AccountId: 011433970860
ContactId: 165cf3c9-1341-4775-9537-739c20820453
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439399 ms
Total Talk Time (AGENT): 152769 ms
Total Talk Time (CUSTOMER): 179942 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/165cf3c9-1341-4775-9537-739c20820453_20250408T15:47_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], I need to uh basically inquire on
[CUSTOMER][NEUTRAL] Something that was declined through my dentist.
[AGENT][NEUTRAL] OK, it was like a claim that was sent in.
[CUSTOMER][NEUTRAL] Yeah, so it was a claim sent in a while back, but it was just recently declined. They said on [PII].
[AGENT][NEUTRAL] OK, um, let's take a look. Do you have the claim number, policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] So let's see for the insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the payer ID from the card, is that what you need?
[AGENT][NEUTRAL] No, the, the policy number, certificate number.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So I'm looking at group number employee ID.
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me make sure
[CUSTOMER][NEUTRAL] Multi-plan, so I've got about 4 different insurances on this one card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not sure what you need.
[AGENT][NEUTRAL] We can do let's see.
[AGENT][NEUTRAL] Uh, what's the last
[CUSTOMER][NEUTRAL] I'm, I'll give you my social. I don't care.
[AGENT][NEUTRAL] OK. Go ahead.
[CUSTOMER][NEUTRAL] I just wanna get this handled.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My social is [PII] and it's [PII]. The insurance was through my husband, but that's my info.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I can give you the amount and the date of service that's in question.
[AGENT][NEUTRAL] The letter that they sent you, did it have a claim number on it?
[AGENT][NEGATIVE] The denial.
[CUSTOMER][NEUTRAL] Um, it just has an account ID. I feel like the account ID is through the, uh, dental office though.
[AGENT][NEUTRAL] Yeah, it probably is.
[CUSTOMER][NEUTRAL] Yeah, I'm not looking at anything from the insurance company. I'm looking at the bill from the dental center and I'm looking at my insurance card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know if it's gonna come up by yours if he was a subscriber, but I'm giving it a search here. It's just been in one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's his first and last name?
[CUSTOMER][NEUTRAL] So uh my husband is [PII] He spells it a little different.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. It could be under [PII]. No, it is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], OK.
[CUSTOMER][NEUTRAL] His father's name is [PII]. So that's why she named it, that's why the spelling, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me try that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you. I appreciate your help.
[AGENT][NEUTRAL] Yeah, what state do you guys live in?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I think I found you here. Can I just verify your date of birth and address, please, [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm [PII] and our address is [PII].
[AGENT][POSITIVE] OK, perfect. Alright, let me go look at claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just let me know when you want the date. I have the the original date of service and the amount.
[AGENT][NEUTRAL] OK, what was the date of service?
[CUSTOMER][NEUTRAL] The date of service was actually [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] And then the dental company kept trying to get.
[CUSTOMER][NEUTRAL] Payment, I, the dental company says it was just a, a simple cleaning. I was in, within my time, you know, it wasn't too soon on the six-month deal.
[CUSTOMER][NEGATIVE] They said, I don't see any reason why the insurance didn't pay for it.
[AGENT][NEUTRAL] OK, let me see what's see here.
[CUSTOMER][NEUTRAL] And I paid every other cleaning, so it's kind of weird.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] OK, so I show two different claims were submitted for that date of service, um, the last one that I see under here that's showing a denial was processed, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It's only the denial was because it was a duplicate. It was already paid.
[AGENT][NEUTRAL] Uh, there was no denial for any other reason, just saying we've already paid that claim, so they had already, yeah, they had gotten payment back in [PII] for this. I don't know why they're submitting it now.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] OK, so they, can you tell me the date they received payment?
[AGENT][NEUTRAL] It was issued on [PII]. It would have been mailed out to them in the form of, yeah, it would have been mailed out in the form of a check, so it would have come, you know, obviously shortly after that.
[CUSTOMER][NEUTRAL] 7623. OK.
[CUSTOMER][POSITIVE] OK. Well, I will let them know and I appreciate your help. That's the mystery.
[AGENT][NEUTRAL] Yeah, not a problem, and they've cashed the check, [PII], so.
[CUSTOMER][NEUTRAL] OK. Tech is cash.
[AGENT][NEUTRAL] They, they got paid.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. I appreciate your help. And then um I'm just gonna, uh, you know, get the date and stuff. What's, what's your name? Do you mind, [PII]?
[AGENT][NEUTRAL] No, not at all. My, yeah.
[CUSTOMER][NEUTRAL] Sharing your name.
[AGENT][NEUTRAL] My name is [PII], which is spelled [PII] and then if you want my last initial to my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you. I'll just, you know, make a little more official when I let the dental office know. I appreciate your help. Thanks so much.
[AGENT][POSITIVE] Yeah, not a problem.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome. Have a blessed day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.