AccountId: 011433970860
ContactId: 03349866-d325-4c42-999d-9c5abd5f9f16
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409160 ms
Total Talk Time (AGENT): 119012 ms
Total Talk Time (CUSTOMER): 123934 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/03349866-d325-4c42-999d-9c5abd5f9f16_20250114T22:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling you on behalf of provider offers for dental claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. And did you say your name is [PII]?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] [PII]. OK, [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then what is the patient's name, please?
[CUSTOMER][NEUTRAL] I got the patient name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] name.
[AGENT][NEUTRAL] OK and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] That you when I take.
[CUSTOMER][NEUTRAL] Policy number is checking. Just give me a moment, OK?
[AGENT][POSITIVE] Yes sir, take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 02437260.
[AGENT][NEUTRAL] OK, let me pull that policy up for us.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I've got the policy pulled up and what is the date of service?
[CUSTOMER][NEUTRAL] So is [PII].
[CUSTOMER][NEUTRAL] Looking for a claim.
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Charge amount is checking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Charge amount.
[CUSTOMER][NEUTRAL] It's for $1,014.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then what is the name of the facility?
[AGENT][NEUTRAL] Or physician that you're calling for?
[CUSTOMER][NEUTRAL] Chandler
[CUSTOMER][NEUTRAL] Chandler Modernantry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So why exactly?
[AGENT][NEUTRAL] [PII], I'm gonna put you on a brief hold so I can pull the claim in for you and I'll be right back.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So I did uh try to find the claim for you and I do not find a claim on file for that date of service for [PII].
[CUSTOMER][NEUTRAL] You don't see claim for [PII].
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK. Let me check.
[CUSTOMER][NEGATIVE] Uh, actually, this claim was denied.
[AGENT][NEGATIVE] I don't find it for the provider given.
[CUSTOMER][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] I have a claim on
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have a claim on file for that data service, but I do not have it for the facility that you gave me the name of.
[CUSTOMER][NEUTRAL] Chandler Modern Industry, that's the provider.
[AGENT][NEGATIVE] No, it's, it's not showing.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, [PII], that's correct.
[AGENT][NEUTRAL] Yes sir, let me pull it in. There's some remarks on the claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] It's saying that the patient was not eligible on the date of service.
[CUSTOMER][NEUTRAL] [PII], you mean dissipation was not there?
[AGENT][NEUTRAL] Right, it's just saying that the claim was the insurance was.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And it, it was denied for eligibility.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So patient plan was not active, right? When was this patient plan term?
[AGENT][NEUTRAL] For that date of service.
[AGENT][NEUTRAL] The effective date for the policy is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So why there's no payment for 92 of 24. Patient was active on the date of service, right?
[AGENT][NEUTRAL] Patient was active on the data service, but the way that this policy works, it's done weekly.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] So, the patient was not eligible on that data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem. Thank you very much for that information that you provided. You have a great day.
[AGENT][POSITIVE] You too, [PII] you have a blessed one thank you so much for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.