AccountId: 011433970860
ContactId: e6d87f15-b24f-4b15-9bfa-01c6da6a67c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556950 ms
Total Talk Time (AGENT): 194521 ms
Total Talk Time (CUSTOMER): 207487 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/e6d87f15-b24f-4b15-9bfa-01c6da6a67c6_20250423T18:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I, I, I have a question about, uh, my policy and what's covered and what's not. Do I have the right extension or, or should I call someone?
[AGENT][NEUTRAL] Yeah, I can help you with your policy. What's the policy number?
[CUSTOMER][NEUTRAL] I have no idea. It's, it's under my wife's name. If I give you her name, can, can you look it up by that?
[AGENT][NEUTRAL] Yeah, we can definitely look it up by name. What's the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you reside in the state of [PII]?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] All right. And let me get [PII], let me get [PII]'s date of birth, please, and your full address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] And we're looking at the dental policy, correct? You're looking to see what's covered on this?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Are you looking for a specific procedure or?
[CUSTOMER][NEGATIVE] Well, just in general, I mean, I went for, uh, uh, it used to be I went for a, uh, twice a year for cleaning and, you know, once a year, whatever, they did X-rays and it was covered. And now they're sending me a bill for $266. And I said, well, I, I, I was told I didn't know anything when they had it done. Oh, well, you need to get with your insurance company and find out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What they're paying what they're not paying, so it's a recent bill that I just got sent that um.
[CUSTOMER][NEUTRAL] Wondering why.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] So yes, I need to know like what's covered and what's not.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Was it for a date of service of
[AGENT][NEUTRAL] [PII] this year, is that what you were seeing?
[CUSTOMER][NEUTRAL] No, I don't think it would be under, uh, my name's [PII]. I'm her husband.
[CUSTOMER][NEUTRAL] I think it was in, in, uh, I think it was more in, I don't think I went on [PII]. I may have, but I'm not sure where, where I had done was I had a check, a regular routine cleaning and checkup, and they took some X-rays. Is that what was done?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, so data service is 21325 under your name for Doctor [PII].
[CUSTOMER][NEGATIVE] I'm trying to find a dang bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's showing that you had um a cleaning.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then it looks like an oral evaluation.
[AGENT][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Showing X-rays.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEGATIVE] So they told me before I did all that, oh, it's no charge, you're covered and, and uh they won't be been way when I checked out. They gave me a bill with zero balance. I was covered. And then two months later they're sending me a, a $266 bill.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] And that, that's my first, uh, checkup this year, and my last one was supposed to be in June and I canceled it and put it off all the way to this year. So I know it's been more than 6 months. I know you have to have 6 months in between.
[CUSTOMER][NEUTRAL] Cleans and stuff.
[AGENT][NEUTRAL] So, it looks like a portion of it was applied towards your deductible. So you have a $50 calendar year deductible that had not been met.
[AGENT][NEUTRAL] Um, so it was applied.
[CUSTOMER][NEUTRAL] So that means I would pay $50.
[CUSTOMER][NEGATIVE] But they're charging me 266, so why isn't the rest of it being covered?
[AGENT][NEUTRAL] Let me see what the total charges were.
[CUSTOMER][NEUTRAL] Yeah, please.
[CUSTOMER][NEGATIVE] I mean, I can understand if I had to pay a $50 deductible, I wouldn't even be calling you, but they're trying to charge me $266. I've never been charged that when I just went for a cleaning and an X-ray.
[CUSTOMER][NEUTRAL] And we've been with you guys for I don't know how many years, as long as I can remember, my wife's had this policy.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] When the money is applied towards the deductible, um, that means that you're paying a portion of the medical expenses until you reach that.
[AGENT][NEUTRAL] So you hadn't reached your deductible of $50. So that means that you're responsible for additional cost until that's met.
[CUSTOMER][NEUTRAL] But when I just have to pay the $50 and my deductibles met.
[AGENT][NEUTRAL] Mm mm, no, because the money for part of the part of the claim.
[AGENT][NEUTRAL] Um, a portion of it, which was
[AGENT][NEUTRAL] I believe the
[AGENT][NEUTRAL] bit wing X-rays, that portion was applied towards the deductible. So that should now be met for the year.
[CUSTOMER][NEUTRAL] OK, so if I met the deductible with that portion, why isn't the rest of it being paid?
[AGENT][NEGATIVE] So the other denial on here.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] See that's making no sense to me.
[AGENT][NEUTRAL] So until the deductible is met, you're responsible for the cost.
[AGENT][NEUTRAL] Like it's not gonna pick up a percentage until that $50 is met.
[CUSTOMER][NEUTRAL] Can you send me a copy of our policy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] Yeah, absolutely. You should have gotten an explanation of benefits for the date of service also, um, showing you the services rendered, what was paid and what was denied with denial reasons on them too. If you'd like me to send that to you, I can send that to you.
[CUSTOMER][NEUTRAL] I want everything you got that you can send me because I need to understand this better.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So you're saying the first time we go to the dentist of the year, no matter whether it's, uh, $75 or it's $3000 we're responsible for it because there's no $50 deductible yet.
[AGENT][NEUTRAL] You're res you're responsible for a portion, yes, until the deductible is met, correct.
[CUSTOMER][NEUTRAL] Am I hearing that correct?
[CUSTOMER][NEUTRAL] OK, alright, well send me all that please so I can study this up because I may need to look into a better policy.
[AGENT][NEUTRAL] OK, Mr. [PII], I just need an email to send this information to please. We don't have one on file.
[CUSTOMER][NEUTRAL] [PII], that's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I will send you the explanation of benefits from the recent date of service. I'll send you a copy of the policy as well. Was there anything else that I can help with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I think that'll be it.
[AGENT][POSITIVE] All right, Mr. [PII]. Well, thank you for calling. I hope you have a good rest of your day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.