AccountId: 011433970860
ContactId: ca1a3342-968e-455b-9bc1-909a20083bbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 728580 ms
Total Talk Time (AGENT): 354123 ms
Total Talk Time (CUSTOMER): 219749 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/ca1a3342-968e-455b-9bc1-909a20083bbd_20250210T15:19_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] Hey [PII], this is [PII].
[AGENT][POSITIVE] Good morning, Mr. [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I'm trying to find out, OK, I just got the insurance, uh.
[CUSTOMER][NEUTRAL] With this, with my, the company I work for.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I had a dentist appointment today and I was trying to get a teepo but they told me that I cannot get a Tu because I got the.
[CUSTOMER][NEUTRAL] Wait a whole year before my baby get a people.
[CUSTOMER][NEUTRAL] Or something like that.
[AGENT][NEUTRAL] All right. Yes, sir. I can check that for you, sir. Do you have your policy certificate number?
[CUSTOMER][NEUTRAL] I really don't cause uh.
[CUSTOMER][NEUTRAL] I, I said get them I, I can mm.
[CUSTOMER][NEUTRAL] I can see, let me see, can I find it real quick.
[AGENT][NEUTRAL] Do you have an ID card yet?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I can look it up by your social if that's OK.
[CUSTOMER][NEUTRAL] But the, the number they had, uh, I, I, I guess it's right.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 57
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Um, that doesn't sound like our policy number. Would it be OK if I looked your policy up by your social? And if not, I can use your name.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, it's OK.
[AGENT][NEUTRAL] Alright, and that number please sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And can you verify your current mailing address, email, date of birth, and phone number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The phone number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what else, what else you need?
[AGENT][NEUTRAL] Uh, your date of birth, please, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] My birthday is [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But I'm, I'm quite a few years older than you are, but one day.
[AGENT][NEUTRAL] One day difference in our birthday.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so yes, sir, what I can do to, um, what is your email address?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Would you like for me to email you a copy of your card, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I can do that. Now, with your policy, it does have a 12 month waiting period for major procedures. Now, there is a simple tooth extraction that is covered.
[AGENT][NEUTRAL] Under the basic services.
[AGENT][NEUTRAL] So I am not sure. Were they talking to you about oral surgery to extract that tooth?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that oral surgery is considered a major procedure.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Well they saying like they really don't know if it's gonna be a major surge. They don't really know till they get up in there. So that's why I was trying to see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Of the base you say I, I do have.
[AGENT][NEUTRAL] You do have basic services and preventive services are covered um as of [PII]. The major procedures, there is a 12-month waiting period. So for any major services such as oral surgery or crowns or bridges, um, root canals, all that is, there is that waiting period of 12 months.
[CUSTOMER][NEUTRAL] So it will
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I'm like in and I'm like in the tea.
[AGENT][NEUTRAL] So for the simple extraction it it could be considered for benefits now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to let them know that.
[AGENT][NEUTRAL] They should know that. Um, let me see if they called. Bear with me just one second.
[AGENT][NEUTRAL] I check the notes.
[AGENT][NEUTRAL] OK, so it looks like [PII] from the dentist's office called this morning.
[AGENT][NEUTRAL] And [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And we sent them what's called a fax back which is just um.
[AGENT][NEUTRAL] Simple ver uh verification of coverage and what's covered under if it's major preventive.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that we did send that to them, so they should know.
[CUSTOMER][NEUTRAL] Yeah, well, way she talking like.
[CUSTOMER][NEUTRAL] Uh, like, like, uh,
[CUSTOMER][NEGATIVE] Like I wasn't gonna cover nothing today. I gotta wait a whole year before I be able to get that people on, but.
[CUSTOMER][NEUTRAL] No, I don't know.
[CUSTOMER][NEUTRAL] The way she talking like it's gonna be a major surgery or something.
[AGENT][NEUTRAL] Yeah, it just depends on how they code it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if they coded.
[CUSTOMER][NEUTRAL] Maybe I can get her um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, based on then and explain it to a more.
[AGENT][NEUTRAL] Right, and if they coded as a.
[AGENT][NEUTRAL] Basic procedure, then it could be covered and that's just a simple extraction.
[AGENT][NEUTRAL] If they have to go in and do oral surgery, then that would fall under your twelvemonth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Waiting period time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just sent you an email of your ID card. On that email there is our.
[AGENT][NEUTRAL] Portal address and you can create a login and password. If you want to view your policy benefits, you can click on the policy number and it will download your benefits so you can review them.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would be for your dental uh benefits and disability. You have disability with us as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And talk to them and see if they, if they think that they can do that under, you know, just a simple extraction.
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] And of course,
[CUSTOMER][NEUTRAL] I will ask to see.
[AGENT][NEUTRAL] Yeah, they're probably gonna say they won't know until they look at it, you know.
[CUSTOMER][NEUTRAL] Yeah, that's the thing they I already looked at. I already did it.
[AGENT][NEUTRAL] Did they say it would have to be an oral surgery for extraction?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That you say.
[CUSTOMER][NEUTRAL] I did the X-ray. I, I, I, I did an X-ray last week. I paid for my own pocket.
[AGENT][POSITIVE] Well if you did that you need to send us that itemized billing so we can provide benefits for you.
[AGENT][NEUTRAL] Cause X-rays are covered.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Ask them for an itemized um billing with that procedure code showing the x-rays you did last week, and you can submit that to us and we can reimburse you for that if it's covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I, I, uh, you send it to them.
[AGENT][NEUTRAL] Don't
[CUSTOMER][NEUTRAL] Uh, the 10 I need.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You would need if you've already paid for it out of pocket.
[AGENT][NEUTRAL] You would need to request that itemized billing and send it to us for reimbursement.
[CUSTOMER][NEUTRAL] OK, well, uh, well I need to get it from them, or?
[AGENT][NEUTRAL] You'll need to get that itemized bill from the dental office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that will have the procedure, you know, the X-rays, codes that we need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To be able to provide benefits to you. Now, that would, if you file a claim, benefits are gonna come back to you.
[AGENT][NEUTRAL] If they file the claim, benefits would go directly to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they may file the claim for you if we pay them then any overpayment, they should return to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] But don't miss those benefits.
[CUSTOMER][NEUTRAL] OK, I'm not.
[AGENT][POSITIVE] They're your benefits. We want you to have them.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I can go up to, uh, I go back up there cause I'm on way to another doctor right now cause I gotta get my physical done.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, ask him about that.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] You know, they can always submit the claim to us and we can review it for benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if it's payable then we can pay it.
[AGENT][NEUTRAL] But if it's the um major
[AGENT][NEUTRAL] Procedure like the major oral surgery that would fall under that 12 month waiting period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh.
[CUSTOMER][POSITIVE] I get these real call right quick.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's, uh, that's my wife's cousin so I can get her a car, so I, uh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I, so I give her a call and let her know.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] And you let us know if there's anything else we can do to help you, OK?
[CUSTOMER][NEUTRAL] Alright and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] My pleasure to help you this morning. Anything else?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, ma'am, what's your name again just because I need to call back and let you know.
[AGENT][NEUTRAL] Well, my name is [PII].
[AGENT][POSITIVE] And it's been my pleasure to assist you. Now, any of our representatives will be more than happy to assist you in any way.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If I'm busy. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And I hope you can get that tooth taken care of. I know tooth, tooth problems are hard.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEGATIVE] They are miserable.
[CUSTOMER][NEUTRAL] I've been dealing with
[CUSTOMER][NEUTRAL] I've been dealing with for 2 months now.
[AGENT][POSITIVE] Oh my goodness, you need to get that thing taken care of. That'll drive you crazy or it does me anyway.
[CUSTOMER][NEGATIVE] It that would have been doing driving me crazy.
[AGENT][POSITIVE] Mhm. I get it. Well, hopefully they'll be able to provide those services for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] All right. Well, Mr. [PII], it's been a pleasure to assist you and you be sure to call us if there's anything else we can do.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you, sir. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.