AccountId: 011433970860
ContactId: 41346fc1-7ccc-4fb6-83d6-35e1ae5d1bf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347500 ms
Total Talk Time (AGENT): 136063 ms
Total Talk Time (CUSTOMER): 68003 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/41346fc1-7ccc-4fb6-83d6-35e1ae5d1bf7_20250606T18:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from dental office checking claim status. Could you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're needing claim status on a dental policy, is that correct?
[CUSTOMER][POSITIVE] Yes. Uh-huh. Great.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Oh sure. The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient's policy number is 02457480.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then any information that is provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes [PII]. The patient name is [PII]. Date of birth on [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] So the claim detail is on [PII]. The submitted amount of $954 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so I do show that this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 7159.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $346 even.
[AGENT][NEUTRAL] And that was paid on single check [PII].
[CUSTOMER][NEUTRAL] And the payment date.
[AGENT][NEUTRAL] Same date as the process date?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It checks in data.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] OK. I'm asking to check mail date.
[AGENT][NEUTRAL] So that check processed on the [PII], which was a Friday, so it would not have been mailed out until the following Monday.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] We're not open on the weekends, [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. Can I get the uh patient responsibility on this claim?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, then you can print that from our portal using that claim number if you go to [PII].
[CUSTOMER][NEUTRAL] Thank you. Uh, I just want to know the last, uh, one more information, like any denial on this claim?
[AGENT][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK. May I know the code?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So on code 9944 that was denied, the policy does not provide benefits for any procedure or service not listed in the schedule, and that remark would be on your explanation of benefits once you print it.
[AGENT][NEUTRAL] And then, I'm sorry, let me go back.
[AGENT][POSITIVE] Yes, that's, that's correct for that code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on code.
[CUSTOMER][NEUTRAL] 9944 is non-covered.
[AGENT][POSITIVE] That's correct. Mhm.
[CUSTOMER][NEUTRAL] Thank you. Can I get the reference number for this call?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, yes, one moment. The reference number on this for this call, [PII] would be my name along with today's date.
[CUSTOMER][POSITIVE] Fine, [PII]. And really, thank you so much for just a wonderful day. Thank you.
[AGENT][POSITIVE] Oh, you're welcome. Yes. Can I help you with anything else?
[CUSTOMER][POSITIVE] More today. Thank you.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] Oh, thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.