AccountId: 011433970860
ContactId: 71339799-a407-4865-b4e8-a06ae4ae9db0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419190 ms
Total Talk Time (AGENT): 219394 ms
Total Talk Time (CUSTOMER): 127070 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/71339799-a407-4865-b4e8-a06ae4ae9db0_20250604T15:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey how you doing?
[AGENT][POSITIVE] Hi, how can I help you today?
[CUSTOMER][NEUTRAL] Yes, I was calling, um, I have a question about my, uh, I guess my policy. I went to go get a dental cleaning, um, Monday, and essentially they said that nothing was covered or that there it's their first time dealing with y'all and they just have some questions about how do we go about paying for the dental cleanings and whatnot.
[AGENT][NEUTRAL] OK, um, first, can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Callback number is gonna be [PII].
[AGENT][NEUTRAL] OK, and what's your policy number?
[CUSTOMER][NEUTRAL] Um, is that gonna be the payer ID?
[AGENT][NEUTRAL] No, it might say policy certificate number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yes ma'am, I see it. It's gonna be 026.
[AGENT][POSITIVE] Good, OK.
[CUSTOMER][NEUTRAL] 087
[CUSTOMER][NEUTRAL] 07.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], can I get you to verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the mailing address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And they were wanting to know.
[AGENT][NEUTRAL] Um, what exactly were they wanting to know?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Um, so they, I guess when they looked it up, they were trying to figure out like how would stuff go about being paid for because um she said the only thing that she could see that you guys or that was covered by my insurance was um.
[CUSTOMER][NEUTRAL] I think she said like a uh.
[CUSTOMER][NEUTRAL] Some pictures or like an X-ray or something, but she said that this says the dental cover, I mean, the cleaning and other things were not listed as being covered, so she was trying to see maybe it's like, how does it work? Do they, I mean, I pay upfront then they pay me back or vice versa and I just told I honestly didn't know. It's my first time using the insurance.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, um, no, we pay off of UCR which they someone in their billing department should know that. Let me see, uh, just real quick or should know more about that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it does look like we sent them a list of um what's covered under your policy. Cleanings are covered.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Um, but let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and have you set up an online portal account yet?
[CUSTOMER][NEUTRAL] For um APL.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] No ma'am, I have not.
[AGENT][NEUTRAL] OK, um, so what might help?
[AGENT][NEUTRAL] Um, because we sent them a list of everything that is covered and this is um more for your benefit as well. If you log into [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And uh click create OSC account.
[CUSTOMER][NEUTRAL] And I could.
[AGENT][NEUTRAL] You'll be able to view your policy and everything that's um.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] That's covered. You don't have a waiting period for anything. You said you did a cleaning. You're allotted a cleaning once every 6 months with a 0 month waiting period.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, I will say when you sign up for the online portal account you'll need to use the information that we have on file. Um, can I get you to verify the address, the, I'm sorry, the email address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so when creating an account you'll want to use that email and from there after you um create an account, you'll be able to view your documents and it'll you'll see the same thing that we sent to your dental provider um that shows that you get a cleaning once every 6 months exam uh.
[AGENT][NEUTRAL] You get 2 exams uh in a 12, in a 12 month period. Um, you are allotted X-rays once every 5 years, and since you just got this, um, you should be able to be seen for all of those, um, because you do have basic expenses, major expenses, um, and oral surgery expenses, but we go based off of UCR and um.
[CUSTOMER][NEUTRAL] You should
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] If if they have questions on that they can call us back. I do see that they called us a few days ago um and we provided this um fax back to them and the fax back is just everything that we have covered and what we pay and so if they have questions on that they can call us but this way you'll be able to see what you get to.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, you are a lot of the cleaning.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I guess I relay that information I'm currently um making that.
[CUSTOMER][NEUTRAL] Email, I mean that uh portal you were just telling me about.
[AGENT][NEUTRAL] OK, and if they decide that they don't want to file the claim, you are allowed to file the claim on your behalf, um, and again, you can do that through that online portal account, um, if you'd like.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It will show in your policy document where you can submit a claim to um so if they won't do it on your behalf you are allowed to do it on your behalf as well.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] don't
[CUSTOMER][NEUTRAL] OK, yeah, that's, uh, that works out then cause that's literally they kind of turned me away, so I kind of wasted the day off work to get my teeth cleaned just for it not to happen, so I just wanna kinda get that resolved.
[AGENT][NEUTRAL] Yeah, if they have any other questions because UCR is is.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] More complex than I think um.
[AGENT][NEUTRAL] It can be and so if they have any questions on that they can call us, um, but no, you are allowed a cleaning once every 6 months.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, ma'am. I think that'll be it.
[AGENT][POSITIVE] Alright well thank you for calling APL um and I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Bye.