AccountId: 011433970860
ContactId: 37979782-886e-42d0-befe-c8b4badf5834
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337799 ms
Total Talk Time (AGENT): 106924 ms
Total Talk Time (CUSTOMER): 162981 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/37979782-886e-42d0-befe-c8b4badf5834_20250620T14:32_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have [PII] from a dentist office on the line. Um, we were checking claim status and I was seeing for the claim for policy number 22.
[CUSTOMER][NEUTRAL] 83218
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEGATIVE] It's for 3-19 of 2025 and it shows that it was denied because it was a duplicate.
[CUSTOMER][NEUTRAL] However, whenever I looked at it, um, the only duplicate that I found because I just checked by a procedure code is the very next or the, the claim number that's right below it ending in 7864, and she said that one was for the lower and then the claim number 1881 was supposed to be for the upper.
[CUSTOMER][NEUTRAL] Um, so it's, it's not a duplicate, but I was wondering if you could, if you could check in on that because there's only one procedure code that was duplicated and that's because it was a separate part of the mouth.
[AGENT][NEUTRAL] Is it for the same data service though?
[CUSTOMER][NEGATIVE] But I wasn't able to find anything else.
[CUSTOMER][NEUTRAL] No, um.
[CUSTOMER][NEUTRAL] There there isn't any duplicate for the data service of 319.
[CUSTOMER][NEUTRAL] Uh 25.
[CUSTOMER][NEUTRAL] That's why I was confused and so I just decided to look it up by a procedure code.
[AGENT][NEUTRAL] No, we only, if, if it's a duplicate, it's gotta be the same day, same everything, so if it's not, then we just need to get that claim reprocess. Give me one second while I pull it up.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Come on on base.
[AGENT][NEUTRAL] 319.
[CUSTOMER][NEGATIVE] Yeah, my on base has been real tricky today.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Like all of our computers go off the weekend early and then Monday they're too tired to work.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, OK, let me check your records. OK, so she just needs to get that reprocessed.
[AGENT][NEUTRAL] OK, you can, you can either tell her or you can send her over and I'll let her know that we'll get it reprocessed.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and send her to you just so that she knows um one moment and I'll I'll uh I'll introduce you.
[AGENT][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Alright [PII] I have [PII] from claims and she's going to uh talk you through that, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, but you explained to him that this is not the first time that we call, we call on [PII] and they said it was gonna take the review for 5 business days.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] You can send her on over. I got her I got her. Thank you.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How are you?
[CUSTOMER][POSITIVE] Hi [PII] how are you? Good morning.
[AGENT][NEUTRAL] I'm doing well thanks for asking. OK, she stated that um you're calling about a claim for 3-19-2025 and uh the claim denied for being a duplicate.
[CUSTOMER][POSITIVE] Mhm correct.
[AGENT][NEUTRAL] And so I looked at it and I do not see that we have processed these charges previously so what I can do is go ahead and have this claim sent back for review.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Again.
[CUSTOMER][NEGATIVE] That's what they told me when I called on [PII]. They were gonna send it back to review and it was gonna take 5 business days and we are in [PII]. It's been more than 5 business days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I do apologize for that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So they didn't do anything since I called on [PII]?
[AGENT][NEUTRAL] No ma'am, it looks like it has not been.
[AGENT][NEUTRAL] Reprocessed.
[AGENT][NEUTRAL] Um, I'm gonna go ahead and
[CUSTOMER][NEUTRAL] I have the reference number if you want to.
[AGENT][NEUTRAL] Uh, I won't be able to locate it with the reference number. Uh, I'm gonna go ahead and send it over and we're gonna try to get it expedited on today, uh, and if you wanna check back on Monday.
[CUSTOMER][NEUTRAL] OK, I will because it's been a lot, a lot of time and you guys didn't do anything since [PII] when we call. It says that we're gonna send it back to review, so I hope you do it because it's just the same thing they told me that that time.
[AGENT][NEUTRAL] I do apologize.
[AGENT][NEUTRAL] OK, I do apologize, but I'll go ahead and send it back right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is what I need to do.
[AGENT][NEUTRAL] Uh, no, ma'am, there's nothing else that you need to do because we already have the claim in house.
[CUSTOMER][NEUTRAL] So when I call back on Monday, how do I do to spoke to your department directly or like how do I get in touch with you?
[AGENT][NEUTRAL] Um, whoever you call should be able to give you the status of the claim information.
[CUSTOMER][NEUTRAL] OK, and what was your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me know when you send it so we know we're done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I go ahead and send it back over right now.
[AGENT][NEUTRAL] OK, is there anything else I can help you with on today?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much, [PII]. Is there any reference number that I can take from this call?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] We don't do reference numbers, but you can use my name in today's date.
[CUSTOMER][POSITIVE] All right, thank you so much have a wonderful day.
[AGENT][POSITIVE] Alright you as well thank you.