AccountId: 011433970860
ContactId: 9bce3f90-6f74-4409-a9ad-1a37e9c98828
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438399 ms
Total Talk Time (AGENT): 174933 ms
Total Talk Time (CUSTOMER): 212906 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/9bce3f90-6f74-4409-a9ad-1a37e9c98828_20250102T17:14_UTC.wav
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[AGENT][POSITIVE] Oh what is there is gracias apeleiamaliar.
[CUSTOMER][NEUTRAL] Yes, hi. I'd like to know if you also um help with dental claim.
[AGENT][NEUTRAL] Yes, ma'am. I do um help with dental claims. Do you have a policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I do. That will be 02516774.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is your date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] All right, thank you. And what is your current mailing address?
[CUSTOMER][NEUTRAL] No, thank you.
[CUSTOMER][NEUTRAL] That is [PII], I mean.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. And what is your um email and.
[AGENT][NEUTRAL] Phone number.
[CUSTOMER][NEUTRAL] It, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] I'm, I'm at work, that's uh why, that's why I'm speaking kind of low.
[AGENT][NEUTRAL] That's fine. I understand completely.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Now, is, you are looking for dental coverage?
[CUSTOMER][NEUTRAL] Actually, I just had um a new crown.
[CUSTOMER][NEUTRAL] And uh I think like 1500.
[CUSTOMER][NEUTRAL] And uh I didn't know if I can submit these claims as well and what do I need because I haven't received, uh, I have received but electronic one.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. So with this policy with the APL,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The only type of dental services that would be
[AGENT][NEUTRAL] Covered
[AGENT][NEUTRAL] As, um, if it was resulting due to an accident.
[CUSTOMER][NEUTRAL] Oh, I see. Mm. No, that is not my case, luckily.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, so what you might want to do is to contact your HR department to see if you have.
[AGENT][NEGATIVE] Dental coverage with another company.
[CUSTOMER][NEUTRAL] Oh, that would be wise to do. Yeah, cause I only have uh one insurance for dental.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is Hua.
[AGENT][NEUTRAL] Yeah, that's probably where you would submit the claim. Did you give the general provider your Humana information?
[CUSTOMER][NEUTRAL] I did, yeah, and um they told me that I still needed to pay like 1500, which is high for me.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] That's a lot of money.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A lot of money, yes.
[AGENT][NEUTRAL] Yeah, for me too, I understand.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEGATIVE] Well, I wish we could take care of those dental needs for you, but you just don't have a dental policy with APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And another thing, I also received an invoice from
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wellcare Medical Group.
[CUSTOMER][NEUTRAL] And they say that I owe part of the deductible. They sent me an invoice for $311. I just received it.
[CUSTOMER][NEUTRAL] So, um, should I submit this?
[CUSTOMER][NEUTRAL] To you as well?
[AGENT][POSITIVE] I would definitely
[CUSTOMER][NEUTRAL] To check on coverage.
[AGENT][NEUTRAL] Yeah, I would definitely call them and let them know that you have this secondary gap policy. Now, I can check to see if they sent a claim to us. Do you remember what that date of service is?
[CUSTOMER][NEUTRAL] Um, actually, I have the invoice with me, and it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me see if we have a claim on file for [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, it's my pleasure. Give me just one second. It looks like we do have.
[AGENT][NEUTRAL] A claim for that data service.
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Uh, for an MRI, they say that I pay one part of it, but the deductible was like 600 and something in um
[CUSTOMER][NEUTRAL] I need to cover $311 more.
[CUSTOMER][NEGATIVE] So they're killing me.
[AGENT][NEUTRAL] Yeah, that's a lot.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] I'm just getting this claim pulled up.
[AGENT][NEUTRAL] Was that for Doctor uh [PII]?
[CUSTOMER][NEUTRAL] Um, actually this, as far, as far as I remember.
[CUSTOMER][NEUTRAL] It's from uh Doctor [PII]
[CUSTOMER][NEUTRAL] They're talking about the MRI.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that's, that's the person I saw there, [PII] [PII].
[AGENT][NEUTRAL] So I have a claim for an MRI.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me just get this pulled up. It looks like a [PII]
[CUSTOMER][NEUTRAL] Oh [PII], I don't remember that name. So it might be one of, one of the doctors there.
[AGENT][NEUTRAL] Yeah, probably so.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And that was submitted by you back in November.
[CUSTOMER][POSITIVE] It was, yes, and uh fortunately, you cover $500 that you sent me back.
[AGENT][NEUTRAL] Mhm. And that $500 is the maximum benefit that we can pay for that data service.
[CUSTOMER][NEUTRAL] For the 21.
[AGENT][NEUTRAL] Right, so we did pay that maximum benefit for that data service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I see. OK, so this, I must say, looks like I must pay the 311.
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. So, I really appreciate.
[AGENT][NEUTRAL] I'm so sorry. I wish I could say we could pay it all.
[AGENT][NEUTRAL] Cause I know that's a lot of money.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] But thank you. At least I try and I appreciate the information.
[AGENT][POSITIVE] Absolutely. Well, Miss [PII], it has been such a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that would be it. Thank you so much and you have a um
[CUSTOMER][POSITIVE] A happy New Year.
[AGENT][POSITIVE] You too, Ms. [PII]. Now you call us if we can be of further assistance anytime, OK?
[CUSTOMER][POSITIVE] Yes, thank you so much. Bye-bye.
[AGENT][POSITIVE] And thank you for calling APO. You have a wonderful day and a happy new year to you as well.
[CUSTOMER][POSITIVE] Thank you so much. Bye.
[AGENT][POSITIVE] Thank you bye bye.