AccountId: 011433970860
ContactId: 9dac4ba8-eee1-4a34-90eb-ba9076457c33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377299 ms
Total Talk Time (AGENT): 202001 ms
Total Talk Time (CUSTOMER): 114295 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/9dac4ba8-eee1-4a34-90eb-ba9076457c33_20250325T12:51_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] Yes ma'am. My name is [PII] and I'm, I'm calling about, I'm trying to find out why uh they said it's not a bill, but they haven't paid anything on my teeth being cleaned.
[AGENT][NEUTRAL] OK, you received the explanation of benefits.
[CUSTOMER][NEGATIVE] That's what they say this, but it says it's not a bill, but they didn't pay anything on it. Yeah, but they didn't pay anything on it. All I did was get my teeth cleaned.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I can look into it for you. I just want to make sure I knew what you, what you were looking at so I can look at it with you. And Ms. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have your policy number?
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 59.
[CUSTOMER][NEUTRAL] 241 I think that's what I see.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Do that make sense what I just said.
[AGENT][POSITIVE] Yes, yes, ma'am. It looks correct. I'm about to try it, but it looks like you did it right.
[AGENT][NEUTRAL] Oh, you did. It came right up. OK, Ms. [PII], can you verify your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. My mailing address is [PII].
[AGENT][POSITIVE] Thank you for that. And um your email address, there's an email here too.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII], and all the information provided is a verification of benefits, not a guarantee of payment. Let me look at the claim.
[AGENT][NEUTRAL] And see what happened. Hold on one moment.
[AGENT][NEUTRAL] 4910. Alright, and Ms. [PII], do you mind if I place you on just a brief hold? I'm just gonna look at the claim.
[CUSTOMER][POSITIVE] Yes ma'am, I'm good. I, I can hold.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I thought it was gonna show me what it is, but I knew that this was for medical. So what I'm gonna do is go to PI BFT and see what type of policy you have. And then I'm gonna go to you here who can't handle calls. And I'm gonna go to low.
[AGENT][NEUTRAL] And oh no, 4910 is definitely major. I know that's not on here.
[AGENT][NEUTRAL] OK, so that's what happened because 4910 is not covered. This is not for a cleaning, this is for, oh, unless it's peronal cleaning.
[AGENT][NEGATIVE] That might be what that is, but either way, it's not covered on this policy.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So I did, it looks like I did figure out what happened. So, cleaning like just normal cleanings.
[AGENT][NEUTRAL] Um, are covered on your policy at 100% because it's listed as preventative.
[AGENT][NEUTRAL] The code that
[CUSTOMER][NEUTRAL] That's what I, that, that, that's what I had.
[AGENT][NEUTRAL] The code that um [PII] sent over is 04910, which is
[AGENT][NEUTRAL] It could be a periodontal cleaning. It's not a regular cleaning, it's like a deep cleaning. That's the difference. Your policy doesn't cover major expenses and this code is a major code. See, the code for regular cleaning is like 1110 or 1120. She billed us for 04910, which is a major code and that's why it wasn't paid for.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Cause I, well, put it like this, I get my teeth cleaned every 3 months, but if, if y'all, when, when, when uh the insurance will pay 11 time, then the other times I'll pay. Cause I, I, I go, I go, I go every 3 months. I pay, I pay half of that that bill there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so, uh, may maybe I call her if they, if they do, if they change the code, maybe it'll pay cause all they did, all she did was clean my teeth. They didn't do anything, no X-rays, no nothing. She cleaned my teeth.
[AGENT][NEUTRAL] Yeah, you know what, you, if, if they like, they can give us a call too, but that's what the difference is. If it was a, a regular, like a regular cleaning the ones you get once every 6 months, those are covered at 100%. But this code that they gave that they billed us for is different than just the normal cleaning and that's, that's where that is coming, the difference is coming from.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so they, so they need, they need to put it on a different coat because they didn't do anything but clean my teeth.
[AGENT][POSITIVE] I will ask them um if you, if you're gonna call them back, I will ask them what type of cleaning did I have? Did I have a regular cleaning or was this like a deep cleaning and then have them explain, you know, tell you what it was because that's the difference, but if they have any questions or anything, they can definitely give us a call and we'll be more than happy to explain it and everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you ma'am so much.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That's all, and that and that's twice a year, that's that's twice a year I can get my teeth cleaned, right?
[AGENT][NEUTRAL] Yes, ma'am, for the regular cleanings, it's once every 6 months.
[CUSTOMER][NEUTRAL] For the regular cleaning, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you, ma'am.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that's it. Thank you.
[AGENT][POSITIVE] Alright, well, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.