AccountId: 011433970860
ContactId: dc2d4d5d-792f-458f-ae43-93ba1f6c4e4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1232060 ms
Total Talk Time (AGENT): 302545 ms
Total Talk Time (CUSTOMER): 407932 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/dc2d4d5d-792f-458f-ae43-93ba1f6c4e4e_20250328T17:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, we've received a letter in the mail saying that they have a claim started for my son. He's under our policy. It went to our old mailing address. Um, I'm assuming it's for dental, but I'm not sure. We haven't received a letter like this before from American Public Lice.
[AGENT][NEUTRAL] OK. Do you have your
[CUSTOMER][NEUTRAL] But he hasn't been to the dentist in forever.
[AGENT][NEUTRAL] Oh, OK. Let's see. Um, do you have your policy number, claim number? What do we got?
[CUSTOMER][NEUTRAL] There's nothing on the letter except for the APL and I don't have we actually were calling I don't know if I speak to you we misplaced our dental cards and needed replacements anyway um I can give you my name and it's under my husband's the primary actually.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, no, we can definitely take a, take a look by name. What's the last name?
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] It's [PII] My husband's first name is [PII]
[CUSTOMER][NEUTRAL] And the claim came in, um, my son's name is the same, but he's the 3rd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what the letters addressed to the 3rd with our old mailing address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No worries, and what state do you guys reside in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I think I have.
[AGENT][NEUTRAL] And you here, one moment.
[AGENT][NEUTRAL] All right. And then, uh, for security, I will need to verify some of the policy information. So can I get your first and last name?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII], same last name [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And then I'll need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] Sure, it's [PII] and I'm assuming you have our old mailing address [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yup, and we can
[CUSTOMER][NEUTRAL] Yeah, we have a new mailing address we moved.
[AGENT][NEUTRAL] OK, let's update that. What's the new address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Avalon A V A L O N.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and that's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, let me take a look at claims here and see what I can find.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] The dentists actually has been out on like a sick thing for
[CUSTOMER][NEUTRAL] Like a year and a half and that's why we were trying to I keep on reminding my husband every day call and get the card so we can find a new test.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I seen the letter. I was like, my husband is in the background saying, get the cards so.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] And there's no claim number on it?
[CUSTOMER][NEUTRAL] It's stated
[CUSTOMER][NEUTRAL] No, it's, it's dated for [PII], which was probably delayed because of, um, I guess we didn't, they didn't forward the the mail to our new address, um, and it just says dear policy holder, we've received a claim on your policy and review the review of the claim has started in some cases additional information must be requested from you and your provider of medical services to be processed. We'll contact you with more information if more information is needed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's just signed uh claims department.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] The number I called.
[AGENT][NEUTRAL] OK. Let me go.
[AGENT][NEUTRAL] So it looks like it was for, it's under your husband. Um, not under, um, your son, it looks like. But let me
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, they put the the address, the letter for the 3rd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For, for my son.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Have you been to the dentist recently? No.
[CUSTOMER][NEUTRAL] OK. If it's for you, not for [PII].
[CUSTOMER][NEUTRAL] It's, it's dental. It's our dental insurance.
[CUSTOMER][NEUTRAL] I don't know what he's looking at.
[AGENT][NEUTRAL] I'm just looking through some of the correspondence to see.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And he goes to a different dentist than me and um my son, but he hasn't been to a dentist in what it's got over a year, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Exactly what was submitted, maybe that'll help me cause the correspondence isn't doing much here, sorry.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Are you based out of [PII]?
[AGENT][NEUTRAL] I, yeah, I live in [PII]. Uh-huh.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Yeah, there's this address at the bottom of the letter.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. Did he, did your son ever see like an orthodontist or anything, maybe a while back?
[CUSTOMER][NEUTRAL] A while back, both him and my daughter both seen an orthodontist way back.
[AGENT][NEUTRAL] Like, OK.
[CUSTOMER][POSITIVE] But that we paid cash for that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Why is there something in there from the orthodontist?
[AGENT][NEUTRAL] Just, just.
[AGENT][NEUTRAL] I'm gonna.
[CUSTOMER][NEUTRAL] Well they wouldn't have our dental information anyway because we never submitted it to them.
[AGENT][NEUTRAL] Yeah, and I don't even think there was any sort of coverage on the plan, you know what I mean?
[CUSTOMER][NEUTRAL] Cause everything was out of pocket.
[AGENT][NEUTRAL] Um, so, OK, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, it's not.
[AGENT][NEUTRAL] And I was trying to find the letter that was sent to you, cause sometimes if I can just see that, that makes more sense, but
[CUSTOMER][NEUTRAL] Yes, it is [PII] of this year.
[AGENT][NEUTRAL] Of this year? OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, let me, if you don't mind calling, can I place you on just a brief hold and I'll be right back with you.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] over in customer care this afternoon. How are you?
[CUSTOMER][POSITIVE] I'm good how are you, [PII]?
[AGENT][NEUTRAL] Hi, I'm good. I have a question on a claim. I'm hoping that you could help me with. Do you want the claim number, policy number?
[CUSTOMER][NEUTRAL] Um, let me get the policy number first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Oh, I'm still here. Did you hear me? Did you get it?
[CUSTOMER][NEUTRAL] No, it was like, no, it was so quiet for a second. I don't know what happened.
[AGENT][NEUTRAL] Oh my gosh. I don't even know what happened. OK, I'm sorry. It's 754754585.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the claim number?
[AGENT][NEUTRAL] So it's 3556938.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the insured on the line is [PII], and she's calling because she's like, we got a letter in the mail from you guys saying that a claim had been started on [PII]. But like, we haven't been to the dentist in forever, so we don't know what this is. She wasn't able to give me a claim number or anything. The only thing that I saw recently was actually under the subscriber, but these are subpoenas for information.
[AGENT][NEGATIVE] And I don't know what we're allowed to even disclose to them or if anything.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see what's.
[CUSTOMER][NEUTRAL] What they look like.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Because that's like the only thing that I see that's like recent.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me see exactly who this came from and.
[CUSTOMER][NEUTRAL] Well, it all had to do with let's see, custodian of records with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Within 20 days after receipt of subpoena your order by the court to produce the documents or things requested.
[CUSTOMER][NEUTRAL] Go a subpoena.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't really go into why.
[CUSTOMER][NEUTRAL] On behalf of [PII] A Visa ESQ.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Oh, that's the attorney, OK.
[CUSTOMER][NEUTRAL] Um, give me a second.
[AGENT][NEUTRAL] I can definitely do like a call back if some research needs to be done like offer that. I just, I'm newer and so I just wasn't sure, you know, I just didn't wanna say anything. I wasn't supposed to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, with this being with legal yeah with this thing with legal it looks like [PII] may have handled it um I'm not sure but it looks like she's not available right now so what I would do is I would maybe shoot her an email or something um I don't know if they have some type of.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Lawsuit going on and that's what this is about. I don't know, but the two, so the ones that are DM 25 indicate that no EOB was to be sent.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Right, I know.
[CUSTOMER][NEUTRAL] And then the only correspondence that is out there is from [PII].
[AGENT][NEUTRAL] Right, I did see that and that was about a dependent.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, has attained the age of expiration basically so like he's not gonna be eligible anymore which you know that needs to be sent, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then CS correspondence on [PII].
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] So that was a check.
[CUSTOMER][NEUTRAL] Maybe for his premium or something? Oh.
[CUSTOMER][NEUTRAL] For [PII], so they sent in a check.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To [PII] because of records I guess those records maybe that we're having to be seen. I don't do we bill them? I don't know.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, we build them for the records it looks like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But it didn't come from.
[CUSTOMER][NEUTRAL] Let's see it says your client so we billed them, yeah, so it came from them so that's what that is is the payment for the records basically um.
[CUSTOMER][NEGATIVE] And that's really the only correspondence that's out there so I don't know what they even would have received saying that something was.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] B
[CUSTOMER][NEUTRAL] Because DM 25, you know, says that no EOB is printed, so I have no idea.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] OK all right well I will just shoot her an email and then offer them a call back. I appreciate you looking at it with me thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No problem at all. You're very welcome.
[AGENT][POSITIVE] All right. You have a good day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes ma'am you too.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] It's [PII], yeah.
[AGENT][NEUTRAL] Oh [PII], I'm so sorry uh I apologize for the long hold, um, so I'm gonna need to call you back on this because I can't even find the correspondence that was sent out to you guys so and I.
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, is there any way in the interim can you mail out to, um, cards for us so we have it for the new dentist?
[AGENT][NEUTRAL] Oh yes, absolutely, absolutely, and um let me update the address and then um is this number you're calling from the [PII], is that a good callback number? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, that's my cell, yep.
[AGENT][NEUTRAL] OK, alright, so I will put in the request to send out the cards. Do you want to take down your policy number just to have it or?
[CUSTOMER][NEUTRAL] No, we'll, we'll wait for the cards. We're still still shopping around for the new dentist, so it's no, no rush.
[AGENT][NEUTRAL] OK, alright, so I will put that request in and then I will give you a call back as soon as I have some more info on this, OK?
[CUSTOMER][POSITIVE] OK, thanks a lot I appreciate your help.
[AGENT][POSITIVE] Yeah, not a problem. You have a good rest of your day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.