AccountId: 011433970860
ContactId: cc273730-1846-4d0d-ac0e-f14d0934fcc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1025118 ms
Total Talk Time (AGENT): 391909 ms
Total Talk Time (CUSTOMER): 254228 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/cc273730-1846-4d0d-ac0e-f14d0934fcc2_20250114T15:30_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] Yes ma'am.
[CUSTOMER][NEUTRAL] I got a a thing from y'all saying how much you paid at the dentist.
[CUSTOMER][NEUTRAL] Um, and I need to give you the something off this bill, I mean not bill, but, you know, telling me what.
[CUSTOMER][NEUTRAL] But the amount that I owe.
[AGENT][NEUTRAL] OK, wait a minute. I, so it's kind of hard to hear. You said that you got a bill and you need to know what you owe.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I, I got a claim number here. You sent me a thing saying I only owe $20 but anyways, let me, let me read it to you the claim number, it's uh 3542515.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, hold on one moment and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And I have the claim here, and I just need you to verify your date of birth, mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. OK, and what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says here down here total charge for I guess deductible $28.
[CUSTOMER][NEUTRAL] Deductible 18, so how much is it I'm supposed to owe? Damn.
[AGENT][NEUTRAL] Hold on one moment, I'm pulling up the explanation of benefits.
[CUSTOMER][NEUTRAL] $20. I think it's I think patient responsibility is $20.
[AGENT][NEUTRAL] 515.
[AGENT][NEUTRAL] 12:18
[CUSTOMER][NEUTRAL] Actually they got 32 and 2.
[AGENT][NEUTRAL] Oh, I'm just waiting for the explanation of benefits to come up so I can see what you see.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Yeah, the only reason I'm, I'm asking is I've never had to pay this much because I've always told them when we take, you know, what they have to take, you know, as far as camera pictures and everything like that.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] So the deductible is 32.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Right wings is 2 hold on one moment. 3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me see if I can find your patient um explanation. This is for the provider. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because usually, like I say, usually I don't have to pay anything, you know, and um, I always tell them when I go to them, you know, don't take any more pictures or anything extra, you know what I mean.
[AGENT][NEUTRAL] Right, just do what you need to, so it's covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And um, Mr. [PII], do you mind if I place you on, actually it looks like it just pulled up. Um, do you mind if I place you on just a brief hold? I'm just trying to get to your explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's fine.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why is my own base not talking to?
[AGENT][NEUTRAL] It's a lion.
[AGENT][NEUTRAL] At least I was able to find it that way.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, so yes, taking a look at your um patient explanation of benefits, um, it's looking like the total patient responsibility is $54.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] The reason why it was more than what it normally is is because if they do something that they do stuff extra that they shouldn't have done that cost that cost me money more than what y'all covered because it's never happened before.
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] A part of it was applied to the deductible.
[AGENT][NEUTRAL] So let me see what was applied to the deductible.
[CUSTOMER][NEUTRAL] Yeah, I have a deductible over time, correct?
[AGENT][NEUTRAL] Mhm. You said a deductible return?
[CUSTOMER][NEUTRAL] And that's what
[CUSTOMER][NEUTRAL] No, no. All right, every time I go to the dentist, don't I have a deductible like 20 bucks or something like that I have to pay?
[CUSTOMER][NEUTRAL] Or do I?
[AGENT][NEUTRAL] Well, it's just your policy itself, um, usually it's a $50 deductible.
[CUSTOMER][NEUTRAL] Oh, each time?
[AGENT][NEUTRAL] Each year.
[CUSTOMER][NEUTRAL] 00, once a year, OK, I got you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] I, I haven't, I haven't paid the $50 deductible for the year.
[AGENT][NEUTRAL] I'm trying to see which one of the 32 or the 18.
[CUSTOMER][NEGATIVE] OK, I mean, I just wanna get it, yeah, I just wanna get it straight before I call them, and that way I can make sure that if they made a mistake and did something they weren't supposed to do extra, I don't make sure they don't do the same thing again, and I let them know that I don't appreciate it.
[AGENT][NEUTRAL] Was to the deductible.
[AGENT][NEUTRAL] Right. And let me see if um this is for [PII]. What they, yeah, this is for last year. So let me see what was used last year. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so with that last claim, yes, the deductible was met and you had $1,049 left for your um of your calendar year max to use. You used $451 last year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so I have it um.
[CUSTOMER][NEUTRAL] So I didn't meet my deductible for, I mean, I hadn't up to that point met my paid my deductible yet for the year.
[AGENT][NEUTRAL] Right, and then after this was processed, the deductible was met.
[CUSTOMER][NEUTRAL] I just wondered um my deductible is $50 a year, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, well, I just wondered, I mean, I know I had seen that doctor.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] At least once before the year, I mean, that, I think that was the 2nd time that year wasn't that I've seen them.
[CUSTOMER][NEUTRAL] So I didn't pay anything the first time.
[AGENT][NEUTRAL] Let me see, patient responsibility 100%. I'm just looking over this. I'm just trying to see what the difference was for this.
[CUSTOMER][NEUTRAL] On your
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, not this year, but this claim versus the others.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] That's why I wanted to call you first before I call them, you know.
[AGENT][NEUTRAL] Yes, so we can get it straight and see if there's an error somewhere or if this is true.
[CUSTOMER][NEUTRAL] Or they just do something extra they normally don't do.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] So you're saying they shouldn't have charged me 54, they should have only charged me 40 from what you've seen so far.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I'm just trying to see what the difference is because like, for example, I see um for that first film X-ray, the deductible is $32 and it shows up in patient responsibility, but there's a portion that was submitted or paid towards the deductible. So I'm trying to see which of these two charges was applied to the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I got you.
[AGENT][NEUTRAL] But I really want you to speak to a dental claims examiner so they can go in detail with you and tell you what the differences are or if this is a true error. Um, do you mind if I place you on just a brief hold? I'm gonna see if someone's available. Just cause I know you want to call the dentist after, so I don't want you to have the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, that's fine. Yes, ma'am.
[CUSTOMER][POSITIVE] Right, well, thank you, thank you very much.
[AGENT][NEUTRAL] You know, we
[AGENT][NEUTRAL] You're welcome. Um, hold on one moment for me, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Because then I don't even know how to handle the calls no more. It's so much.
[AGENT][NEUTRAL] So do we call claims or no? Because claims can clearly help them, but I'm not trying to get in trouble. I'm gonna restart. I just start help desk.
[AGENT][NEUTRAL] No, I don't know nothing about that.
[AGENT][NEUTRAL] I have a deaf client who pass on Friday. How there's no city house.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes, because there's nothing we can help with that needs some research.
[AGENT][NEUTRAL] I'm calling claims. If I get in trouble, I just get in trouble, but I want him to get help now. He's trying to call the dentist. I ain't nobody got time for that. Just, just write me up. I'm about to help this man.
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thank you for calling ATL. My name is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey, this is [PII] on the care team. I didn't hear anything you said. You sound like you're underwater.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] Well, I know you're saying something.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] I can hear you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that better? Can you hear me?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so yes, I can hear you, but you sound like, I don't know, like wavy, like you're underwater like.
[AGENT][NEUTRAL] And then like kind of robotic, say something else.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APU. This is [PII]. How may I help you today?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Uh oh.
[AGENT][POSITIVE] They sounded OK at first.
[CUSTOMER][NEUTRAL] Well, I have bronchitis, so I could be better, but I'm all right.
[AGENT][NEUTRAL] Well I hope you see.
[CUSTOMER][NEUTRAL] What you got?
[AGENT][NEUTRAL] So, I have a um insured on the other line. I was gonna send a hub, but he's trying to call the dentist. He needs help with his explanation of benefits, trying to see why he um has patient responsibility this time versus the other claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Trying to see if um
[AGENT][NEUTRAL] If they sent us over something that was different, so that he can call them and and get it rectified.
[CUSTOMER][NEUTRAL] OK, who do I have?
[AGENT][NEUTRAL] Um, Bostic Basil, the sorry, the policy number is 160.
[AGENT][NEUTRAL] 3081.
[CUSTOMER][NEUTRAL] And I have basil on my line.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's for that claim, um 3542515.
[CUSTOMER][NEUTRAL] Say that one more time, 354?
[AGENT][NEUTRAL] Mhm. 2515.
[CUSTOMER][NEUTRAL] What data service is it for? do you know?
[AGENT][NEUTRAL] This, hold on one second.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Mm, yeah, deductible applied that's why, go ahead.
[AGENT][NEUTRAL] And I went over that with them. I don't even see the data of service on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And so 12 6.
[CUSTOMER][NEUTRAL] It's 12 6.
[AGENT][NEGATIVE] OK, um, uh, my arm base is stuck on page 2 and I'm like, where I can't.
[CUSTOMER][NEGATIVE] Oh, I know at my own base, I can't even, uh, deal with that. It's so slow. I can't deal with that. Mm mm no.
[AGENT][NEUTRAL] I'm sorry, it just popped up. I see it now. It was stuck. I'm sorry.
[CUSTOMER][NEUTRAL] That's OK, no problem, but go ahead and give it to me. I'll take it.
[AGENT][NEUTRAL] OK, and can you say your name one more time?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] The.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You met me, remember?
[AGENT][NEUTRAL] I do, but you were coughing in the beginning, so I didn't know let's say or just say, so I just want to make sure.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] Yeah, oh, I know it. Yeah, this cough is never, never leaving, I don't think.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] I hope you feel you got some well, I'll send you a message.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Alright, send it on, girl.
[AGENT][NEUTRAL] All right. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Hey, um, thank you so much for holding. I have [PII] on the line and she's going to be assisting you with your claim, um more in detail, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] All right, Mr. [PII], this is [PII] over in the dental department. How can I help you today?