AccountId: 011433970860
ContactId: be75a703-33ea-4d20-956b-23ae422f124e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356959 ms
Total Talk Time (AGENT): 177169 ms
Total Talk Time (CUSTOMER): 160033 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/be75a703-33ea-4d20-956b-23ae422f124e_20250505T22:29_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] and Broker Resources. How are you?
[AGENT][POSITIVE] Hey, I'm good, Miss [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] I'm well. I have um a clearance Delt on the line. He just recently went in for a cleaning for his dental services, and they're not paying, and he's wondering why. I do have a policy number and I have verified him.
[AGENT][NEUTRAL] OK, what's his policy number please? Yes ma'am, I'm ready.
[CUSTOMER][NEUTRAL] If you're ready.
[CUSTOMER][NEUTRAL] It's 00 yeah, 00614283.
[AGENT][NEUTRAL] OK, let me look that up real quick so I'm ready when he gets on the phone.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I've got Clarence pulled up and he said he went in for a dental cleaning, but our insurance, his insurance didn't pay for it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what he's saying. Do you want a callback number just in case?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, you can go ahead and put him through Morgan and I'll um check his claim status and his benefits for him.
[CUSTOMER][POSITIVE] Thanks, [PII]. I appreciate you.
[AGENT][POSITIVE] No problem at all. You have a good night.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] All right, bye bye Miss [PII].
[CUSTOMER][NEUTRAL] Hey [PII], I have [PII] on the phone for you. She's in our claims department for dental, and she'll take it from here, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Thank you. Have a great night.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Hi, [PII], this is [PII] in the care team. Hello, sir. So I understand that you had a client. I'm doing well. How are you doing today, sir?
[CUSTOMER][NEUTRAL] Hello, yes ma'am.
[CUSTOMER][NEUTRAL] How you doing?
[CUSTOMER][POSITIVE] I'm pretty good, pretty good.
[AGENT][POSITIVE] Awesome, awesome.
[AGENT][NEUTRAL] Um, so I understand you had a claim that was sent in and the claim was denied. Is, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, OK, let me look at it, um.
[CUSTOMER][NEUTRAL] Now this the the.
[AGENT][NEUTRAL] Yes, sir, go ahead.
[CUSTOMER][NEUTRAL] The reason I was asking because this is the first cleaner I've had this year.
[CUSTOMER][NEGATIVE] And you don't deny it. I'm paying 1818 something a month, you know, and, uh, and denied, you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir I understand.
[AGENT][NEUTRAL] OK, let me see um.
[CUSTOMER][NEUTRAL] At least pay something on it.
[AGENT][NEUTRAL] It just says uh and and the date of service that you went to, sir, do you remember what day it was that you went?
[CUSTOMER][NEUTRAL] I got the paper in front of me. It's uh [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, 48.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Let me look real quick, sir.
[AGENT][NEUTRAL] OK, there are 2 claims sent in that day.
[AGENT][NEUTRAL] One of them was was paid, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then let me see the other, the procedure code for the one that wasn't paid, let me look that and it just states.
[CUSTOMER][NEUTRAL] So you did pay one of them?
[AGENT][NEUTRAL] Yeah, yes sir, one of them was paid and on this one it has a remark on it that um it wasn't paid because the policy does not provide benefits for any procedure or service not listed on the scheduled of covered dental services, so it wasn't covered under your plan for that one code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was not paid and I can give you the code too if you would like like that.
[CUSTOMER][NEUTRAL] No, no, that's fine. I, I just wanna make sure, see, I didn't know if you paid the other, you know, I, I, I, I figure you pay $50 for cleaning, don't just something like that.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yes, sir. I can tell you, I can tell you how much the um.
[AGENT][NEUTRAL] Claim was paid.
[CUSTOMER][NEUTRAL] Well, just, just, just as long as I know you paid someone that's all.
[AGENT][NEUTRAL] $57.
[AGENT][NEUTRAL] Yes, sir, we did. It was just that one procedure code that wasn't covered under your policy that wasn't paid.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That, that's, that's, that sounds good. I'm, I'm, I'm satisfied. I'm not mad.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. I understand. OK, well, Mr. [PII], can I help you with anything else today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I guess I got another insurance. I'm now what she told me is when I filed it with my other insurance that that y'all are the primary. I tried to get it changed, but she said no, y'all are the primary and then the other will pick up what y'all don't pick up, but I had to file it with y'all first and then if y'all don't, you don't whatever left on the bill, they'll pay it, whatever, you know, so, OK, I'm good.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] I understand. Yes, sir. OK. Well, I'm glad I was able to help you and clear it up for you, sir.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Alright, cause look, look here, I thought y'all was closed. I said oh Lord, I gotta worry about this all night long. I said, I'm gonna call anyway. So y'all not open, what time y'all close?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] We're gonna close here in
[CUSTOMER][NEUTRAL] You're in [PII].
[AGENT][NEUTRAL] Um, we're gonna close here in about 25 minutes.
[AGENT][NEUTRAL] We close at [PII] central time.
[CUSTOMER][NEUTRAL] Oh, OK, last time it just right.
[AGENT][NEUTRAL] Yes, you did.
[CUSTOMER][NEUTRAL] OK, OK, all right.
[CUSTOMER][POSITIVE] All right, thank you, ma'am.
[AGENT][POSITIVE] Well, you're welcome, Mr. [PII]. I hope you have a good rest of your night, and we thank you for calling APL, sir.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Well, you too, man.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye, sir.