AccountId: 011433970860
ContactId: da9d985e-4ad9-4e96-b325-5fc944eb1504
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394600 ms
Total Talk Time (AGENT): 209518 ms
Total Talk Time (CUSTOMER): 111565 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/da9d985e-4ad9-4e96-b325-5fc944eb1504_20250513T12:51_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning [PII] how are you?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] Uh, doing great. My name is [PII]. I was calling because, um, about a reference to claim number which one is it? 3600231?
[AGENT][NEUTRAL] OK, Mr. [PII], you have a question on this claim, is that correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. What is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and your policy number please.
[CUSTOMER][NEUTRAL] OK, policy number.
[CUSTOMER][NEUTRAL] 259-820-2
[CUSTOMER][NEUTRAL] 0, 259-8205, sorry, yeah.
[AGENT][NEUTRAL] The last number is a 5. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you. So give me a few minutes, Mr. uh [PII] to get your information pulled up and then I will have to verify several things with you first for security and also any information provided would be a verification of benefits and not a guarantee of payment. So first off, um, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the phone number that we show for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And then lastly, your email address, please.
[CUSTOMER][NEUTRAL] TOO
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] [PII] I mean, sorry, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, so just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do have this claim pulled up. How can I help you with that today?
[CUSTOMER][NEUTRAL] Um, how would that, how was this question about how will it be paid out direct deposit and when will I receive it?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so I do show this was scheduled for direct deposit and it went through a nightly processing last night, so it typically takes about 2 to 3 business days for you to be able to receive that and that just kind of depends on your financial institution as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's, it's typically about 2 to 3 business days.
[CUSTOMER][POSITIVE] Oh, OK, that's cool.
[CUSTOMER][NEUTRAL] OK, and then another question, um, I know you see it pulled up and they, I see they gave less than what was due for as like the bill.
[CUSTOMER][NEUTRAL] That's why I was trying to see like.
[CUSTOMER][NEUTRAL] It was a certain percentage that I was given.
[AGENT][NEUTRAL] Hm, I can look at the the remarks on it for you and you will also, you probably can't see your explanation of benefits now, but you will be able to see that, um, later this afternoon. It's just once, you know, it, it just takes a little while for that to get in here. OK, so on one of the codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that was a $35 benefit.
[AGENT][NEUTRAL] Or $35 charge on there. It says this benefit has been applied to your calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then on one of the codes, the charge was 375, the benefit amount that was paid was 288.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also a portion of that benefit had been applied to your calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And one of the codes, um,
[AGENT][NEUTRAL] It was a $50 charge, the benefit on there paid.
[AGENT][NEUTRAL] Let's see, that one paid.
[AGENT][NEGATIVE] $40 and that was the max on that. And then the 220, there was one for $225 that was denied, and the reason for the denial, it states that this policy does not provide benefits for any procedure or service not listed in the schedule.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So code 3221 was just not covered by your insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, so it's not covered by certain things that they do not cover.
[AGENT][NEUTRAL] Correct. So some of the benefits were applied towards your calendar year deductible, and then the other, there was one code that's just not covered under your policy.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] OK, and quick question for you, so now since that was saying I still have.
[CUSTOMER][NEUTRAL] A certain amount of money left that they would pay because I know it's um like 7050 $750 per calendar year.
[AGENT][NEUTRAL] Give me one moment. I have to go to different screens to get different information, Mr. [PII], just a moment.
[CUSTOMER][NEUTRAL] Oh, that's fine, that's fine.
[AGENT][NEUTRAL] OK. So as of now, you have a room, you've met your deductible and you have
[AGENT][NEUTRAL] Its $328 of your $750 for your calendar year, so you have a remaining $422 as of now.
[CUSTOMER][NEUTRAL] Oh, that's left 422 left, OK.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. That's what I was just trying to see. OK, and then also like cleaning and things of that, yeah, cleaning, yeah, cleanings are covered at 100%, right? No deductible, nothing, right?
[AGENT][NEUTRAL] OK, is there any
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and that doesn't affect the money that I have left for like the 422.
[AGENT][NEGATIVE] No, sir, that does not.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Well, you're certainly welcome. Um, so again, is there any other questions that you have or anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK, well, if that is all I could help you with, Mr. [PII], thank you for calling APL and I hope you have a very nice and safe day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.