AccountId: 011433970860
ContactId: c5a9433e-3c99-409c-8d62-2cbac09fca45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 879479 ms
Total Talk Time (AGENT): 200589 ms
Total Talk Time (CUSTOMER): 212114 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/c5a9433e-3c99-409c-8d62-2cbac09fca45_20250505T17:39_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I need to talk to uh somebody in the department where they delivered the check.
[CUSTOMER][NEUTRAL] Oh, I had 2 checks sent to me.
[CUSTOMER][NEUTRAL] And then somebody called me and they told me, they said, I'm sending a text to you and not to the dentist's office. And then
[CUSTOMER][NEGATIVE] They turn around and uh stop payment on them.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Let me pull up your policy and then I can look more into it and definitely get someone if we need to. May I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] OK, uh 00604575.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I have you here, and I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I do see the checks here. Do you mind if I place you on just a brief hold so I can look into, into all this for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute now, let me see.
[AGENT][NEUTRAL] 358
[AGENT][NEUTRAL] The 358-5712.
[AGENT][NEUTRAL] 8305.
[AGENT][NEUTRAL] Oh sure, uh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Right, so we didn't wait, wait, wait, wait, wait, wait, wait, wait.
[AGENT][NEUTRAL] Provider version to will be ensure her remaining balance, not a PO.
[AGENT][NEUTRAL] It's just two different claims, OK, so.
[AGENT][NEUTRAL] No, it's not, it's the same.
[AGENT][NEUTRAL] We pay the provider.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] We said two different amounts.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I'm gonna go ahead and get a claims examiner on the line for you, OK? I'm on the other line, hold on.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Before I do that, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][NEUTRAL] Alright, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] Good how are you babe?
[AGENT][NEUTRAL] I'm doing good. Um, OK. Can you, uh, well, I have somebody that wants to talk to you. Um, this policy number 604575?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 604.
[AGENT][NEUTRAL] Mhm. 575.
[CUSTOMER][NEUTRAL] 575. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes.
[CUSTOMER][NEUTRAL] The dental?
[AGENT][NEUTRAL] So it looks like there's 2 claims that we were
[AGENT][NEUTRAL] Supposed to pay to her and we pay to the provider.
[AGENT][NEUTRAL] We're gonna get a refund on it.
[AGENT][NEUTRAL] And she's under the impression that we stopped the check to her, but I don't see that we have sent her out a check yet.
[AGENT][NEUTRAL] But I didn't tell her that. I just, uh,
[CUSTOMER][NEUTRAL] Mm, I don't either.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see calendar year maximum was met.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is it the same data service.
[CUSTOMER][NEUTRAL] No, not the same data service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What the
[CUSTOMER][NEUTRAL] OK, I don't know. Give me one second. I don't know dental that much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I don't even know what the max is.
[AGENT][NEUTRAL] Oh, hold on.
[CUSTOMER][NEUTRAL] I got it look at the.
[CUSTOMER][NEUTRAL] The policy
[AGENT][NEUTRAL] Oops, hold on 25.
[CUSTOMER][NEUTRAL] You can go ahead and put her through. I mean, she's just gonna have to wait until I figure it out.
[AGENT][NEGATIVE] You're trying, you're trying to find like, why does it keep doing this? Hold on, the calendar year max for the policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is $1000 with a $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this for 20?
[CUSTOMER][NEUTRAL] 2024 OK.
[AGENT][NEUTRAL] Oh wait, hold on, 24, let me, let me, I think it's the same. Let me just double check. Yeah, it's the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where is my?
[CUSTOMER][NEUTRAL] Calculate order.
[CUSTOMER][NEUTRAL] 358727272 62 72727272 76 she's already it's maxed out.
[CUSTOMER][NEUTRAL] So something came in on.
[CUSTOMER][NEUTRAL] Uh, [PII] paid $539 for [PII].
[CUSTOMER][NEUTRAL] And then when by the time we voided it out for whatever reason.
[CUSTOMER][NEGATIVE] [PII] voided these out.
[CUSTOMER][NEUTRAL] Yeah it's already been maxed out.
[CUSTOMER][NEUTRAL] But something was supposed to go to her?
[AGENT][NEUTRAL] Yeah, she's saying this payment of the 5:39.
[AGENT][NEUTRAL] And the 350 was supposed to be paid to her and in the notes it says that we were refunding it, we were refunding it from the provider.
[AGENT][NEUTRAL] But I don't see, so she's under the impression that the voided check here is the voided check to her, but it's the voided check from
[AGENT][NEUTRAL] The providers
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] It's how it's what I'm getting, but the
[CUSTOMER][NEGATIVE] And pay the provider not interested.
[AGENT][NEUTRAL] Because what I saw was cleared.
[AGENT][NEUTRAL] So that's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well [PII] called her check blah blah. I called the insured, explained the provider.
[CUSTOMER][NEUTRAL] Rep [PII] will pay insured her remaining balance, not APL close hub.
[CUSTOMER][NEUTRAL] Going to request a refund from the prior submitted a hub to claim to determine if this has been the insured wants to be called back call tomorrow when she asks the first.
[CUSTOMER][NEUTRAL] She knows that the provider received their payment.
[CUSTOMER][NEUTRAL] Claim entered 2 checks voided claim was filed correctly and paid the provider.
[CUSTOMER][NEUTRAL] Was paid correctly and paid the provider not insuredly check file correctly.
[CUSTOMER][POSITIVE] I called the uh OK I I have no idea right, I'm ready when you are.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I have
[CUSTOMER][NEUTRAL] Oh can, come here.
[CUSTOMER][NEUTRAL] Hold on one minute before you. Come here.
[CUSTOMER][NEUTRAL] What that's what you're doing. Go let Papa look at.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Yes, ma'am. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hi Ms. [PII] this is.