AccountId: 011433970860
ContactId: cf567f3e-aaba-4b8a-98d1-7a81993fbf9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245380 ms
Total Talk Time (AGENT): 114176 ms
Total Talk Time (CUSTOMER): 133980 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/cf567f3e-aaba-4b8a-98d1-7a81993fbf9b_20250403T12:42_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] Um, yes, I was actually, uh, figuring out someone's benefits and I guess it just stopped like it went, I don't know, something happened to the line, but I actually want at this point just wanna check on a claim too to see what the payment on a claim is.
[AGENT][NEUTRAL] OK. Is your name [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I believe we were speaking, um, hold on one moment, I think I'm still in the policy.
[CUSTOMER][NEUTRAL] And I didn't hear anything. It just like went sort of like, OK, what happened?
[AGENT][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Like I didn't hear anything.
[AGENT][NEUTRAL] This is for um [PII].
[CUSTOMER][NEUTRAL] Car, yes.
[AGENT][NEUTRAL] OK, so I'm still in there. So did you hear, well, I get, so we were looking for major coverage, so the policy doesn't have major coverage. Did you hear that part? OK.
[CUSTOMER][NEGATIVE] And he doesn't have it doesn't have it, there's not even a waiting period. There's just no major coverage on it, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and do you, so if a tooth is broken.
[CUSTOMER][NEUTRAL] Do you cover for that or does there have to be decay on there for filling?
[AGENT][NEUTRAL] What, um,
[AGENT][NEUTRAL] So do you have a code for it? I don't, I don't.
[CUSTOMER][NEGATIVE] If a piece is broken off.
[AGENT][NEUTRAL] Dental isn't my only product. I don't I'm not sure. OK.
[CUSTOMER][NEUTRAL] Yeah, I, I do have a code for it.
[CUSTOMER][NEUTRAL] And and I know you won't know until the claim, but it's code 22335.
[AGENT][NEUTRAL] 2335.
[CUSTOMER][NEGATIVE] Like for a front a front tooth and it's like kind of like kind of broken off.
[AGENT][NEUTRAL] Let me see, I'm just looking on. OK, so yes, 2335 is under basic restorative, so it's at 80%.
[CUSTOMER][NEUTRAL] I don't know if that'd be considered cosmetic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and even if it's just because it's chipped and broken off it'll pay?
[CUSTOMER][NEUTRAL] You don't really know I guess but.
[AGENT][NEUTRAL] Oh, it doesn't from, to my knowledge, whether it's shipped or not, if that code is billed, we're just gonna.
[AGENT][NEUTRAL] Work with the bill code.
[CUSTOMER][NEUTRAL] OK, the, the, the other thing, OK, and then what did you all receive a claim for 3:17?
[AGENT][NEUTRAL] $317 on [PII].
[CUSTOMER][NEUTRAL] Oh, [PII] 3:17. I'm sorry, um.
[AGENT][NEUTRAL] It's OK. And since it is a new call, um, we don't have to verify because we just got off the phone, but all the information provided is a verification of benefits, not a guarantee of payment. You said [PII]?
[CUSTOMER][NEUTRAL] Is this [PII]?
[AGENT][NEUTRAL] Or is this from last year? OK.
[CUSTOMER][NEUTRAL] Yes, [PII]. No, that's [PII]. [PII], I'm sorry.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, you're fine.
[CUSTOMER][POSITIVE] how good it is.
[AGENT][NEUTRAL] Yes, we do have a claim here. Let me see if this is from you. What's the name of your provider's office?
[CUSTOMER][NEUTRAL] Doctor Lane Lane Dental.
[AGENT][NEUTRAL] OK, yes. Um, so that's claim number 3582892. We paid $40 on the claim.
[CUSTOMER][NEUTRAL] You have lane
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, do you take out deductible or something?
[AGENT][NEUTRAL] Um, there was no deductible, it looks like.
[CUSTOMER][NEUTRAL] So the claim was for 100 and you all, OK, but you, but we the claim was for 100 and you paid 40.
[AGENT][NEUTRAL] Right, I'm gonna go through the breakdown with you. Just give me a second. So code 00220 was billed at $35 and we paid $28. Code 00140 was billed at $65 and we paid $12. Um, if you like, I don't know why they were paid those dollar amounts, but I can get an examiner for you if you'd like to explain for you.
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's OK. That's what they allow. They only allow $12 on the limited. I just wondered if that's because they took out a deductible or something because that's such a low payment, but.
[CUSTOMER][NEUTRAL] Um, I guess that's just what they allow on a woman exam. OK, alright, well thank you for your help. So we got paid.
[CUSTOMER][NEUTRAL] Uh, $40 for that claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK all right well thank you for your help today and um.
[AGENT][POSITIVE] You're very welcome. [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] No, no, not at all, thank you.
[AGENT][POSITIVE] Alright, well thanks for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.