
[CUSTOMER][NEUTRAL] Mhm. So you didn't make a payment. OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I get 2 sheets one for your one for the actual that.
[AGENT][NEUTRAL] So 1, so at first, the first claim that you received was 0 means that it was actually pending.
[AGENT][NEUTRAL] And it was waiting on verification of eligibility?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that the one that you're inquiring about?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] It says total bill charges and then the total patient responsibilities because the claim was currently pending. However, once we receive eligibility, we sent out a new EOB.
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] Mm, mhm.
[AGENT][NEUTRAL] And the new EOB shows your responsibility because we didn't make a payment on it.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] So the one with the zero balance was dated [PII], but the most recent, recent ELB was dated.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was, that was after the eligibility was verified and that's why you have a patients uh responsibility well you still have a patient responsibility because we didn't make a payment so.
[CUSTOMER][NEUTRAL] Uh we'll both check dates for on the [PII].
[CUSTOMER][NEUTRAL] On this paper.
[AGENT][NEUTRAL] The check dates, it does say the [PII], but.
[AGENT][NEGATIVE] There's no pay we didn't make a payment because there was no premium received.
[CUSTOMER][NEUTRAL] Uh, uh, OK. Um.
[CUSTOMER][NEUTRAL] Am I currently still
[AGENT][NEUTRAL] Yeah you're active it's just you didn't have a premium at that for that week.
[CUSTOMER][NEUTRAL] Paying the premium?
[AGENT][NEGATIVE] So when you don't make a premium payment then it means that there's no benefits available for that week.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm. OK. Can you tell me which week, like full week that is still on there?
[CUSTOMER][NEUTRAL] That I wasn't active.
[AGENT][NEUTRAL] No, it did, I didn't say that you weren't active. There's a question that you will have to ask your benefit advisor at your employer.
[CUSTOMER][NEUTRAL] Mhm, it's just that.
[AGENT][NEUTRAL] But for the week of [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, that week of [PII], which you receive services.
[AGENT][NEUTRAL] There was no premium paid.
[CUSTOMER][NEUTRAL] Mm. OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let's talk about.
[CUSTOMER][NEUTRAL] Uh I guess so.
[AGENT][NEUTRAL] Alright, I do apologize, but make sure you reach out to your benefit coordinator at your employee to verify that information.
[AGENT][NEUTRAL] To make sure that it is correct.
[CUSTOMER][NEUTRAL] Oh, OK, what's, what's the difference between active and not paying the premium?
[AGENT][NEUTRAL] The difference between active and not active, so your policy is active and then you work it looked like you work for a temp agency or something, so if there's no premium pay taken out, then there's no benefits available for that week.
[CUSTOMER][NEUTRAL] Um, OK, so just take a lot to that.
[AGENT][NEUTRAL] So then active is when a premium payment was made when we receive a premium payment for that week, then that means that you have available.
[AGENT][POSITIVE] Benefits for the week.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][POSITIVE] That's fine, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day. Goodbye.