AccountId: 011433970860
ContactId: 11be52fd-d9c3-4276-aa46-2e0319a45940
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354720 ms
Total Talk Time (AGENT): 112069 ms
Total Talk Time (CUSTOMER): 167695 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/11be52fd-d9c3-4276-aa46-2e0319a45940_20250305T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, [PII]. My name is [PII], and I'm calling from the provider office looking for a payment status. I hope you have a great day today.
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] I am great. What about you?
[AGENT][POSITIVE] I'm doing good. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, please. The callback number is [PII].
[AGENT][NEUTRAL] That's their APL policy number?
[CUSTOMER][NEUTRAL] The APL policy, yes, yes. That's my callback number. So if we call disconnect then you can call me on this number.
[AGENT][NEUTRAL] Oh, I'm sorry, I'm sorry. OK, and then the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 421355.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Member's first name is [PII], that is [PII] and then the last name is [PII], and the middle name is [PII]. And the date of birth is [PII]. And the date of service I'm looking for is [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] The submitted amount was $344.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][POSITIVE] Sure, sure, no problem
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, provider's office name is Bear Family Dentistity and provider's tax ID number is [PII] and the address is [PII].
[AGENT][NEUTRAL] Alright, so I'm trying to receive the claim on Janu.
[CUSTOMER][NEUTRAL] Doctor's name is
[CUSTOMER][POSITIVE] Yes, yes, please continue.
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry. So I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] And what is the claim number of this?
[AGENT][NEUTRAL] The claim number is 3555981.
[CUSTOMER][NEUTRAL] And what is the game status of this game right now?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] On [PII], the claim was denied, and hold on one moment for the denial reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy does not provide benefits for any procedure or service not listed in the covered dental services and procedures, so it was a non-covered um service.
[CUSTOMER][NEUTRAL] OK, so the claim received and processed and denied on [PII], and it has been denied due to uh not a covered service, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And the codes on this claim is D0364. Could you please confirm that, ma'am?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] Yes, D 00364 is the code.
[CUSTOMER][NEUTRAL] D 0364, right?
[AGENT][NEUTRAL] Yes, the code is 00364.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please uh fax the EOB so it can be helpful for us to record in our system.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes, the fax number is [PII].
[CUSTOMER][POSITIVE] And could you please put the attention of my name on the fax so it will be helpful for me to get the fax very soon.
[AGENT][NEUTRAL] Sure, and [PII], what's the last first initial to your last name?
[CUSTOMER][NEUTRAL] That is [PII]
[AGENT][NEUTRAL] And the fax number, and the fax number was [PII].
[CUSTOMER][NEUTRAL] As in cat.
[CUSTOMER][POSITIVE] Yes, absolutely, [PII], absolutely.
[AGENT][POSITIVE] Alright, well I'll go ahead and send this over to you now and was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, could you please spell out your name for me and give me the reference number for this call, ma'am?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and that's [PII] The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for all the information you have just gave me. Uh, how much time it will take to get the fax, ma'am?
[AGENT][POSITIVE] Um, for faxes, for faxes, we usually say to give it at least an hour. If you haven't received it by end of day today, just let us know and we'll be more than happy to send, um send it to you again.
[CUSTOMER][NEUTRAL] The EOB via fax.
[CUSTOMER][POSITIVE] OK, OK, thank you so much again. I hope you have a great day take care thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APL.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][NEUTRAL] Bye bye.