AccountId: 011433970860
ContactId: 40095364-bba0-42f9-9fd7-9c4d33fe3366
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267739 ms
Total Talk Time (AGENT): 92748 ms
Total Talk Time (CUSTOMER): 120953 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/40095364-bba0-42f9-9fd7-9c4d33fe3366_20250613T13:40_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], my name's [PII] and I'm calling from Carolina Center for Endedonics. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Good good I'm calling in reference to a claim for a patient.
[AGENT][NEUTRAL] OK, I can help you with claim status. Um, and did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Oh like in November.
[CUSTOMER][NEUTRAL] Um, good question. I'm looking, sorry, um, you want the patient ID number?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um, it might say a policy certificate number or benefits number.
[AGENT][NEUTRAL] Typically a 01 or 02.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Yeah, it's 01.
[CUSTOMER][NEUTRAL] 628-999 I think.
[AGENT][NEUTRAL] Alright, let me look.
[CUSTOMER][NEUTRAL] Because you make primary.
[CUSTOMER][NEUTRAL] They should, so I cannot build up because you're I can right and deny it without without that you will be unless you can the EOB.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Of course [PII].
[CUSTOMER][NEUTRAL] Actually, it's [PII].
[AGENT][NEUTRAL] OK, and what is her date of birth?
[CUSTOMER][NEGATIVE] You haven't got nothing from them.
[CUSTOMER][NEUTRAL] Oh goodness, too many screens uh [PII] or [PII] sorry, I used to work in [PII] and I'm, I just recently moved here and they are in a different program than I am, so it's slightly different than what I the way I'm used to looking at it. So in case you're like, what is why is this lady sounds like she has no clue because I kind of don't, but I'm figuring it out.
[AGENT][NEUTRAL] OK, that's OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's OK. Um, let me see, do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, there's two data services. One is from 42 and one is from 423, and I have the claim number for both.
[AGENT][NEUTRAL] OK, that's the claim number.
[CUSTOMER][NEUTRAL] 32319 is one of them. They were both sent by e-claims.
[AGENT][NEUTRAL] OK, our numbers are a little bit longer, so I'll look it up by date of service.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's what I kind of figured, so that's why I was like, it might be different. That's usually how it works with the claim, so sorry about that.
[AGENT][NEUTRAL] And you said it was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] Alright, it looks like we received the claim. I'm going on [PII]. Uh, it looks like we received that claim on uh [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It looks like that claim was denied.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The services were rendered after the termination of coverage.
[AGENT][NEUTRAL] So I imagine that will be your.
[AGENT][NEUTRAL] The claim status for for all of them.
[CUSTOMER][NEUTRAL] OK, and when was her termination?
[AGENT][NEUTRAL] Uh, it looks like this policy lapsed on [PII].
[AGENT][NEUTRAL] Let me see, and she doesn't have any other policies with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I assume that's gonna say the exact same thing for that second claim then.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, all right, then I will go ahead and.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Alright thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You also thank you bye bye.
[AGENT][NEUTRAL] Right, bye.