AccountId: 011433970860
ContactId: beb4f4f8-e0e7-4f30-be0f-47c342ea41c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686710 ms
Total Talk Time (AGENT): 262814 ms
Total Talk Time (CUSTOMER): 265183 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/beb4f4f8-e0e7-4f30-be0f-47c342ea41c0_20250326T13:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII], and I have a couple questions about my policy.
[AGENT][NEUTRAL] OK, and what is your policy number?
[CUSTOMER][NEUTRAL] 0161.
[CUSTOMER][NEUTRAL] 5679.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] 615-679. Is that correct, please?
[CUSTOMER][NEUTRAL] Uh, uh, 5679, I think, yeah, I think you said it was right. I, I I wasn't pay attention to you.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 615679.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have your name, please, and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, I don't have you under this policy number, so let me see if I can find you by your name.
[AGENT][NEUTRAL] You said [PII], is that right, sir? [PII]? OK, thank you. One moment.
[CUSTOMER][POSITIVE] Correct. Yup.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Because I got a group number too on the card here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That means anything.
[CUSTOMER][NEUTRAL] The group number is 13611.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 361
[AGENT][NEUTRAL] What state do you reside in, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] OK, and may I please have your call back number if we were disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I believe I have your policy here. Thank you for providing that uh group number and verify your complete mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the last thing will be your email address please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, thank you very much for the information. I have your policy pulled up and let's see here, 61569. I'm just trying to see what was missing here 615. OK, so it's the 15 of the 6, so it's 1615679. OK, alright, thank you. I have your policy pulled up, sir, and how can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I got some questions.
[CUSTOMER][NEUTRAL] One, I need to, I guess my first question should be I need to get a root canal and I wanna see if there's, uh, the people they referred me to is in my.
[CUSTOMER][NEUTRAL] We call in network or in my network or whatever you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now your policy does not have a network, a preferred provider network. It pays by usual customer and reasonable rates. Again, there is no network. There's no network.
[CUSTOMER][NEUTRAL] OK, so I, anybody they, they, uh, refer me to will be covered.
[AGENT][NEUTRAL] Yes, sorry, it should be covered, yes. Now, the root canal, of course, I can't tell you that it's covered without a procedure code, but there's no network that you have, there's no network of dentists that you have to see. There's not a network.
[CUSTOMER][NEUTRAL] Oh, OK. That, that, that brings up uh uh alarm another question. I had, uh, 3 people, I believe it was like 2 years ago.
[CUSTOMER][NEGATIVE] And they, I had to pay like more of it because they said I wasn't.
[CUSTOMER][NEUTRAL] Completely covered, like,
[CUSTOMER][NEUTRAL] Like, like I was out of network because the way I'm breathing they were saying.
[AGENT][NEUTRAL] You had a what what done?
[CUSTOMER][NEUTRAL] But that was at a
[CUSTOMER][NEUTRAL] I had uh 33 teeth removed about 2 years ago, surgically removed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From [PII].
[CUSTOMER][NEUTRAL] I think it's on my surgery, on my dental.
[AGENT][NEUTRAL] 2 years ago.
[AGENT][NEUTRAL] OK, so it shows that we did pay on oral surgery that was for [PII]. We paid on that $392.40 is what we paid on it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I, I think I end up paying like $700 of that of of.
[AGENT][NEUTRAL] Now your your policy pays by percentages uh for oral surgery that is considered major and we pay 40% of the UCR so but we did make a payment on that particular claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. That, that, that, I guess that's why I was thinking I was out of, uh, like, you know, like you say, you know, I know there ain't no network, but I, you know, I was lead to believe I was out of network on that, I guess.
[AGENT][NEUTRAL] No sir.
[CUSTOMER][NEUTRAL] Oh, so I, I need a root canal done, uh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] How much does that cover? How, how much does my policy cover on that?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] It will cover and that also falls under major, that will be covered at 40%.
[CUSTOMER][NEUTRAL] That'd be at 40%.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] So things like root canals, crowns, bridges, dentures, um, partials, those fall under, and oral surgery, those fall under major services.
[CUSTOMER][NEUTRAL] I, I.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I see that. Alright, but now I, I gotta get back to my second part of uh.
[CUSTOMER][NEUTRAL] My uh
[CUSTOMER][NEUTRAL] My, uh, I guess, my ex-wife, she went to the emergency dental.
[CUSTOMER][NEUTRAL] On, uh, I think it was the [PII] if I remember [PII].
[CUSTOMER][NEUTRAL] I, I've talked to you guys before. I got, I got these papers. I, I, do I email them in?
[CUSTOMER][NEGATIVE] I had to pay
[CUSTOMER][NEUTRAL] Uh, $90 and $700 for them to.
[CUSTOMER][NEUTRAL] Do whatever they did like a filling or something, but.
[CUSTOMER][NEUTRAL] But they, this is like none of it's, uh, claimed on their insurance and I was trying to turn it into you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you
[AGENT][NEUTRAL] OK, so you need to file a claim. OK, so in order to file a claim, what you can do is you can't email it to us, but you can fax it to us or mail it to us or you can create an account on the online service center and upload the information.
[CUSTOMER][NEUTRAL] Oh I can create the account on that uh.
[AGENT][NEUTRAL] At the
[CUSTOMER][POSITIVE] It says right here
[CUSTOMER][NEUTRAL] Uh, I'm, I'm, I'm not seeing that at the moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I uh go to the [PII] and do a claim.
[AGENT][NEUTRAL] Yes sir, you have to first create an account on our secure website.
[AGENT][NEUTRAL] So that is
[CUSTOMER][NEUTRAL] Yeah, I, I think I did that.
[AGENT][NEUTRAL] OK, so you think you've done that.
[CUSTOMER][NEUTRAL] I got a I got a note there it says get an ADA claim form.
[AGENT][NEUTRAL] Yes, you need a
[AGENT][NEUTRAL] Or you can just submit the receipt that has the ADA codes on it along with the charges.
[CUSTOMER][NEUTRAL] OK, I, I got attending. Oh, OK, that's the attending doctor's statement, right?
[AGENT][NEUTRAL] Yes, the attendant, uh, yes, sir dentist's statement, yes, sir, and it should have codes on there as well.
[AGENT][NEUTRAL] It may start with a D like David or.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] And then maybe like 012. OK.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, yeah, let's go here, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see that now.
[AGENT][NEUTRAL] So what you can do with that is you can write your policy number on there which is 1615679 and then you can upload that information on to the website after you create an account or you can fax it to us.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK, uh, I might just fax it to you guys.
[AGENT][NEUTRAL] OK, I can give you a fax number.
[CUSTOMER][NEGATIVE] I'm not good at doing all the other stuff.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I was trying to see if I had it on this one deal, just one paper, but I guess not.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][POSITIVE] fax number if I can get that off you real quick.
[AGENT][NEUTRAL] Of course, it is 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] 943 damn it I'm sorry 9432.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEGATIVE] To be sorry.
[AGENT][POSITIVE] Uh, no problem.
[CUSTOMER][NEUTRAL] I knew I was having a dyslexic moment.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] So I'm gonna make sure just so I didn't have a complete dyslexic moment [PII].
[AGENT][POSITIVE] Yes sir that is correct, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I, I got the, like the 22 little receipts that I got that day from my pay. Then I got the ADA. Do I need to put that, those two little receipts with the ADA or the ADA will show all that?
[AGENT][NEUTRAL] Well, the ADA will show the procedure that she had done along with the charges, and then from that, the claim will be processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Uh, I appreciate your help. I will get this done.
[AGENT][POSITIVE] OK, you are so welcome, Mr. [PII]. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, yeah, just on the piece of paper I put you said put the policy number.
[AGENT][POSITIVE] Yes, sir, please, please do.
[AGENT][NEUTRAL] And just to make sure that
[CUSTOMER][NEUTRAL] And it's just
[CUSTOMER][NEUTRAL] Oh go ahead.
[AGENT][NEUTRAL] OK, and just to make sure the policy number is 1615679.
[CUSTOMER][NEUTRAL] OK, uh, on my little card here is I have a 0, then I got 0 then 161. Do I need to add a 0 at the beginning or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir, you can add the 0. OK, I just wanna make sure you have that card. And what is your wife's name? Just wanna make sure she's on the policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes, yes, so she is OK, she shows on the policy, OK.
[CUSTOMER][POSITIVE] Alright, I appreciate it.
[AGENT][POSITIVE] You are so welcome, Mr. [PII], and thank you for calling APL. You have a good day, sir.
[CUSTOMER][NEUTRAL] Alright you too.
[AGENT][POSITIVE] Yes sir thank you take care bye bye.
[CUSTOMER][NEUTRAL] OK