AccountId: 011433970860
ContactId: 4c1b82e0-69f8-4669-9f8b-d8709f599538
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275739 ms
Total Talk Time (AGENT): 90558 ms
Total Talk Time (CUSTOMER): 98699 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/4c1b82e0-69f8-4669-9f8b-d8709f599538_20250609T18:41_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office Urban Dental. I want to check a claim status for a patient, please.
[AGENT][NEUTRAL] OK. Happy to check on a claim. Let me take a note here. Do we have the patient's policy number?
[CUSTOMER][POSITIVE] Oh yes it.
[CUSTOMER][NEUTRAL] Have right here.
[CUSTOMER][NEUTRAL] 02585551
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Thank you. And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] Yes, the service is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And then do we have a bill amount?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh yes, it is $713.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] Alright, thank you so much for your patience. So, uh, looks like the member's policy terminated as of [PII], so the claim was received. It was, however, denied just due to the fact that the patient was not eligible at the time of service.
[CUSTOMER][NEUTRAL] Oh, regarding on that one, we have the insurance verification form right here that it says there's no termination date for the patient's policy. Can we appeal this, can we, can we appeal this one?
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] You can definitely appeal it um I mean it looks like the insured had it through a staffing agency and employer, so they must no longer be with the employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] But if you'd like the appeal information, I'm happy to give it to you.
[CUSTOMER][NEUTRAL] Uh yes. Can I have the appeal's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII], [PII]. Zip code is [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm and you're gonna address it to APL attention claims department?
[AGENT][NEUTRAL] Uh, appeals must be filed within 180 days of the decision. This claim is processed on [PII].
[CUSTOMER][NEUTRAL] How many days again?
[AGENT][NEUTRAL] 180.
[CUSTOMER][NEUTRAL] And it was processed [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, yeah, OK, [PII], um, thank you so much for this one. I, I'm good. Uh, before I forgot, can I have the reference number for the call?
[AGENT][NEUTRAL] Uh, call reference is my name with today's date.
[CUSTOMER][POSITIVE] Today's date. OK, thank you so much, [PII]. Um, I think that sounds like a special assisting. You have a great day.
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.