AccountId: 011433970860
ContactId: 2caf5ac9-5f53-4fe4-9233-4fc20908d81c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 646450 ms
Total Talk Time (AGENT): 283235 ms
Total Talk Time (CUSTOMER): 201161 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/2caf5ac9-5f53-4fe4-9233-4fc20908d81c_20250224T15:52_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][NEUTRAL] Yes, hey, [PII], this is [PII]. Um, I was calling in reference to, um, uh, my dentist, they sent me a note saying that uh they were having problems getting the insurance.
[AGENT][NEUTRAL] Problems getting the insurance. OK. Um, well, I can, I can help you. Um, [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I don't have the policy number. I'm at work right now, but my, uh, phone number is [PII].
[AGENT][POSITIVE] Thank you for
[CUSTOMER][NEUTRAL] And it's for Doctor [PII] in [PII].
[AGENT][NEUTRAL] OK, I can also look the policy up with your social.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It might have been uh maybe because my credit card had expired and I got a new one. I don't know.
[AGENT][NEUTRAL] Like the, well, I'm gonna see if it's um you mean like your if your premium came out or anything? Is that what you mean?
[AGENT][NEUTRAL] For the insurance, or you mean at the dentist?
[CUSTOMER][NEUTRAL] Um, they, they just said that, that, um, they had a message for me to call and check out the insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I just found your policy. Hold on one moment, I'm bringing it up now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Let's see, date of birth [PII]. It's [PII].
[AGENT][NEUTRAL] And your mailing address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, sorry, this one is actually a physical address?
[CUSTOMER][NEUTRAL] Um, is it [PII]?
[AGENT][NEUTRAL] No, this one is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK, that's an old one.
[AGENT][NEUTRAL] OK, do we need to update your address?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what would you like me to update it to?
[CUSTOMER][NEUTRAL] OK, and it has to be a physical address?
[AGENT][NEUTRAL] No, it can be a [PII].
[CUSTOMER][NEUTRAL] Oh OK then I'll keep it at the [PII].
[AGENT][NEUTRAL] Well, it's not on file, but I add it. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm. [PII] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is the [PII] the best number to reach you on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I've updated your um information here and then which um are they trying to, have they sent in a claim and it's been denied or what do they mean they are having a hard time getting the insurance?
[CUSTOMER][NEUTRAL] Um, I guess so. I, I, I don't know. She just left a message telling me to call my insurance company.
[AGENT][NEUTRAL] Is there a way that we can give them a call? I don't know what they're looking for.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] Sure, sure, um, just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can call them on 3 way if you like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Hello. OK, I'm ready for the number whenever you're you're ready.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII] and that's Doctor [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I call him on the other line?
[CUSTOMER][NEUTRAL] Oh no, no, no, that's fine, and if we get if we get disconnected then you'll call me back.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][POSITIVE] Yes, ma'am, I will.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling River General Office of Doctor [PII]. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling from APL. Um, we have a mutual patient and she received a voicemail stating to call her insurance company, but we don't know what for. I am with the insurance company. I'm just trying to see what y'all need.
[CUSTOMER][NEUTRAL] What was the patient's name?
[AGENT][NEUTRAL] Um, her name is, oh, sorry, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So she had a rejected explanation of benefits for [PII]. The reason given was awaiting information from patient lawyer slash association, um, so it sounds like you guys need more information to process the claim.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Rejected it.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] Data service was [PII].
[AGENT][NEUTRAL] OK, I see it here.
[CUSTOMER][NEUTRAL] I have the claim number.
[AGENT][NEUTRAL] No, I have it here. Um, I see what it is. I'll explain it to her. Thank you. I just didn't know what the request was. So thank you.
[CUSTOMER][NEUTRAL] Yeah, do we need to reprocess it if you have the information you needed?
[AGENT][NEUTRAL] No, so basically this is just saying because of the type of employer, it's a uh like a temp agency, so we have to check each week to make sure they're eligible still for their benefits. It's just we have to do that with all um like temp accounts because you know how the assignments may change. So that's all that saying they're waiting, we're waiting for the employer to confirm the eligibility for your data service so we can pay out on the claim.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, got you. I thought maybe HR hadn't provided some of the patients.
[AGENT][NEGATIVE] Oh, no, no.
[CUSTOMER][POSITIVE] Alright well thank you for the follow up I appreciate you.
[AGENT][POSITIVE] All right, you're welcome. Have a good day.
[AGENT][NEUTRAL] OK, hello, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so, um, they have everything they need. So basically that it's just saying we're waiting for benefits in a card to let us know that the benefits um are eligible or that you're eligible for benefits. We have to do this for everyone weekly. So, um, once they send the response back, we automatically begin to uh or continue the claim, processing the claim.
[CUSTOMER][NEUTRAL] OK, and who are you waiting for to call you back?
[AGENT][NEUTRAL] So we're waiting for benefits in a card. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But
[AGENT][NEGATIVE] Hold on, now that I'm looking at this, I mean, that is the reason that it is on the explanation of benefits, but now that I'm looking at it, right, it doesn't make sense. Um.
[CUSTOMER][NEUTRAL] OK, because I'm retired.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I never had that problem, you know, before.
[AGENT][NEUTRAL] So hold on.
[AGENT][NEUTRAL] Yeah, let me send this back. I'm gonna send this back to be reprocessed, um.
[AGENT][NEUTRAL] And get a new decision because
[AGENT][NEUTRAL] That wouldn't apply to this. So I don't know if this is an I mean, clearly it's an error, but I don't, they need to reprocess this. Um, I'll go ahead and send this back to claims for reprocessing and then they'll um provide your dentist with a new, um,
[AGENT][NEUTRAL] Decision. Sorry, I couldn't get it out.
[CUSTOMER][NEUTRAL] OK, so there's nothing that I need to do?
[AGENT][NEUTRAL] And then you
[AGENT][NEUTRAL] No, um, you'll also receive an explanation of benefits once it's completed, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just reading the notes to see if I missed anything. No, that, it just doesn't make, because you're on bank draft, so it doesn't even go to the employer anymore. OK, yeah, I'm gonna go ahead and send this over. But no, there's nothing that you need to do. Um, you'll just receive the explanation of benefits, um, and the dentist will also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I have an appointment tomorrow, so I don't want them, you know, um, to not take me.
[AGENT][NEUTRAL] I'm gonna make this urgent, um, urgent.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome and hopefully we can get a response today. Uh, I'm gonna put in there that you have an appointment tomorrow and this needs to be figured out before then.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] So that we don't get it rejected.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate the expedition on this.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That was it. You've been so kind and helpful.
[AGENT][POSITIVE] Well, thank you, Ms. [PII]. I appreciate you and thanks for calling APL. I hope you have a great week.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.