AccountId: 011433970860
ContactId: 7296bc10-b87e-4986-ba52-efc2808a4bd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468119 ms
Total Talk Time (AGENT): 206862 ms
Total Talk Time (CUSTOMER): 107150 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/7296bc10-b87e-4986-ba52-efc2808a4bd8_20250122T20:53_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, this is [PII]. I'm calling from a dental provider's office. How are you?
[AGENT][POSITIVE] Hey, I'm doing wonderful thank you for asking how about yourself today?
[CUSTOMER][NEUTRAL] Good, I am calling about a patient's claim, a couple of them actually. I wanted to check on the status of their insurance coverage, with the effective dates were, um, beginning and ending.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that. Um, do you mind if, and you said your name was [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you mind, Miss [PII], if I get a quick call back number from you?
[CUSTOMER][NEUTRAL] Absolutely it's [PII].
[AGENT][POSITIVE] Wonderful. And what's, you said we're calling on a couple different policies or different information for one policy? Gotcha.
[CUSTOMER][NEUTRAL] It's the same same policy, same policy 2 patients, 2 claims.
[AGENT][POSITIVE] Perfect. OK, what is that policy number?
[CUSTOMER][NEUTRAL] 02510357
[AGENT][POSITIVE] OK perfect let me get that pulled up.
[AGENT][NEUTRAL] All right. And would you be able to verify both patients' first and last names and dates of birth?
[CUSTOMER][NEUTRAL] Yes, the first patient's first name is [PII], last name [PII].
[CUSTOMER][NEUTRAL] Her birthday is [PII].
[AGENT][POSITIVE] Perfect. And then that 2nd patient?
[CUSTOMER][NEUTRAL] The 2nd patient is [PII].
[CUSTOMER][POSITIVE] Definite
[CUSTOMER][NEUTRAL] And her birthday is [PII].
[AGENT][POSITIVE] Perfect thank you thank you and so for [PII] to start um do you know the claim number we wanna look at for [PII] or do you want us to search for it?
[CUSTOMER][NEUTRAL] Nope, I've got it right here. It's 355-1506.
[AGENT][NEUTRAL] You said 355-1506?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] I just noticed that there's a different policy number on [PII]'s.
[AGENT][NEUTRAL] Yeah, I just like I'm trying to find, I'm trying to find this policy. I'm so sorry, one second, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm actually I'm just gonna open a new tab and
[AGENT][NEUTRAL] Search it there.
[CUSTOMER][NEUTRAL] Yeah, because I have everything under [PII]'s policy, not one under [PII], but the claim has [PII].
[CUSTOMER][NEUTRAL] As the insured and different policy number.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] 28.
[AGENT][NEUTRAL] And just bear with me. Hang tight. I am.
[AGENT][NEUTRAL] Checking things out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so it looks like that policy number, [PII] was the subscriber at one point and it looks like it got put in under that policy instead of the policy she's now a dependent on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um.
[AGENT][NEUTRAL] It looks like, and I'm just.
[AGENT][NEUTRAL] You know,
[AGENT][NEGATIVE] It looks like it was denied because it was terminated after service or it says it was like serviced after coverage was terminated.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but it looks like she was active under this other policy instead, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me, I'm just going to like.
[AGENT][NEUTRAL] I'm gonna have somebody re-review that uh for the correct policy number, but would you mind reading me on that that claim number one more time?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, 3551506.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] The other claim that you want to look at, was it the same policy number as that first one?
[CUSTOMER][NEUTRAL] It's the one under [PII], the, the policy number I gave you.
[AGENT][NEUTRAL] OK, so then let's look at that one and that was for um.
[CUSTOMER][NEUTRAL] That was for [PII].
[AGENT][NEUTRAL] Aurora, OK.
[AGENT][NEUTRAL] And what's the policy number for hers?
[CUSTOMER][NEUTRAL] 02510357
[AGENT][NEUTRAL] I'm so sorry. Yes, I meant to ask what the claim number was.
[CUSTOMER][NEUTRAL] Oh sorry, yep, 355-0002.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And this was just for recently, I see.
[AGENT][NEUTRAL] Alright, so this one is just pending eligibility, um, and so.
[AGENT][NEUTRAL] With that one though like the employer group like communicates with us eligibility and sometimes they don't send it uh I don't know all the time I guess so we're just waiting for elig eligibility information from that employer group um and then it'll be able to be processed from there.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so then if that goes through, do you guys just automatically reprocess that at that time or do we have to resend it?
[AGENT][NEUTRAL] So they will automatically reprocess it so you don't have to worry as soon as they get the eligibility information from that employment group they will list the pending status and continue to reprocess.
[CUSTOMER][NEUTRAL] OK, alright, OK, that is all I needed for today.
[AGENT][POSITIVE] Oh, it's, I'm so glad I could help you. I will get a request for somebody to relook at that first um policy or that first claim we talked about for [PII] and hopefully you hear something back on that quite soon.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK sounds great I appreciate it thank you.
[AGENT][POSITIVE] My pleasure, thank you.
[CUSTOMER][NEUTRAL] Mhm bye.
[AGENT][NEUTRAL] Bye bye.