AccountId: 011433970860
ContactId: 5ac0f48f-c405-48c3-a71e-342a658d6291
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337380 ms
Total Talk Time (AGENT): 154967 ms
Total Talk Time (CUSTOMER): 81357 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/5ac0f48f-c405-48c3-a71e-342a658d6291_20250116T18:33_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling from a dental provider's office, and I'm calling to check on a claim.
[AGENT][POSITIVE] OK, yeah, I'd certainly love to help you with the claim status today. Can I have your name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Perfect and do you mind if I get a good call back number from you real quick?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. And what's your member's policy number today, ma'am?
[CUSTOMER][NEUTRAL] The policy number I have on file is.
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 37
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 260.
[AGENT][POSITIVE] 26 perfect. And one second while I get that pulled on up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] And what is the.
[AGENT][NEUTRAL] Hold on, I'm sorry.
[AGENT][NEUTRAL] What is the date of service on the claim we want to look at today?
[CUSTOMER][NEUTRAL] It's going to be for.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 920 [PII], OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] All right, and can you verify for me, please, the name of the provider listed on this?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, I appreciate that. And I do see your claim here. I show that we received your claim on [PII]. No, I'm sorry.
[AGENT][NEUTRAL] I show that we received it 11:05 2024, and then.
[AGENT][NEUTRAL] We processed it the same day.
[AGENT][NEUTRAL] Um, I have the claim number listed as 3511715.
[AGENT][POSITIVE] And I do oh, I'm sorry.
[CUSTOMER][NEUTRAL] Um, let me go back.
[CUSTOMER][NEUTRAL] No, you're OK, go ahead, sorry.
[AGENT][NEUTRAL] No, don't be sorry. Um, I do have that the claim was denied, and I show the reason stating it's the same on all three, but it says our records indicate that premium for this service date was not received. Therefore, benefits are not payable. If premium is being paid through COBR, please contact us, and then it gives our contact information.
[CUSTOMER][NEUTRAL] So what what do you mean by a premium like her?
[CUSTOMER][NEUTRAL] Does that mean like her monthly payment or like her copay or?
[AGENT][NEUTRAL] Um, so it's like the monthly payment, um, with the group she's in, they evaluate it week over week instead of month over month and so every week it's different eligibility.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And so it looks like during that time period, they did not receive premium for that week on that data service.
[CUSTOMER][NEUTRAL] 2 weeks.
[CUSTOMER][NEUTRAL] From the group that she's part of.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Wow, OK.
[CUSTOMER][NEUTRAL] And what did we, so because I'm expecting a total of 365, do you see that?
[CUSTOMER][NEUTRAL] For that data service 9 2024.
[AGENT][NEUTRAL] Um, hold on, let me go back to the claim.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] I guess I'm seeing the total being like a lot higher for all three charges.
[CUSTOMER][NEUTRAL] Oh let me go back let me see, sorry.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] 127 $238 and 165 $530.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Yeah, so I, I definitely see like that's what was charged. We just don't have any benefits payable for.
[AGENT][NEUTRAL] For for the patient.
[CUSTOMER][NEUTRAL] OK alright well um I'll reach out to the patient.
[AGENT][POSITIVE] OK, perfect. Is there anything else I can do to help you, Miss [PII]?
[CUSTOMER][NEUTRAL] No, the, oh, what was your name again?
[AGENT][NEUTRAL] Oh yeah, it's [PII], first initial, last name, [PII].
[CUSTOMER][NEUTRAL] OK, and do you by chance have a reference number for me?
[AGENT][NEUTRAL] It's just gonna be my name in today's date.
[CUSTOMER][NEUTRAL] Full year, so 2025.
[AGENT][NEUTRAL] You bet you.
[CUSTOMER][POSITIVE] OK perfect I'll go ahead and we'll reach out to the patient.
[AGENT][POSITIVE] Alrighty, so you have a wonderful day and if there's anything else we can do to help you, please reach out to us, OK?
[CUSTOMER][POSITIVE] Thank you you as well alright thank you.
[AGENT][POSITIVE] My pleasure. No, you're OK. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK bye