AccountId: 011433970860
ContactId: f3cfa8d5-8ab3-4312-a7c4-24d7be8d2c34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522799 ms
Total Talk Time (AGENT): 215558 ms
Total Talk Time (CUSTOMER): 236175 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/f3cfa8d5-8ab3-4312-a7c4-24d7be8d2c34_20250624T12:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi sir, my name is [PII]. The policy is under my husband [PII]. I'm calling to inquire about a claim that was for last year. We got additional billing sent to us a couple days ago.
[CUSTOMER][NEUTRAL] And we just don't think the amount is fair or right.
[AGENT][NEUTRAL] OK, let's take a look.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] Do you have the claim number or the policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, hang on a second. I'm just gonna pull it up on the message.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Try to look him up. There he is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I know the date it was [PII].
[CUSTOMER][NEGATIVE] No I'm going back.
[AGENT][NEUTRAL] OK. Do you have your guys' policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] No, no, not on hand, no, I don't, sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give you her social.
[AGENT][NEUTRAL] OK, that works. What's the social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright. Thank you. Give me just a moment here, let me do a search.
[AGENT][NEUTRAL] And what's the last name?
[CUSTOMER][NEUTRAL] [PII] Birth date is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And was this data of service for you or was it for him?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For him.
[AGENT][NEUTRAL] For him.
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the name is, uh, urgent Dental Service Center.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] It is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It really all went out, you know.
[CUSTOMER][NEUTRAL] They're telling us that we still owe $610.
[CUSTOMER][NEUTRAL] We paid
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We paid a total of $955.20 that day off our Merit card.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They sent us the bill, OK, I'm sorry, the bill that they sent us saying that we still owe $210.40.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm sorry, we already paid 900 and something dollars for an urgent visit.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because East Indieden was wasn't available.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So I do see a claim from them. The only thing that I show was denied.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was an X-ray and it's just because limited to 1 X-ray per 5 years.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well, we
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] I can send you a copy of the EOB from the date of service to show you what we covered, but we didn't deny the entire thing from what they sent.
[CUSTOMER][NEUTRAL] They had
[AGENT][NEUTRAL] I mean, they were sent
[CUSTOMER][NEUTRAL] But we paid 900, we paid $955.
[AGENT][NEUTRAL] Hang on.
[CUSTOMER][NEUTRAL] Did you not get that amount paid towards it?
[AGENT][NEUTRAL] I mean, I only
[CUSTOMER][NEUTRAL] I have a
[AGENT][NEGATIVE] I only can show what what they submitted to us and what we paid to them, you know, that's all I can see. They don't they don't show us what you paid out of pocket.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] So we could have already paid the X-ray fee and.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They just forgot about it or something?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Maybe, um, I'm, I'm just saying that's the only thing on that date of service that I see that we didn't cover and that was just because he probably had already had an X-ray within that five-year period of time, you know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] He, he did, and they refused to use East Indies dental record because East Indies sent them.
[CUSTOMER][NEUTRAL] His dental records?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Cause they were closed that day. They refused to use it, and so they did it again.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] Which isn't fair on us, because he argued with him on. We were aware of the five-year thing.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And we, and we told him.
[AGENT][NEUTRAL] So, I'm just stating that that's the only thing that I see that we received that we denied was not a covered service or benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, whatever.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, difference that they're charging you or saying that you still owe. Um, I would definitely be asking for a breakdown of that, say, well, I already paid you X amount of dollars and I know the insurance has paid you, so where are you coming up with this number from?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, can you email me the EOB? Is that possible?
[AGENT][POSITIVE] Yeah, yeah, yeah, yeah, absolutely.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And I have my burn and it really.
[AGENT][NEUTRAL] It's a Yahoo email that's on file. Is that, is that still correct?
[CUSTOMER][NEUTRAL] Yes, do you have suits, Tiffany or Delbert suits I didn't know which one you had.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, let me
[AGENT][NEUTRAL] Oh, I'm sorry. Let me go back here.
[AGENT][NEUTRAL] It is [PII]. Is it OK to send it there? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, I'll send the explanation of benefits to you um now via email and that way you have that and um yeah, definitely ask them for.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] They need to, you know, explain where that's coming from.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, we need to break down because it's just we paid $955.
[CUSTOMER][NEUTRAL] We're pretty sure that included the X-ray that we told them no to, but they did anyway.
[AGENT][POSITIVE] Right, I mean, I feel like that more than covers that for sure. So, and like I, you know, and we definitely send them a payment, so yeah, they need to show where they're coming from with that, so.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, I appreciate the help. I really do.
[AGENT][NEUTRAL] Anything else? Yeah. No, not a problem. Is there anything else?
[CUSTOMER][NEUTRAL] No, that was
[CUSTOMER][NEUTRAL] We're all, we're all, everything else has been covered, right? He wanted to know how much he left, uh, are you able to tell me how much he has left for his benefits this for this year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For this year, let's see.
[CUSTOMER][NEUTRAL] Cause he has more teeth, yeah, he has more teeth distractions to get done.
[AGENT][NEUTRAL] 625. Yeah, everything else I saw had been paid, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I a.
[AGENT][NEUTRAL] He still has a calendar year amount left of $1,185.60.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um and we are big.
[CUSTOMER][NEUTRAL] OK, I'll let him know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you. Appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Uh