AccountId: 011433970860
ContactId: 8412eeb2-20de-4a69-8aaf-2caa0430ef8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 822960 ms
Total Talk Time (AGENT): 456476 ms
Total Talk Time (CUSTOMER): 160516 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/8412eeb2-20de-4a69-8aaf-2caa0430ef8d_20250422T19:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Is about
[CUSTOMER][NEUTRAL] Yes, I wanted to know what my dental insurance covered.
[AGENT][NEUTRAL] OK, I can help you with your dental insurance. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Policy 02582916.
[AGENT][NEUTRAL] 62. OK, hold on one moment.
[AGENT][NEUTRAL] And that was 2582962?
[CUSTOMER][NEUTRAL] No, 2582916.
[AGENT][NEUTRAL] 16. OK, hold on one second.
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, here we go. And I have you here, Ms. [PII]. I just need to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, let me pull up your benefits so I can see what type you have.
[AGENT][NEUTRAL] OK, so you want to just like go over your coverage?
[CUSTOMER][NEUTRAL] Yeah, well, I need to get a root canal.
[AGENT][NEUTRAL] OK, let me see. This is, I'm waiting for the um the schedule of benefits to pop up here. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here it is. So your policy covers preventative, which is like your cleaning, sealants, fillings, uh, well, no, not fillings, uh, and then it also covers radiograph and FMX, that's your imaging, full mouth x-rays, and then it covers basic expenses and basic restorative expenses, so like your fillings, your
[AGENT][NEUTRAL] Um, sealants, things like that, but as far as a root canal, that's considered major and this policy does not cover major services.
[CUSTOMER][NEUTRAL] OK, what about a console?
[AGENT][NEUTRAL] Console, yes, let me see.
[AGENT][NEUTRAL] So for or evaluations or consultations, um, to your, the policy would pay 2 per 12-month period, um.
[AGENT][NEUTRAL] Do you know if you want me to look and see, let me look at this claim here and see if that's been used.
[AGENT][NEUTRAL] So, on this claim from [PII], it used one of the evaluations.
[AGENT][NEUTRAL] Um, but it's, let me see, yeah, so then it wouldn't be eligible for another one until [PII].
[CUSTOMER][NEUTRAL] When did it, I mean, I went to my dentist, but
[CUSTOMER][NEUTRAL] They've known about my root canal since last year, so why would they use another one?
[AGENT][NEGATIVE] Now, I, I can't answer that one now. They'll have you, they'll have to explain why they billed for another one. I, I don't know, I can't answer that one.
[AGENT][NEUTRAL] Because it, it.
[AGENT][NEUTRAL] It would be different if we were charging it, but this is a they've billed it to us, so we're just processing the claim. So I don't know why they.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] You know what I mean, why they sent it, why they did that again. But wait a minute though, because the one from March, they that was paid, so they were able to use it. Oh, you're saying they've known since last year, so why did they use, yeah, we wouldn't be able to.
[AGENT][NEUTRAL] Oh, you could, you could, um.
[AGENT][NEUTRAL] Was the
[AGENT][NEUTRAL] Yeah, they're the only ones that would be able to answer that. I was just thinking while I'm speaking to you. I'm sorry. um.
[AGENT][NEUTRAL] I don't know what made them do another evaluation, maybe because it was a year, like maybe they have a time frame in between that they can use them.
[AGENT][NEUTRAL] But that would just be up to them. That's not.
[CUSTOMER][NEUTRAL] And so you say.
[CUSTOMER][NEUTRAL] Yeah. So it would be um
[CUSTOMER][NEUTRAL] You said I get 2 a year or I only get 1 a year?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2 for 12 months. Um, so 2 a year.
[CUSTOMER][NEUTRAL] So I don't have another one?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] If this is the only claim, then yeah, you do, you have another one for [PII].
[AGENT][NEUTRAL] So I misspoke, my apologies, because I said [PII], but it's too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per 12 months. So, yes, ma'am, you do have another one that you should be able to use, limited to two oral evaluation procedures in any combination for 12 months. Yes.
[CUSTOMER][NEUTRAL] OK, and does it cover anything else? Like I know like it doesn't cover like the whole root canal, but does it cover like caps because there's a root canal and then it's like caps and everything like, does it cover any of that because like they want like $2000. So like, you know, I pay for insurance, so like any help would be, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So is there anything else?
[AGENT][NEUTRAL] Consultation. I'm just going through the benefits trying to see if I can.
[CUSTOMER][NEGATIVE] They can't like
[CUSTOMER][NEUTRAL] I'm right here.
[AGENT][NEUTRAL] Now, there's like a
[AGENT][MIXED] The only thing that's even remotely closed would be like the simple extraction, but everything else on here is, is more so for like fillings and crowns, bridges, caps, all of that is considered major because I guess because you have to get the numbing and all of that.
[CUSTOMER][NEUTRAL] Get this. I don.
[CUSTOMER][NEGATIVE] It's not in the point. I'm not here for an.
[AGENT][NEUTRAL] Um, now you could see if, and I don't know if this is, this is just, I'm just trying to think through it, if you reach out to HR, I don't know how they do with the open enrollment and how, you know, changing or upgrading policies to see maybe if there's something like a plan that does have major.
[AGENT][NEGATIVE] But I don't know how that would even that even that wouldn't work.
[CUSTOMER][NEUTRAL] But see, I thought when
[CUSTOMER][NEUTRAL] I thought when I did all of it, I did the high one of all of it, is what I assumed I did.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Like, is there a better plan?
[AGENT][NEUTRAL] See, so each, so because we're through the employers, each employer can select different plans to offer to their employees. So I, I do know that there is a policy that does cover major now. Major does have a twelve-month waiting period, but there are policies that cover major. I don't know if your job selected those policies though. So,
[AGENT][NEUTRAL] Uh, we could see it, but even then it would be a twelve-month waiting period.
[CUSTOMER][NEGATIVE] And I'm like in a lot of pain.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Hm. Hold on one second.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me look at the employer.
[AGENT][NEUTRAL] I'm just trying to see if there's a way that we can get.
[AGENT][NEUTRAL] Not around it, but around it.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so benefit.
[AGENT][NEUTRAL] And a card.
[AGENT][NEUTRAL] See, cause they do give the option to make make changes to existing plans, upgrade, downgrade.
[AGENT][NEUTRAL] My, so that's a good thing, but then,
[AGENT][NEUTRAL] My concern is
[AGENT][NEUTRAL] The waiting period unless.
[AGENT][NEUTRAL] I wonder if there's a way to like.
[AGENT][NEUTRAL] Backdated to
[AGENT][NEUTRAL] [PII], but that's still [PII].
[AGENT][NEUTRAL] I'm just trying to think, um.
[AGENT][NEUTRAL] The only options honestly would be to see if you can upgrade.
[AGENT][NEUTRAL] I will see if I could upgrade and if I can.
[AGENT][NEUTRAL] If I have to have it like, let's just say if it starts from [PII] on or if I could.
[AGENT][NEUTRAL] Backdated to [PII] when I open.
[AGENT][POSITIVE] I'm saying me because I'm thinking about how to handle it. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's, that's what I would do. I will see if I can upgrade. If I can, I would see if it has to be effective the upcoming month or if now you might have to pay if there's a difference for the higher.
[AGENT][NEUTRAL] But then, um, you know, and see if they can say, hey, this, this is the policy effective [PII], then [PII], you'll be eligible, might have to wait it out a little bit, but maybe that could be an option, but you'll have to check with HR to see how they do their enrollment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But that's what I would do.
[CUSTOMER][NEUTRAL] How do I get to that point?
[AGENT][NEUTRAL] To what? Call them?
[AGENT][NEUTRAL] Like reach them?
[CUSTOMER][NEUTRAL] Yeah, HR. Yeah.
[AGENT][NEUTRAL] Oh, I can either give you their phone number, so, um, I can give you their phone number or I can give you the phone number and transfer you over to a representative, uh, whichever you prefer.
[CUSTOMER][NEUTRAL] You could give me the number and transfer me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so it's 800.
[AGENT][NEUTRAL] 497.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 4856.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][POSITIVE] You're very welcome. I wish I had better news for you, Ms. [PII]. Was there anything else I can help you with before I get you over to benefits in the card?
[CUSTOMER][POSITIVE] Yeah, that's it. Thank you.
[AGENT][NEUTRAL] You're welcome. Thanks for calling APL. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, I hope they can help her.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol precis.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][NEUTRAL] For calling Benefits in the card, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] I'm doing good how about you?
[AGENT][NEUTRAL] I'm sorry. And I'm from APL. I'm sorry, I did it like I was transferring internally. I'm good. How are you doing?
[CUSTOMER][POSITIVE] I'm doing good. How about you?
[AGENT][NEUTRAL] I'm good. Um, I have a member on the other line who wants to see if she can do some upgrading to her dental policy.
[CUSTOMER][NEUTRAL] So you can inform her that there is a higher plan that she can get with the dental plan.
[CUSTOMER][NEUTRAL] But I, I think you can transfer it over as well. But that's pretty much gonna be the answer.
[CUSTOMER][NEUTRAL] They only offer one dental plan.
[AGENT][NEUTRAL] Oh, OK. Um.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm gonna get it to you just because she wants to speak to.
[AGENT][NEUTRAL] Someone else, but moving forward. All right, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] That's fine. You can transfer her over.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][POSITIVE] Thank you so much for holding. I have benefits in the car on the line and they'll be assisting you further, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] How you doing today, ma'am?