AccountId: 011433970860
ContactId: fe0c982b-b6f0-4474-ad4d-7495818d79e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 917229 ms
Total Talk Time (AGENT): 459962 ms
Total Talk Time (CUSTOMER): 320975 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/fe0c982b-b6f0-4474-ad4d-7495818d79e4_20250508T19:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] Oh hey [PII] good how are you?
[CUSTOMER][MIXED] I am good. I do have an upset customer on the phone.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] Calling about a claim.
[AGENT][NEUTRAL] OK, um, are they just needing clarification on a claim or are they checking on it?
[CUSTOMER][NEGATIVE] Well, he, he says that it's a dental claim and the dentist's office called, was told that something was covered and how much it was gonna pay and now they're not paying it and he's owing $700 more than he thought he was and the last person he called before me hung up on him and but um.
[AGENT][NEUTRAL] Mm yikes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] 00 man, OK, fun. All right, um, do you have his name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] His name is [PII]. Policy number is 220.
[AGENT][NEUTRAL] [PII], uh huh.
[CUSTOMER][NEUTRAL] 1664. [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a callback number for him?
[CUSTOMER][NEUTRAL] And it's called that
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] Yeah, it's the one he's calling on.
[CUSTOMER][NEUTRAL] That [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got it. OK, thank you. All right.
[CUSTOMER][NEUTRAL] And he, he's fully verified.
[AGENT][POSITIVE] OK awesome thank you for that yep you go ahead and send him over.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright, here he is.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi [PII] how are you?
[CUSTOMER][POSITIVE] Not bad how are you?
[AGENT][NEUTRAL] Doing all right thank you uh so my name is [PII] and um [PII] had told me we're just needing uh information regarding a dental claim is that correct?
[CUSTOMER][NEUTRAL] There's 2 different appointments but once we got the procedure done, I was told that I owe a certain amount to walk out that door paying that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] 9 months later for appointment they say I owe money.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Send the EOB.
[AGENT][NEUTRAL] [PII], I'm really sorry, [PII], it's very difficult to hear you. I'm sorry.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Is that better?
[AGENT][NEUTRAL] Um, uh, could you say something again? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, so what happened was I was going to get a procedure done. I called the insurance company, told them what they would cover and this much and how much.
[CUSTOMER][NEUTRAL] I walked out
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] thinking like everything was good.
[CUSTOMER][NEGATIVE] Two different appointments like that. 9 months later they say, uh, things didn't get covered, so I sent them the EOBs. Then 2 weeks later they call me saying something didn't get covered for another appointment. I sent them the OBs for that and they get a call today saying that everything was paid and that I owe $700 almost out of pocket so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. Do you have those claim numbers, [PII]?
[CUSTOMER][NEUTRAL] So it's been a lot of back and forth.
[CUSTOMER][NEUTRAL] I don't. It was an appointment in June and then there was one more appointment after that.
[AGENT][NEUTRAL] OK, so this was specifically regarding 2 visits, correct?
[CUSTOMER][NEUTRAL] Two visits together equaling still $700 out of pocket.
[AGENT][NEUTRAL] Oh, OK, I understand, and you said that was in uh June of last year?
[CUSTOMER][NEUTRAL] June last year and then another appointment date I believe it was after the June so sometime between June and maybe December or something like that.
[AGENT][NEUTRAL] OK, bear with me just a moment let me take a look at these claims and see what I can find for you.
[CUSTOMER][NEUTRAL] Right, because they're saying that everything was paid or covered.
[CUSTOMER][POSITIVE] And I've already paid money walking out the door.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And now they're telling me I owe 700, so I was trying to do a three way phone call between them, me and you, and they hung up in between so.
[AGENT][NEUTRAL] Oh, OK, well, I am sure sorry about that. Let's see.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So I do see one from [PII]. Let me take a look at this one.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Yeah, that's one of the
[AGENT][NEUTRAL] This one I'm showing um registered as a duplicate so it looks like they tried to refile it bear with me just a moment.
[AGENT][NEUTRAL] OK, so I do show, um, I did find it it looks like the main claim uh for this um all the date of service was [PII], um, and we did pay a benefit on every procedure except for one which was for your bite wings and apparently that uh we weren't able to as it was two within the the time frame uh so bye wings for this policy are limited to 1 per 12 month period.
[AGENT][NEUTRAL] So it looks like there might have just been one other but still that's not that that's one that's one so give me just a moment let me try to find uh reasons for these others that was um $92 just so that you are aware and let me make a note of this claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not the biggest deal, but I'm still wondering why they talk to the insurance company you guys or whoever told me I would out of pocket with a a certain amount off out the door payment amount and then.
[CUSTOMER][NEGATIVE] You know, 10 months later I'm getting told $700 please.
[AGENT][POSITIVE] Sure and that's again I'm really sorry for the confusion um having not I I don't know what was said or anything like that but I do know that sometimes a lot of confusion can.
[CUSTOMER][NEUTRAL] I know it's not you personally.
[AGENT][NEUTRAL] Um, no, I get it, I, I, but I understand your frustration, um, so I do know in some cases some providers will simply ask, you know, is this procedure covered, and to which we'll answer yes, um, and you know sometimes they may not look at the frequencies, uh, so that's, that's a big issue there, but, um, continue bearing with me just a moment, [PII], let me try to find these others that could have denied.
[CUSTOMER][NEUTRAL] Yeah, at least you figured out something.
[AGENT][NEUTRAL] That's just one.
[CUSTOMER][POSITIVE] So like that's more progress than I've gotten in weeks, more progress than I've gotten in weeks.
[AGENT][NEGATIVE] I'm so sorry. This is, I know this can be such a headache.
[CUSTOMER][NEUTRAL] You know, $100 is a big deal.
[CUSTOMER][NEUTRAL] Whatever here you go, you know, but.
[AGENT][NEUTRAL] Right, and that's what I'm trying to look at.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Something else here.
[AGENT][NEUTRAL] So I do see another claim, uh, [PII], that was from this was from [PII] of last year, um, and for this one.
[CUSTOMER][NEUTRAL] Yeah, that was the other request.
[AGENT][NEUTRAL] OK, so for this one and this might be where a lot of the.
[AGENT][NEUTRAL] Back and came from so we did pay the original benefit. It does look like this claim was originally filed with us on [PII] of year however they seem to have not received the payment that we sent, uh, via check in the mail so I do see record where that check had been voided and reissued to the provider and that was let's see.
[AGENT][NEUTRAL] That was uh [PII], so if you'll give me one because we did pay those benefits and from what I see here there's nothing that we did not pay for this claim. So give me just a moment let me see if I can't track the check number down um because if there's a problem.
[CUSTOMER][NEUTRAL] Yeah, cause they're saying I owe something.
[AGENT][NEUTRAL] Yeah, if they're not receiving that then that's going to be not necessarily that we couldn't pay a benefit it's just, you know, obviously an issue with the payment. So let's try to identify that. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'm showing that this check cleared with them on [PII], um, so we're not quite through the weeds though unfortunately at this check was for $232 and again we did pay that so I'm trying to find.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Where they didn't pay or where they just haven't received something.
[CUSTOMER][NEUTRAL] Yeah, because they're saying I offer for both those appointment dates.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, um, have they, have they tried reaching out to us at all?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That you're aware of?
[CUSTOMER][NEUTRAL] I, I gave them the phone number they said they would but.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, um, let me see if I can find one of that.
[CUSTOMER][NEGATIVE] I just tried to do it 3 way where I will call you where I was on the phone with them and calling you. They can't even wait 5 seconds. I said alright, give me a minute. I'm calling them 3 way. I merged it immediately and they hung up, so I don't know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh my gosh, I let me see if I can't find any record of them trying to reach out.
[CUSTOMER][NEGATIVE] Yeah, it's a, it's been a headache.
[AGENT][NEUTRAL] I understand. So, and I will say that, [PII], I did look at all of the claims that you have with us. Um, the only one potential issue that I saw was that check was voided, but again they did receive that payment and it was cleared, uh, [PII] and then of course there was that other with um.
[AGENT][NEUTRAL] The uh bite wings that was just within that time but again that was only 90 call so give me just a moment let me take a look here.
[CUSTOMER][POSITIVE] Uh, I'd much rather just pay $100 to $700 so so far I think we're making progress here.
[AGENT][NEUTRAL] Well, that's something, but it does seem like there's.
[CUSTOMER][NEUTRAL] And then they didn't get one check you said.
[AGENT][NEUTRAL] There must be some kind of mix up um because uh from everything that we've received we've paid the benefits so if it's a matter of them you know maybe they.
[AGENT][NEUTRAL] I don't know if they misplaced it or they simply haven't received this and have reached out. That's why I really think we should talk to them. I will also say, [PII], um.
[AGENT][NEUTRAL] I don't see any record of them reaching out.
[AGENT][NEUTRAL] Except on let's see.
[AGENT][NEUTRAL] Last time we got a call from a provider regarding your account was uh [PII].
[AGENT][NEUTRAL] And they were trying to check on a claim that we had not yet received um and so we told them that we didn't received that claim um but I don't see any other record after the or after that so here's what I'm going to recommend um first off, I don't I'm sorry if this is repeated information, but just so that you are aware, um, have you created an account on our online portal?
[CUSTOMER][NEUTRAL] I'm not surprised.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, I do recommend doing that. I can send you I can send you these EOBs if you'd like a record of what we have received, um.
[CUSTOMER][NEUTRAL] No, yeah.
[CUSTOMER][NEUTRAL] I've already gotten them. I've already gotten them and sent them to them. I've already gotten those and sent them.
[AGENT][NEUTRAL] Oh, you have, OK, OK, so that's all that we've got, um, so if that's it.
[CUSTOMER][NEGATIVE] Yeah, and then even after getting them they called back and said I owed more money.
[CUSTOMER][NEUTRAL] Than they thought
[AGENT][NEUTRAL] Mm mm no. so again from what I see and you can, what I was saying is if you'd like to look, you know, you on the website, it shows all of these claims and what was paid specifically so you know, and if there was a mess up there, then you know obviously we'd be able to see it, but it looks like there's some sort of miscommunication, um, and we would have to speak with the provider at this point because from our end we, we pay everything except for those wings.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I mean, you're, you're coming in kind of choppy. I can still understand you, but if I get them on the phone right now, I don't know if that's choppy. Well, I can still understand you though it's still working, but I don't know if my 3 ways with them right now if they're gonna hear you, you know.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Well, that's, um, I don't know how far it is from you either, [PII], but if you'd like, uh, if it's easier, you can simply go there in person when you're able to and you know, give me a call or give us a call, um, and hand them the phone, you know, or if that's what it takes so that we can get this figured out for you.
[CUSTOMER][NEUTRAL] The thing is, is the, the, the dental office is down the road from my apartment, but I'm a trucker, so that's even harder. And then the insurance for the billing department is a different company in [PII] and I live in [PII].
[AGENT][NEUTRAL] Oh, sure, yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, I could try freewaying them right now. I don't know the answer.
[AGENT][NEUTRAL] I mean if you wanna try to get them on the line.
[AGENT][POSITIVE] You absolutely can, we can give it a shot for sure.
[CUSTOMER][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] Know your party's extension you may dial it now. Otherwise, please select from the following menu options. Press 1 to use our dial by name directory. Press 2 if you are calling to inquire about a recent charge on your bank statement. Press 3 if you would like to speak to a representative in our commercial sales department. Press 4 if you would like to speak to a representative in our medical sales department.
[CUSTOMER][NEUTRAL] For all other inquiries please press 0 or stay on.
[CUSTOMER][NEUTRAL] Please stay on the line while your call is transferred to the operator.
[CUSTOMER][NEUTRAL] Good afternoon how may I help you? Hi, I'm trying to get a hold of somebody for the uh dental.
[CUSTOMER][NEUTRAL] And how much I owe for that.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Get a hold of someone in reference to what again you said.
[CUSTOMER][NEUTRAL] Oh, OK, one moment.
[AGENT][NEUTRAL] I am here just so you know [PII] I'm just muting.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is not available to take your call. Please leave a message after the tone. Press the pound key to end recording.
[CUSTOMER][NEUTRAL] I don't know how to end
[CUSTOMER][NEGATIVE] Yeah, they didn't answer they're not ever good about that.
[AGENT][POSITIVE] That's OK if you ever wanna try again, um, that's perfectly fine again, we'll, we'll do what we can to get you to help you out with this.
[CUSTOMER][POSITIVE] Alright, I appreciate your time and help. Uh, do I give maybe you do I give you guys a phone number to reach out to them or something?
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Unfortunately we can't um but you know again if you're able to get a hold of them, give them our information or again just try to do a three way uh however we can.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright, thank you for your help.
[AGENT][POSITIVE] Alright, you are very welcome have a great rest of your day, [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][POSITIVE] Thank you. Bye-bye.