AccountId: 011433970860
ContactId: c0c2a6bd-9bd0-4ff6-9966-c49704775887
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1219719 ms
Total Talk Time (AGENT): 595898 ms
Total Talk Time (CUSTOMER): 389228 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/c0c2a6bd-9bd0-4ff6-9966-c49704775887_20250228T19:47_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, you say your name is what now?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] So, it's [PII], so, hey, so this is uh [PII]'s home and and um.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] I'm calling uh on behalf of a bill that that you guys not pay uh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me see, uh, well, to make sure I get y'all the right information. oh.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] May I have a callback number, Mr. [PII] just in case we get disconnected?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And whenever you're ready, I need the policy number, OK.
[CUSTOMER][NEUTRAL] Well the number it's gonna be the VIN number it's gonna be uh 022.
[CUSTOMER][NEUTRAL] 16153.
[AGENT][NEUTRAL] OK. May I have your date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And I need the mailing address and email address on file for verification.
[CUSTOMER][NEUTRAL] Uh, mailing address is [PII].
[CUSTOMER][NEUTRAL] My email is uh [PII].
[AGENT][NEUTRAL] And this is for your medical claims?
[CUSTOMER][NEUTRAL] Well, no, this, yeah, well, it's for my dental, um, my girls.
[AGENT][NEUTRAL] Dental? OK.
[CUSTOMER][NEUTRAL] Yeah, my, my, my wife just told me about it. She took the girls to get the teeth cleaned and, and, uh, there, there's a bill left there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like $300 something dollars I need to find out why, why is that.
[AGENT][NEUTRAL] OK, what is the, do you know what's the date of service, what day they went in for the cleaning?
[CUSTOMER][NEUTRAL] Uh, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I'm your phone please so you can because I don't.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Do you know the day that they clean it? Cause I'm looking now.
[CUSTOMER][NEUTRAL] Just hold tight for us so if you don't mind while we try to find it.
[AGENT][POSITIVE] Sure, no problem. It's OK. Take your time.
[CUSTOMER][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] It was on the [PII].
[CUSTOMER][POSITIVE] The [PII], he really, really good.
[CUSTOMER][NEUTRAL] The [PII] or what?
[CUSTOMER][NEUTRAL] It was
[AGENT][NEUTRAL] [PII] of this year.
[CUSTOMER][NEUTRAL] [PII] so.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was it this year?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, it was this year, uh huh. OK.
[AGENT][NEUTRAL] OK, um, let me check and see if it's the claim we just received. One moment.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What kind of
[AGENT][NEUTRAL] Yeah, we just received that claim on the [PII], so it is in line to be processed. It has not been processed yet. It was recently received.
[AGENT][NEUTRAL] That's one for [PII] and one for
[AGENT][NEUTRAL] The Ivoriano.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Alright, I'm sorry about that, y'all.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] So right now they're in line to be processed, so they should be processed usually within 7 to 10 business days, but it was received on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So are you seeing that bill for $300 some dollars?
[AGENT][NEUTRAL] Um, there is one for $215 and this one is for Ivoriana, and then let me pull the one for um in [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment, let me pull this.
[CUSTOMER][NEUTRAL] So they have another appointment on on [PII] cause she has cavities. I'm trying to make sure they gonna pay for it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the one for [PII] is for 198.
[CUSTOMER][NEUTRAL] OK, will they be getting paid?
[AGENT][NEUTRAL] We cannot guarantee any payments until we process the claim. The claim is in line to be processed. It takes 7 to 10 business days for it to be processed and for us to send the check out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7 to 10 in a day.
[AGENT][NEUTRAL] Mhm. Yes, and it was recently received on the [PII].
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So you know it it it you say you guys received it on the [PII].
[AGENT][NEUTRAL] Yes, we received the claim on the [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I know, but when, when, when, uh, when is their, uh, appointment [PII], yeah, [PII], she said, yeah, she said that that they couldn't see them until the balance was paid.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] And I told them that they had insurance, you know.
[CUSTOMER][NEUTRAL] Well she said didn't pay for it from from the previous time they went and got a cleaning.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Which was 6 months ago.
[AGENT][NEUTRAL] 6 months ago. So it's not for the [PII]?
[CUSTOMER][NEUTRAL] Le
[CUSTOMER][NEUTRAL] So yeah, that what we just asked you. We asked you was it [PII]. You said yeah this year. Yeah, it's so that would be the previous, uh, she said, she said it was a bill for for $300 something dollars.
[CUSTOMER][NEUTRAL] From the previous, yeah, yeah, but that's the last time they went was 6 months ago for a cleaning, yeah.
[CUSTOMER][NEUTRAL] OK, so do you see a bill on there for 6 months ago, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the claim.
[CUSTOMER][NEUTRAL] So they go every 6 months.
[AGENT][NEUTRAL] Yeah, let me pull the only other claim I've got here, which is the one for [PII]. I don't know if that's the one that um she's um mentioning um because we did send payment on that one, but there is uh a few items that were not covered. So let me pull this one.
[CUSTOMER][NEUTRAL] Close the door. OK, I will.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I wish you me your phone because I, I, I need to listen to what she's saying. OK, I'm gonna, I'm gonna mood.
[CUSTOMER][NEUTRAL] OK, so what you say, uh, what was the cover now?
[AGENT][NEUTRAL] OK, I'm pulling the information of that claim because there were some items that were not paid and there were some that were paid. OK, so, um, let's see. So I pulled the one for Indiana first um for [PII].
[AGENT][NEUTRAL] There was a claim for $383 and we paid $245.
[AGENT][NEUTRAL] The, the reason for that payment of $245 is because there is a $50 deductible.
[AGENT][NEUTRAL] And there is one code that was not paid and let me go ahead and pull that one and see why.
[AGENT][NEUTRAL] OK. So the code they used for the fluoride is not a cover code. So, um, that one was not covered. And based on this information, it looks like that was $55.
[AGENT][NEGATIVE] So $55 yes, and $50 was not covered. Mhm.
[CUSTOMER][NEUTRAL] For the fluoride?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and.
[CUSTOMER][NEUTRAL] OK, but, but she said that that that's a bill of $300 something dollars, so it, it's.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if it's combined because more than likely it's gonna be a combined probably between the two girls, um, because that's the amount that I see on uh [PII]. So let me just calculate this really quick. Um 383 be paid um.
[CUSTOMER][NEUTRAL] But that won't be the floor right. It's gonna be so.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] 8245. So the remaining 138 for that and let me look at um.
[AGENT][NEUTRAL] Your other daughter's uh claim, OK?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let see.
[AGENT][NEUTRAL] OK, so for [PII], the claim was for 193 and we paid, let's see.
[AGENT][NEUTRAL] We pay 59. Let me see why we only pay 59.
[AGENT][NEUTRAL] OK, so the fluoride at the end they, they're coating the fluoride, but that code is not covered under the members on the plan. So that's the reason that one is not being covered, um, and then uh it looks like, let's see which one is this one.
[AGENT][NEUTRAL] The pro fee they charge for is for a minor less than [PII] of age. Let me see if, how old is she?
[AGENT][NEUTRAL] Oh, she is [PII], yeah. The codeine they use for the cleaning is for a child less than [PII].
[AGENT][NEUTRAL] And that's why that one was tonight as well.
[AGENT][NEUTRAL] So they probably just need to review his information and see what they can do about sending probably the claim back to us or something like that, but the two denials are because one of them is just not listed, is not covered under our plan, which is the fluoride.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] And then the pro fee that they charge for Ivorian, that is for a minor.
[AGENT][NEUTRAL] So in between both of them, um, I see that there is a difference of 200, um, let's see, let me add this together.
[AGENT][NEGATIVE] $270 was not paid.
[AGENT][NEUTRAL] Between the two of them.
[CUSTOMER][NEUTRAL] Why not?
[AGENT][NEUTRAL] OK. Again, um, because of the fluoride and because of the uh prophy, the cleaning that they um charge as a minor on Evoriana.
[CUSTOMER][NEUTRAL] OK, I run is a amount.
[CUSTOMER][NEUTRAL] She was a child.
[AGENT][NEUTRAL] 14 years, uh, 14 years and up is considered a regular prophy.
[CUSTOMER][NEUTRAL] 14 years.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] So, hold on, hold on now.
[CUSTOMER][NEUTRAL] A [PII] child is considered what an athlete?
[CUSTOMER][NEUTRAL] I is that what you're saying?
[AGENT][NEUTRAL] It's, it's pay under, is under the regular pro ee.
[AGENT][NEUTRAL] It's not pay under a minor trial. minor child is less than [PII] of age.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEGATIVE] I wish I would have told me all that before I got all the insurance and pay y'all all that money, man, cause y'all got, you know, hoops and losing for people to jump through. I mean, I thought my girls were covered for that, you know, the dental, dental stuff, man, you know.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] They are covered, but the coding that they're using is, is, it seems to be not accurate based on the age. Um, so what they need to do, the best thing is for you to tell the, the provider of service, the Children's Dental Center, to give us a call. They receive a, a explanation of benefits from us indicating why we did not pay that. So I'm not sure if they just charged um the wrong things or what happened.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] But um based on the information they send in, that is the denial.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, so, so, so help me understand that. OK, I, I rather.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is my [PII] daughter and [PII] is my [PII] daughter. So [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] She, she, she can't get a cleaning, but she can't get a teeth cleaning on the insurance that, that I have.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] She can, she can get a cleaning, yes. It's just that they need to charge for a regular pro uh it goes by codes. It's kind of hard to understand because it's medical, it's a medical field. So, um, they go by codes and there's a code for regular cleaning, regular just regular for anybody cleaning, and there is um a cleaning for minor child, so for a kid. And um so based on her age.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] She would have been under the regular cleaning.
[AGENT][NEUTRAL] Instead of the minor child. So I'm not sure if they just charged the wrong code or what happened. I, I, I cannot tell because they all have their own rules and regulations. I'm not sure what are the rules and regulations in the place that she was seen.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but, um, if they call us, um, we can probably go over this, but they did receive the explanation of benefits and in the back of that explanation of benefits it said on them know exactly why we didn't pay. It is the same reason that I'm giving you. The, the code for the prophy is for a child that is less than [PII] of age.
[AGENT][NEUTRAL] And then, um, again, the floor is mhm.
[CUSTOMER][NEUTRAL] So, OK, so.
[CUSTOMER][NEUTRAL] I'm sorry, so, so the dentist's office.
[CUSTOMER][NEUTRAL] Charged as she was [PII] or or or less of age, is that what you're saying?
[AGENT][NEUTRAL] Less, [PII] than 14. Less than 14. Mhm, yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, they, OK, they, they, they said that she would list for. OK, so you, so they gotta go in there and corrected that she just get a regular, regular cleaning for kids [PII] and up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I cannot tell him to correct it, um, because we cannot tell them what to do. Now, uh, the thing is that um if they
[CUSTOMER][NEUTRAL] No, no, no, no, I'm talking about her mother. No, I'm talking about.
[AGENT][NEUTRAL] So, uh yeah, I.
[CUSTOMER][NEUTRAL] No, I'm talking about her mother when she take them back.
[AGENT][NEUTRAL] Yeah, I really, I cannot tell you what to tell to them, um, but I can only, again, I can only tell you what's on the paperwork and that is what's in the paperwork. It's saying that this fee is not that.
[CUSTOMER][NEUTRAL] No, I'm asking you. No, no, so I'm asking you, so if, when, when they go back to the dentist and they go in there for a cleaning, when since [PII] is [PII], when she'll be [PII] next month. So, when, when she go in there and get a cleaning.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, would you guys cover that?
[CUSTOMER][NEUTRAL] It's what I'm asking
[AGENT][NEUTRAL] Yeah, if it's under a regular profi.
[CUSTOMER][NEUTRAL] The the regular cleaning OK.
[AGENT][NEUTRAL] Which is gonna be, uh, yeah, regular cleaning. Mhm. Yes, so, yeah, when she goes in, she can let them know, hey, uh, the last time he was charged as a minor and he got, did not get paid, um, so is there another way that um she can get a cleaning without having to, you know, run as a minor because it's not gonna get paid. It was denied the last time and it might get denied again if you charge as a minor. Mhm.
[CUSTOMER][NEUTRAL] It's not gonna be
[CUSTOMER][NEUTRAL] Yeah, because y'all looking at her age before y'all pay, correct?
[AGENT][NEUTRAL] Mhm, correct, yes, there's age limitations in some of them and if they have any questions about how the benefit works, what's the limitations, what's the breakdown of the coding that we do pay and we don't pay, we can always send that to them and you should have a also a copy on the paperwork we send in with the cards and all that information is in there.
[CUSTOMER][NEUTRAL] Oh, that's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so I'll just have her mother just let them know.
[CUSTOMER][NEGATIVE] When, when, when they go to this, so, so, oh OK, OK, this, this, this problem, this old bill since it wasn't paid.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if they go in there and correct it, will it be paid in by you guys or or not?
[AGENT][NEUTRAL] If there's any corrections and in the corrections we see that um it's something that needs to be paid, we'll go ahead and reprocess.
[CUSTOMER][NEUTRAL] This is the whole class.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then, OK. Uh. What about, uh, they have an appointment on [PII] for um.
[CUSTOMER][NEUTRAL] To get their cavities fixed when they get paid?
[AGENT][NEUTRAL] Yeah, for the cavities that is uh basic basic and restorative charges which is paid at 80% under the plan, um, so we cannot guarantee any payments over the phone, but that is a cover service. um, and again if they have any questions or if you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Have any questions if it's a cover service or not based on the coding, you can always ask them for the code and and call back with the code or have them to call us and get a full breakdown of the coding. We can send a full page of all the codes that we cover and how much we cover like what percentages for each one of them.
[AGENT][NEUTRAL] So they go by that and they charge the correct ones if you need to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, well, um.
[CUSTOMER][NEUTRAL] That's the route that we'll go then we'll, we'll, uh, have them to call you guys and get all this stuff right now so so we had to run to their problem in the first.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because I, I, I pay pretty good money, you know, but the issue implies for them girls, for my girls to get, uh, you know, be able to get seen and stuff get paid for, so, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] That's why that that was my reason to call today.
[AGENT][NEUTRAL] OK, but yes, um, the, the, the fillings, um, those are covered 80%, so we will cover the 80% of um depending on, yeah, on the coding that they send in, OK.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] 80% OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and, and, and how many, uh, how much percent of the of the cleaning do you guys go without fluoride?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, the, the cleaning is usually the regular cleaning is 100% paid.
[CUSTOMER][NEUTRAL] 100% pay, OK, OK, alright, OK, alright, so.
[AGENT][NEUTRAL] Mhm, yeah. It's, it's the correct one. OK.
[CUSTOMER][NEUTRAL] So, so Ionic gonna have to get a regular cleaning and not and not the, the amount of cleaning.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right, right, that's right, OK.
[AGENT][NEUTRAL] Mhm. Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright then, that's that's what I need to know, huh, thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too. You too.
[AGENT][POSITIVE] Thank you. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Alright, so, so you gotta get a regular clean.