AccountId: 011433970860
ContactId: e273b3db-6863-4118-9088-bb6cedaecec6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380329 ms
Total Talk Time (AGENT): 184726 ms
Total Talk Time (CUSTOMER): 153721 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/e273b3db-6863-4118-9088-bb6cedaecec6_20250108T20:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], good afternoon. My name is [PII]. I was calling because I received a bill today and um I do have dental insurance, but I was wondering as to why nothing was covered.
[AGENT][NEUTRAL] OK, um, so is it just so I can have clarity, is it a bill or it's a claim?
[CUSTOMER][NEUTRAL] Uh, Bill.
[AGENT][POSITIVE] Bill, OK. And um Ms. [PII], may I have a good contact number in case we're disconnected and I'll be more than happy to look into your bill for you.
[CUSTOMER][NEUTRAL] Yes sure [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02554897.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And Ms. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Um, my you said my address?
[AGENT][NEUTRAL] Yes, ma'am, your mailing and email.
[CUSTOMER][NEUTRAL] OK, my mailing address is [PII]. My email address is [PII].
[AGENT][NEUTRAL] Alright, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So, so you're saying you received a bill from a provider saying something wasn't covered for a claim, is that?
[AGENT][NEUTRAL] Cause I don't, OK.
[CUSTOMER][NEUTRAL] Yes, nothing was, it's, it says covered.
[AGENT][NEUTRAL] So let me look at this claim.
[CUSTOMER][NEUTRAL] Um, I had an X-ray and a.
[CUSTOMER][NEUTRAL] Or evaluation.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm pulling up the claim now.
[AGENT][NEUTRAL] Oh, this claim hasn't finished processing. OK, so what, so the claim was sent in to us from [PII].
[AGENT][NEUTRAL] So we have to um check each week just because of the like it's a tip agency, so we have to check each week just to make sure eligibility, you are eligible for benefits so that we can pay out. Um, so, so this claim is not finished processing. We're just waiting for eligibility from um MAU that you were working and you have the payroll deduction taken out so we can pay on the claim, but this isn't finished.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] yeah.
[AGENT][NEUTRAL] So if you received the bill, I would, I would say to um just disregard the bill for now because we haven't finished processing the claim.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Because once we get that eligibility back, then your job just says, yeah, she was working, she had the payroll deduction taken out and then we just go ahead and keep processing.
[CUSTOMER][NEUTRAL] Well, I need to call [PII]. I just talked to her, so I need to call her back, um, because I have a dentist appointment on the [PII]. I have to have a teeth removed. I can't have stuff like this going on.
[AGENT][NEUTRAL] Yes, ma'am, I completely agree. Um, unfortunately, on our end, there's really nothing else, we just wait for that eligibility and then as soon as it's received it, it comes in and then the examiner sees it and they just keep on processing, um.
[AGENT][NEUTRAL] But why did you receive a bill?
[AGENT][NEUTRAL] Because we didn't have a denial or anything.
[CUSTOMER][NEUTRAL] I have no idea.
[AGENT][NEUTRAL] I mean, we sent, we sent them the explanation of benefits, but on on it it says that we're waiting for eligibility and we'll continue processing once the, once it's received.
[CUSTOMER][NEUTRAL] How?
[AGENT][NEUTRAL] So I'm sorry that you receive the bill.
[CUSTOMER][NEUTRAL] Well, this is
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, well, as long as we got that squared away, it's OK.
[CUSTOMER][NEGATIVE] Because I was wondering, I'm like, why am I paying for insurance every week if because I pay I pay over $150 a month in insurance. Well, no, I pay right at $200.
[AGENT][NEUTRAL] And it's not cut, right?
[CUSTOMER][NEUTRAL] Um, because I have, um, medical, vision and dental, and that's for myself and my kids.
[AGENT][NEUTRAL] Oh yeah, I, I mean, I would feel the same way too. Why am I paying this and that is covered. Um, but in this, this case, it's a little different and we only have to do that just because, you know, sometimes with temp services, they can be on assignment one week gone the next, you know, so we just have to check weekly.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] I'm sorry for all the confusion. I hope I helped a little bit.
[CUSTOMER][NEUTRAL] All right. Well,
[CUSTOMER][NEUTRAL] But you did, you did, because I was about to do, you know, I didn't understand that, but yes, that's, that's, that's OK. That's, that's better, that's better because I know the, the, the first young lady that I talked to, she said that it's looking like I'm in the red right now because the insurance company, I mean the um temp agency haven't sent in my payment for this month, I mean for this week.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, if you
[CUSTOMER][NEUTRAL] And she said they normally send it in on Wednesday. Well, I'm like, well, today is Tuesday, tomorrow is Wednesday. So if they send it in every week on Wednesday, then I'm sure they will send it in this Wednesday as well because I'm working, so.
[CUSTOMER][NEUTRAL] I just didn't, I, I just didn't understand that, but yeah.
[AGENT][NEUTRAL] Well, I can completely understand that, especially receiving a bill. So if you have any questions or need us, I'm the only [PII] here, um, but anyone will be able to assist you, but yeah, that's what's happening. Um, we just have to check that every week.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Every week, great deal. That's fine with me.
[CUSTOMER][POSITIVE] OK, thank you so very much.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Not at this moment.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a good day and happy New Year.
[CUSTOMER][NEUTRAL] As well.
[AGENT][POSITIVE] Thank you. Bye-bye.