AccountId: 011433970860
ContactId: edeab4df-fd1a-4690-bf3c-47dda6493b35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1049170 ms
Total Talk Time (AGENT): 398247 ms
Total Talk Time (CUSTOMER): 264646 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/edeab4df-fd1a-4690-bf3c-47dda6493b35_20250303T19:09_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, yeah, I was calling about a
[CUSTOMER][NEUTRAL] I believe they claimed that wasn't.
[CUSTOMER][NEUTRAL] Process because it was believed that I didn't or the premium for it wasn't paid by my employer.
[AGENT][NEUTRAL] OK, so you're the insured and you're calling about a claim for yourself, is that correct?
[CUSTOMER][NEGATIVE] Uh, yeah, I had dental service in January and I recently got mail from, I believe you guys that showed me that my patient responsibilities were not paid for by you guys, even though I have insurance with you guys, I guess.
[AGENT][NEUTRAL] OK, so you're wanting to check on the claim status. Is that correct?
[CUSTOMER][NEGATIVE] Uh, I think so, cause I called last week about it, and I was told to talk with my employer because they said that my premium wasn't paid during the period where I had dental service, but when I talked to my employer, they said it was uh all paid for. My premium was uh being paid for and I should have benefits activated for me, but you guys sent the mails claiming that.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] My premium wasn't paid for.
[AGENT][NEUTRAL] OK, so yes sir I can take a look at this for you and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, Mr. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Coming in.
[AGENT][NEUTRAL] What is your phone number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Uh, one second, let me get my card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 02280546.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] OK, so Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will need to verify several pieces of information with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and your home mailing.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Address please?
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] What you say?
[AGENT][NEUTRAL] Miss
[AGENT][NEUTRAL] Mr. [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, can you, you said home address, right?
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so again, that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. And lastly your email address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I can see that this coverage you have with APO Mr. [PII] is through your employment through TRC staffing, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is
[AGENT][NEUTRAL] And what is the data service that you're calling about?
[CUSTOMER][NEUTRAL] It was for a dental service, I believe it was on [PII], if I'm not mistaken, I don't have the paper with me right now.
[AGENT][NEUTRAL] And do you have your claim number?
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's the number on the or the mail that was given to me, correct?
[AGENT][NEUTRAL] It would be on the document, yes, so that you, your explanation of benefits that you received.
[CUSTOMER][NEUTRAL] Uh, yes, give me one second. I need to go grab the papers.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, sir. I'm here.
[CUSTOMER][NEUTRAL] Do you need the one with that has the $0 or the one that has my
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I need the one related to your data service that you said that you received.
[CUSTOMER][NEUTRAL] The one that has.
[CUSTOMER][NEUTRAL] Yeah, it came with 2. There's one with $0 for my patient responsibilities and then there's one with, uh, about $244 for my patient responsibilities.
[CUSTOMER][NEUTRAL] And they both have different claim numbers.
[AGENT][NEUTRAL] OK, so you can give me each one of them.
[CUSTOMER][NEUTRAL] OK, well, the first one is 35514889.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the other one is 35586667.
[AGENT][NEUTRAL] OK so just one moment.
[AGENT][NEUTRAL] OK, so you did receive those because we received that claim, that same claim twice. This is for [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, yes, sir. So according to the records.
[AGENT][NEUTRAL] Um, which this comment or this remark rather should be on the 2nd page of the explanation of benefits that you received.
[AGENT][NEUTRAL] But it states that our records indicate that premium for this service state was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Yeah, it's like the premium, right?
[AGENT][NEUTRAL] And then it goes on to mention the next sentence has to do with uh cobra. Now we receive your
[AGENT][NEUTRAL] Information from benefits in a card.
[AGENT][NEUTRAL] And as of now, we have not yet received that. Once that has been received, then your claim would continue to be processed.
[CUSTOMER][NEUTRAL] Can you, wait, so you haven't received or premium from Benefits in the card.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] Correct. As of at this time, no, sir, not, we have not.
[CUSTOMER][NEGATIVE] So, right now, I'm currently not receiving any benefits even right now.
[AGENT][NEUTRAL] For this data service again, I'm showing, let me just double check a couple of things. This was for data service 13, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can I place you on a brief hold?
[CUSTOMER][NEUTRAL] Um, sure, yes.
[AGENT][NEUTRAL] You can hold.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mr. [PII], thank you very much for holding for me. OK, so yes, sir, at this time, premium has not yet been received from benefits in a card.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For a January to encompass your [PII] data service. Now I'll be happy to connect you with them if you would like, if you have additional questions, but again, once we are able to confirm the eligibility, then the claim would continue to be processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it was there was no uh premium paid on the service that's correct, is that correct?
[AGENT][POSITIVE] As of this moment, yes, sir, that is correct.
[AGENT][NEUTRAL] The weekly prem we have not received premiums.
[CUSTOMER][NEGATIVE] And you're still not receiving it currently.
[AGENT][NEGATIVE] We have, but not for that we are receiving premium, but we have not received premium that encompasses that data service.
[AGENT][NEUTRAL] According to our records at this time.
[CUSTOMER][NEUTRAL] But like
[AGENT][NEUTRAL] Again, any additional information on that?
[CUSTOMER][NEUTRAL] So only on
[AGENT][NEUTRAL] It would have to, you would have to discuss that, Mr. [PII], with benefits and a card.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] But let's say for currently this week or like last week I'm the premium was paid for, correct?
[AGENT][NEUTRAL] As of right now, your policy is show and we receive these files on a weekly basis.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So as of right now, your policy is showing as active and currently in our system, it's paid to [PII] at this time, but it is active.
[CUSTOMER][NEUTRAL] So, so if I want to get service like.
[AGENT][NEUTRAL] But again, any ques.
[AGENT][NEUTRAL] Your policy is active. If a provider calls us at this point, we would tell them your policy is active.
[CUSTOMER][NEUTRAL] So it is active
[CUSTOMER][NEGATIVE] But my benefits is not.
[AGENT][NEUTRAL] And they would
[AGENT][NEUTRAL] Again, with the policy being acted, that is what we would tell them, but we just have not received the premium to for this particular data service on those two claims, and that would be a question for benefits and a card.
[AGENT][POSITIVE] Which I will be happy to give you their phone number and I can also connect you with one of their representatives if you would like, Mr. [PII].
[CUSTOMER][NEUTRAL] Mm, is it, do I have to wait to, or is it gonna be like an instant thing?
[AGENT][NEUTRAL] Uh, I can't answer that. I'm going to transfer you now if you would like.
[CUSTOMER][NEUTRAL] Um, sure.
[AGENT][NEUTRAL] Um, would you like to take down their numbers so that in case you have to call them directly, you can, you will have their number?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, so just let me know when you're ready.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, so their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then also Mr. [PII], yes sir, I'm going to be emailing you a user guide for our portal.
[CUSTOMER][NEUTRAL] 485 6.
[AGENT][NEUTRAL] So that you can set up your profile and be able to have access to your policy information and your ID cards with APL online.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the email that I'm gonna send to you will come from care team at [PII] and you will have that email in just a couple of minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so is there anything else that I could help you with before I connect you with benefits in a car?
[CUSTOMER][NEUTRAL] So, just confirming.
[CUSTOMER][NEUTRAL] If that, if they ask you, you will say I'm on policy, but the premium for the data services just was not paid to you, correct?
[AGENT][NEUTRAL] As of now, we do not have premium for a service for today.
[CUSTOMER][NEUTRAL] And on the date of service correct?
[AGENT][NEUTRAL] Correct. 13.
[CUSTOMER][NEUTRAL] So is that premium paid weekly or only when I have service?
[AGENT][NEUTRAL] Yes, again, it is, it is a weekly payment, but that is all of the, I mean we, any of those types of questions, Mr. [PII] has to be answered by benefits and a card. I don't have access to all of that information.
[AGENT][NEUTRAL] We don't hear at APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, um, again, is there anything else that I can help you with before I connect you?
[CUSTOMER][POSITIVE] Mm, that's all you can connect me. Thank you so much.
[AGENT][POSITIVE] Well, you're certainly very welcome. It was my pleasure and thank you for calling APL. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Hi, you're very welcome. So, one moment please.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][POSITIVE] Hi, good af[PII]. Thank you for calling Benefits in a card. My name is [PII]. Who do I have the pleasure of speaking with?
[AGENT][NEUTRAL] Oh hi [PII], this is [PII] at APL. How are you doing today?
[CUSTOMER][POSITIVE] I'm good and yourself?
[AGENT][NEUTRAL] I'm doing fine, thank you. So I have an insured on the line who's calling uh regarding his premium.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm so sorry. Uh, his last name is [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And his first name is [PII].
[AGENT][NEUTRAL] His, uh, the last four of his social is [PII] and [PII] is spelled [PII]
[CUSTOMER][NEUTRAL] OK, you can put him through.
[AGENT][POSITIVE] OK. Well, thank you so much and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you. Bye-bye.