AccountId: 011433970860
ContactId: 507bfc7a-0ba7-464d-8439-eda9e80c490c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745280 ms
Total Talk Time (AGENT): 224622 ms
Total Talk Time (CUSTOMER): 198941 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/507bfc7a-0ba7-464d-8439-eda9e80c490c_20250211T16:47_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Dandridge Dental. I'm sorry, can you say your name one more time?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII], thanks so much. Um, I, I had a question about, um,
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] One of our patients claims he came in and had a cleaning in December and um on the EOB it says a non covert service and I was just trying to figure out why it wasn't covered.
[CUSTOMER][NEUTRAL] Um, from his insurance breakdown, he is able to get cleaning and exam, well, cleanings every 6 months and an exam to per 12 month period.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Absolutely, so my callback number is [PII].
[CUSTOMER][NEUTRAL] And then the plan ID is 02200869.
[AGENT][NEUTRAL] Thank you. Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, so it is [PII]. His date of birth is [PII].
[AGENT][NEUTRAL] Thank you and [PII], could you verify the date of service that you're inquiring claims that questions are for the claim for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me the member's name and date of birth again.
[CUSTOMER][NEUTRAL] Yeah, no, uh, no problem. The first name is [PII].
[CUSTOMER][NEUTRAL] Um, that's [PII] The last name is [PII], that's [PII], and his date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You said the date of service was in [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] And you received the claim from us from the uh ELB.
[AGENT][NEGATIVE] And I'm not being funny when I say that.
[CUSTOMER][NEUTRAL] Oh no, you're fine.
[CUSTOMER][NEUTRAL] I get it.
[AGENT][NEUTRAL] Cause I'm not showing the claim on file. Are you sure that's from American Public Life?
[CUSTOMER][NEUTRAL] Mhm, yes ma'am. American Public Life Insurance Company [PII]. Well this might be part of the issue. Hold on.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] That sounds like an old claim. What is that claim number?
[CUSTOMER][NEUTRAL] Yeah, no problem. The claim number is 3550027.
[AGENT][NEUTRAL] 3550027.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] This is crazy.
[CUSTOMER][NEUTRAL] Is it something I need to fax in or email?
[AGENT][NEUTRAL] I'm just trying to verify these are the same individuals.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] 9284.
[AGENT][NEUTRAL] How the process
[AGENT][NEUTRAL] Bear with me. I'm researching [PII] cause it's me.
[CUSTOMER][NEUTRAL] Oh no, you're fine.
[AGENT][NEUTRAL] Because that policy number on that EOB is not the same. It's the policy number that you provided me with.
[CUSTOMER][NEUTRAL] OK, so let's let me look because.
[AGENT][NEUTRAL] And it looks like.
[CUSTOMER][NEUTRAL] Now his plan, OK, so his carrier plan ID.
[CUSTOMER][NEUTRAL] Looks different than the policy number on here.
[AGENT][POSITIVE] Right, this is, this right cause.
[CUSTOMER][NEUTRAL] That's interesting. Let me see now the policy number on the EOB is 101563745.
[AGENT][NEUTRAL] It's different
[CUSTOMER][NEUTRAL] Let me look at his smart um.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Because this was like the claim number that you gave me is under a medical policy.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] And of course, it wouldn't be covered on the medical policy cause it's for dental.
[CUSTOMER][NEGATIVE] And I, and honestly when I was looking at the remarks like the the remarks weren't making sense to me that's why I was calling mhm it says nope.
[AGENT][NEUTRAL] You said it was uncovered. I don't blame you. I would have called too.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] You just, I know, if I'm confused and I work for the insurance company, I can only imagine how you were.
[CUSTOMER][NEUTRAL] Yeah cause I was like I was like this don't even make sense but let me see.
[AGENT][NEUTRAL] So bear with me. I'm gonna send this back to the adjuster so that they can reprocess this claim.
[CUSTOMER][NEUTRAL] OK, and let me look back to make sure there's nothing we need to update because.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, she did. I don't know why she didn't search to see.
[AGENT][NEUTRAL] I place you on a brief hold.
[CUSTOMER][POSITIVE] Absolutely no problem at all.
[AGENT][POSITIVE] Thank you. I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hey, [PII], how you doing?
[AGENT][NEUTRAL] I'm good, thank you for asking. [PII]. I'm calling you about a claim. I have a provider on the phone, a dental provider on the phone calling about a claim. Could you pull up the policy? Let me know when you're ready for it.
[AGENT][NEUTRAL] It's 1563745.
[AGENT][NEUTRAL] Part one, claim ending in 0027.
[AGENT][NEUTRAL] Can I have that policy number?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What's the policy number? Cause it, my stuff went off of it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, they do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And put it in a dentalryl. Yup. That's why I called you instead of doing the error because I do know that um.
[AGENT][NEUTRAL] With the indexing, no telling what something to be attached to with the index.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] All right, thank you, [PII].
[AGENT][POSITIVE] You do the same. Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for holding. So I spoke to the adjuster. She is creating a new male number to reprocess this claim onto the under the dental care, under the dental policy.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate it because I like I said, I, I was, I was, I appreciate you. I appreciate you too.
[AGENT][NEUTRAL] Yes, ma'am. You're welcome, Miss [PII]. I had to research it because I was like, this is not a dental care with that claim. Well, I didn't see the claim under the dental policy, and I was like, you sure it was for this year? Because they don't have a claim submitted here since [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I was like let me just let me get the claim number so when I put the claim number in it showed that they used to have a gap insurance here with the insurance policy here with us, and it was just processed under the wrong policy, but they're working on it now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII]. I really appreciate your time. Is there a reference number for this call?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't provide those [PII]. However, you can use my name in today's date as a reference. Would you like for me to spell my name for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you would, please.
[AGENT][NEUTRAL] [PII], in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much I I appreciate your time and I will make a note.
[AGENT][POSITIVE] Alright, well, it was a pleasure speaking with you. Thanks for calling APL and have a great day, [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thanks, goodbye.