AccountId: 011433970860
ContactId: 92614940-e658-417d-8809-cd62525cda17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533539 ms
Total Talk Time (AGENT): 208182 ms
Total Talk Time (CUSTOMER): 176299 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/92614940-e658-417d-8809-cd62525cda17_20250115T14:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, how you doing, [PII]?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] I'm doing good, but I'm calling because of, uh, my dental plan restarted over and um I think it covers, it's supposed to cover $500 for my dental, but the dentist, they told me I still gotta come out of pocket 268. I was just trying to see like if my insurance supposed to cover all of that knowing that it's up to $500.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean, from how it's been explained, yes, but let me take a look and see, see what's going on and why they say you still would owe. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Hold on, let me grab it for you real quick. Well, it's.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My policy number is 0255.
[CUSTOMER][NEUTRAL] 025593553
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here, Mr. [PII]. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] and my mailing address is [PII].
[AGENT][NEUTRAL] And then just your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, and thank you so much for verifying your information. So let me see.
[CUSTOMER][NEUTRAL] Because it covered the right side cause I, when I went it covered the right side but they making me they they making me come out of pocket for the left side, so that's a little crazy.
[AGENT][NEUTRAL] I'm wondering if
[AGENT][NEUTRAL] Left side.
[AGENT][NEUTRAL] I mean, you definitely have the calendar year max of $500. Let me see if.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] For [PII] though.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Only thing I can think of, and if you want me to give them a call or you want to call them on the line with me, I can. The representative that they spoke with the other day, I'm maybe they put [PII] instead of [PII]. And so they saw what you used last year, but you have the full 500. What what was the amount they said you had to um come out of pocket?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was 264 if I'm not mistaken.
[AGENT][NEUTRAL] Let me try that. Hold on one second.
[CUSTOMER][NEUTRAL] I got it um, hold on, let me look real quick cause she texted me to uh.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Because that's what she said, she said.
[CUSTOMER][NEUTRAL] Where is that? Uh, hold on. She said, I verified your insurance and she said your portion for [PII] is gonna be 26,480. This will use the entire 500 for this year benefits, but it's not the entire $500. So in my head I was like, huh?
[AGENT][NEUTRAL] That's the only thing I can think of because when I looked for last year, I do see that you have $315 left for last year, but for this year, you have the full $5. If you want to call him, um, I can speak to him.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, I hope.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm mm let me call the number alright.
[CUSTOMER][NEUTRAL] Hello. Did you take Medicare?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, this is [PII].
[AGENT][NEUTRAL] Hey [PII], this is [PII] with um APL. I was helping Mr. [PII], um, he was concerned about his max for the year and I guess work that's being done and what he has out of pocket. He said he didn't have to pay last year.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So I'm just verifying the um calling to verify the benefits um with you all and make sure that
[CUSTOMER][NEUTRAL] Yeah, so the fax back, yeah, the fax that I received on the [PII], which was two days ago, says that the calendar year maximum is $500 with the $50 deductible.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, and then the procedures he is having done, um, is the 4341, um, on two different quadrants.
[AGENT][NEUTRAL] Wait a minute. You said 4341?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] If you just wanna get that insurance ready so you can get.
[AGENT][NEUTRAL] And that's the only call that's being done?
[CUSTOMER][NEUTRAL] Um, at this upcoming appointment this week, yes, ma'am, those are the codes that we're doing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I'll need um all the.
[AGENT][NEUTRAL] And with the, with the 500 max, he still has the out of pocket?
[CUSTOMER][NEUTRAL] Yes ma'am, because those codes are not covered at 100% according to your fax back.
[AGENT][NEUTRAL] Right, OK. I just wanted to um make sure you guys have the correct information.
[CUSTOMER][NEUTRAL] Yes ma'am, I like I said, I got a fax from you guys on the [PII] at [PII].
[AGENT][NEUTRAL] OK. Well, I just wanted to make sure that, uh, Mr. [PII], hold on one moment, OK?
[AGENT][NEUTRAL] And [PII], you can end the line if you like.
[CUSTOMER][NEUTRAL] All right. I, I'll still, I'll still be there tomorrow.
[CUSTOMER][POSITIVE] OK, sounds good thank you. OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] I didn't want Mr. um [PII].
[CUSTOMER][NEUTRAL] Uh-huh, I hear you.
[AGENT][NEUTRAL] Hey, I didn't want to say more on the phone, so I don't know how they're putting it into the system because 4341 on your policy, she said it's not covered at 100%, but from what I'm showing it's not covered. So I'm gonna just let them do what they're doing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Because I don't want it to come back that you have to pay for everything, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I don't know how they're entering it, but if that's what they show on their end and they're using the full 5, then um we'll just have to go ahead and process the claim once it gets here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] I just didn't want to confuse anything more.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I still got to pay the 2604.
[AGENT][NEUTRAL] Yes, that's what it's looking like. I don't know if their prices went up or something, but stick with what they're doing.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That's crazy cause I didn't come out of pocket last time.
[AGENT][NEUTRAL] And I don't know if you're, you have the same.
[CUSTOMER][NEUTRAL] It was the same work and everything and uh.
[AGENT][NEUTRAL] [PII]. So yeah, this is the same policy. I would just let them um go ahead and file the claim with us and let us process it, and I'm hoping that it doesn't come back as not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. Well, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that was it. That was a that was a good little help.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] All right, Happy New Year.
[AGENT][POSITIVE] Thank you. Bye bye.