AccountId: 011433970860
ContactId: 1091a976-78ce-4b29-8ef7-9840e56dbda3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328459 ms
Total Talk Time (AGENT): 136147 ms
Total Talk Time (CUSTOMER): 98471 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/1091a976-78ce-4b29-8ef7-9840e56dbda3_20250516T16:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am calling from a dental provider's office regarding, um, correspondence that we received, um, for a couple claims just needing, um, to see if there's anything I can help with to, uh, process that the claims.
[AGENT][NEUTRAL] OK, so is this are the claims for the same patient or different patients that you're wanting to check on?
[CUSTOMER][NEUTRAL] Same same subscriber ID, um, two different patients.
[AGENT][POSITIVE] Yes, ma'am. I can look at these for you. I can help you with this, and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[AGENT][NEUTRAL] [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the policy number for the patients?
[CUSTOMER][NEUTRAL] Um, it would be for.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, first off, I need the policy number to locate their information.
[CUSTOMER][NEUTRAL] Oh, OK, the 02555701?
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get that information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah, the any information that is provided will be a verification of benefits and not a guarantee of payment. What are your patients' names and dates of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Um, date of birth is [PII] and um [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So, one moment.
[AGENT][NEUTRAL] OK, so for part 4, well, first off, any information that is provided will be a verification of benefits and not a guarantee of payment. What is, um, what is the data service first off for [PII]?
[CUSTOMER][NEUTRAL] Um, 416 of 25.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Um, $288.
[AGENT][NEUTRAL] And the claim number.
[CUSTOMER][NEUTRAL] Um, claim number, let's see if it's on the correspondence received.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a reference number.
[AGENT][NEUTRAL] OK, so first off, I don't have a claim on file for [PII].
[AGENT][NEUTRAL] You said it was for 416288?
[AGENT][NEUTRAL] Let me, let me redo, let me refresh something. Give me just one second.
[CUSTOMER][NEUTRAL] Um, data service for.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, give me just a moment.
[AGENT][NEUTRAL] OK, so it should be 359-7439.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And at this time, this claim has been denied and the reason for the denial at this point states on here that we are awaiting information.
[AGENT][NEUTRAL] To confirm eligibility for benefits and a card and upon receipt of this information, we will continue processing your claim.
[CUSTOMER][NEUTRAL] OK, and that needs to come from the um subscriber correct?
[AGENT][NEUTRAL] So it's in a holding employer, yes ma'am from their employer.
[CUSTOMER][POSITIVE] OK, and you guys send something out to them? OK, I'll reach out to the um subscriber as well then. Thank you for your help today. Have a good day.
[AGENT][NEUTRAL] We did, mhm.
[AGENT][NEUTRAL] OK, and then, now would you like for me to also check, that was for [PII]. Do you want me to check the other one?
[CUSTOMER][POSITIVE] Yeah, no, it's gonna be the same thing um I appreciate you though you have a good day.
[AGENT][NEUTRAL] Oh, OK. And one last thing, Ay, once the claims have been fully processed and even now you should be able to also have access to the explanation of benefits.
[AGENT][NEUTRAL] By going to our portal at [PII].
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] OK, well, you're welcome. So again, if that is all I can help you with, thank you so much for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye