AccountId: 011433970860
ContactId: f3ca5cb0-e5e4-410f-8f65-26e5dcc7f83c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722460 ms
Total Talk Time (AGENT): 234469 ms
Total Talk Time (CUSTOMER): 240641 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/f3ca5cb0-e5e4-410f-8f65-26e5dcc7f83c_20250620T15:24_UTC.wav
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[CUSTOMER][NEUTRAL] going on
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, um, we need to uh talk with someone about some claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claims. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Go ahead, [PII]. Tell them your information. Uh, I just, just said [PII], when she's ready for the last name, I'll tell her.
[AGENT][POSITIVE] I'm ready for the last name and a good contact number in case we're disconnected.
[CUSTOMER][NEUTRAL] No barrier, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01471302.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, and um Mr. [PII], can you verify your date of birth, mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, mailing address is [PII]. Yeah, there you go.
[AGENT][NEUTRAL] And the email address.
[CUSTOMER][NEUTRAL] I'm thinking of the old one.
[CUSTOMER][NEUTRAL] Uh, should be [PII] OK Dodge. No, let me, it's under mine because I have to handle everything. It's [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] OK, so [PII] had teeth pulled in [PII].
[CUSTOMER][NEUTRAL] And he still has not received his permanent dentures. Well, we filed a claim and I see where they're um not gonna pay on one of the claims and we're trying to find out why they're not gonna pay one of the claims and if because he hasn't received his permits, do we have to resubmit for his permanent dentures?
[AGENT][NEUTRAL] OK, hold on one moment, so let me look at this claim.
[CUSTOMER][NEUTRAL] Because we, um, they're sending us a check but I don't want to cash it and if it's gonna create a problem to submit the second claim.
[AGENT][NEUTRAL] Hold on one moment, I'm just looking at the claim that's been processed, and this is the last claim, um, from [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oops I click on the wrong one.
[AGENT][NEUTRAL] So, if you, OK, so you're saying because the benefits were exhausted, if you resubmit it, will it be covered then? Am I getting that right?
[CUSTOMER][NEUTRAL] No, no, no, no, what I'm trying to find out is, um, OK, so I believe the dentist office, um, put down that he has his permanent dentures. He does not have them yet. He doesn't even get them until Tuesday, so I'm wondering if they are going to pay where he had his teeth pulled for 2024 and then also pay for his dentures that he's receiving in 25.
[CUSTOMER][NEUTRAL] Because they made us pay upfront for everything. So I don't know if it looks like everything was done because it wasn't in 20, everything wasn't done in 24.
[AGENT][NEUTRAL] OK, so the last claim that we processed in 24 was denied because all of the benefits were exhausted. So whatever he does in 25, that's gonna most likely be covered because his benefits are gonna start over in January.
[CUSTOMER][NEUTRAL] OK, so when he gets his permanent teeth, they need to give us another receipt for us to submit because they don't do it. We have to do that for his dentures.
[AGENT][NEUTRAL] For the denture, yes, ma'am. So when he goes back, um, whatever he's doing for next year, when he goes back, yes, just submit it like you did this, and yes, he should, um,
[AGENT][POSITIVE] We should be able to pay out on it because January everything restarts, so he'll have that full balance again.
[CUSTOMER][NEUTRAL] OK, now can you tell me by looking at that, did they put his dentures, his permanent on that receipt or did they not?
[AGENT][NEUTRAL] Um, let me pull up the documents. Hold on one second.
[AGENT][NEUTRAL] Because this is just what we did. Let me see what they sent in. Hold on one second.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, it's coming up now.
[AGENT][NEUTRAL] It's about 5 pages. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Where is the bill? Do you mind if I place you on just a brief hold? I'm just looking through these documents.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Oh, actually, hold on, I just found it.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Yes, I see, I see the dentures on here, um.
[AGENT][POSITIVE] Immediate.
[CUSTOMER][NEUTRAL] OK, because when I talked to the lady at the dentist office, she said that it should have been, um, I think she called it intermediate, which was not permanent dentures.
[CUSTOMER][NEUTRAL] Because he still has not got his permanent dentures, so I don't know how there could have been a claim on them yet because the teeth pulling was for 24, which is what we submitted. Now I'm trying to make sure we can submit his dentures for 25.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] For 25. Let me see if I can tell between these cause all I, all it says is immediate denture. I'm trying to see if I can see if maybe these are the temporary, I'm trying to see if, you know, which one, if it's the temporary or the permanent, so we'll know for next year.
[CUSTOMER][NEUTRAL] Yeah, because
[CUSTOMER][NEUTRAL] Yeah, because, well the dentist said that those were the those were considered temporary.
[CUSTOMER][NEUTRAL] But I'm not trying to file a claim in [PII]. I want to file the claim for his interest in 25.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Alright, let me see, I'm gonna see because there's two separate, so they both say [PII]. 1 says immediate denture, maxillary, the other says immediate denture mandibular. So I'm trying to see what's the difference between the two. do you mind if I place you on just a brief hold while I try to figure this out?
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Because if they're permanent, uh oh.
[AGENT][NEUTRAL] G
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] Because this is all
[AGENT][NEUTRAL] That's why it wasn't covered, not because of what it was, but because there was no more benefits. Anywho, let me get to these are dental codes so I don't know that that's gonna work and the easiest thing to do is pull up the fax back. So let's do that and then see if I can see the code on the fax back and see if that, yup, good idea, you know.
[AGENT][NEUTRAL] Oh, I'm tripping.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] P I BFT.
[AGENT][NEUTRAL] UTBA.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Come get me. I'm like, yeah, good luck with that.
[AGENT][NEUTRAL] Alright, hello.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, so I have, thank you all so much for holding. So I figured out what these are. So this is um this year for [PII] is the um temporary.
[CUSTOMER][NEUTRAL] OK, so, so now he goes on.
[AGENT][NEUTRAL] When we see it.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Oh no, you're fine. I was gonna say when we on your bill when it says complete denture, then those are the permanent ones.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, so since he goes Monday to get his permanent, then we can submit that claim, correct for [PII]?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] OK, and my other question is, um, is it OK for us to cash the check that is supposed to be here today?
[CUSTOMER][NEUTRAL] That's not gonna interfere with another submission since it's supposed to cover for [PII].
[AGENT][NEUTRAL] Yeah, um, you shouldn't have any issues with that check because what you bill or what you send in for the permanent, that's a whole another calendar year. So they should they.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They wouldn't affect each other.
[CUSTOMER][POSITIVE] OK awesome awesome all right well [PII], did you have any more questions?
[CUSTOMER][POSITIVE] All right. Well, thank you so much for your time.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APL. I hope you all have a great weekend.
[CUSTOMER][POSITIVE] Alright you too thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.