AccountId: 011433970860
ContactId: 73963190-01ed-4c6e-a86c-d5ba0fbb3126
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371149 ms
Total Talk Time (AGENT): 125674 ms
Total Talk Time (CUSTOMER): 108729 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/73963190-01ed-4c6e-a86c-d5ba0fbb3126_20250102T22:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Doing alright, thank you. I've got a member on the line, um, and she's calling regarding a claim. Uh, one of the procedure codes is just stating that it's not covered under her policy, um, and she's asking me what procedure it is and frankly it doesn't look like a dental procedure code that I've ever seen, so just wondering if you could help shed some light on that.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] It is 677-217.
[CUSTOMER][NEUTRAL] And this claim was for part one.
[AGENT][NEUTRAL] Part one OK for [PII], right, and what is that claim number please?
[CUSTOMER][NEUTRAL] Uh, it's 354-431-8.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you? Oh, I'm sorry. Oh.
[CUSTOMER][NEUTRAL] Oh sorry. Oh, that's me. No, I didn't know you wanted to talk to her. I'm sorry. Um, I don't know if you could just tell me what procedure. Sorry.
[AGENT][NEUTRAL] Oh, OK
[AGENT][POSITIVE] Oh, OK, what procedure is it? I'm so sorry. I'm so sorry. Sorry.
[CUSTOMER][NEUTRAL] No, you're perfectly fine. No, I appreciate it, but um, honestly I wouldn't mind learning if this is something, uh, screening lion or something that shows what each procedure is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is. It's um the screen is CL COD.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can you tell me right off that one, the 23931?
[AGENT][NEUTRAL] Yes, 23931. That should be, OK, 12.
[AGENT][NEUTRAL] Oh, OK, I think I see what she did. OK, give me one moment please. I'm so sorry. That's normally a filling, um, I do know that, but I think it may have been keyed and wrong, but.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[AGENT][NEGATIVE] The preceding number is supposed to be 0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I thought. OK, that's why I wanted to talk to you because I was like that doesn't even look like a dental procedure.
[AGENT][NEUTRAL] No, let me, let me just pull the claim up real quick. I'm so sorry. I'm so sorry. Uh, do you have it up real quick? Do you have it up to claim up?
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] I do have to climb up yes.
[AGENT][NEUTRAL] Oh, you do. OK, so for that procedure code, the 23931, is it 0239?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It just says 23931. That's all it's uh for this procedure so there are two others on there, but for this one it's the one that's saying it's not a covered procedure.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm thinking, OK, so do you have the actual claim up though, the actual claim?
[CUSTOMER][NEUTRAL] Um, I do on my end. Do you mean in on base?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, that would be smarter, huh?
[AGENT][NEGATIVE] No, no, no, no.
[CUSTOMER][NEUTRAL] I'm still recovering.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I still, I sold a holiday dragon.
[AGENT][NEUTRAL] OK, OK, 12 1924555555.
[CUSTOMER][NEUTRAL] OK, hang on, let's see.
[AGENT][NEUTRAL] 555. OK, it's it's finally oh no it's not coming up. OK, what is this?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it 155? I'm talking to myself now, OK.
[CUSTOMER][NEUTRAL] No, you're fine
[AGENT][NEUTRAL] 667217.
[AGENT][NEUTRAL] OK, that's 121924555.
[CUSTOMER][NEUTRAL] OK, I don't see what was actually sent to us um I see ours and that code.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is showing on our EOB but I don't see what was submitted to us.
[AGENT][POSITIVE] OK, that's because it was a, uh, this is an employee or past employee um claim. OK, so what's gonna, I can talk to Miss [PII]. Miss [PII] used to work here, so I can talk to Miss. Thank you so much for your patience.
[CUSTOMER][POSITIVE] OK, OK, well I appreciate you letting me know either way. No thank you. Alright, I'll hand it over. bye bye.
[AGENT][POSITIVE] OK, thank you, bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello, Miss [PII].
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?