AccountId: 011433970860
ContactId: 7a864cac-485f-4dca-b36f-6eafed8e4a51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252520 ms
Total Talk Time (AGENT): 86269 ms
Total Talk Time (CUSTOMER): 49697 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/7a864cac-485f-4dca-b36f-6eafed8e4a51_20250326T21:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm trying to check um why a patient's claim got denied.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims and may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] You're calling from provider service company.
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] OK. And may I have your callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Sorry, one second, 616-994.
[AGENT][NEUTRAL] OK, uh, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's gonna be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] This is the dental.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yes, dental.
[AGENT][NEUTRAL] OK um what is the date of service for the claim?
[CUSTOMER][NEUTRAL] The data service is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it's for an oral examination.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so that was done.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the reason for that denial is because uh the oral examinations, um, I believe that's gonna be, let me see if it's once every 6 months or 2 per year. Give me just a second.
[CUSTOMER][POSITIVE] Say that one more time, I'm sorry.
[AGENT][NEUTRAL] Bear with me. I'm trying to locate the other claim to see why you denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, no, you're fine.
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] And this was, you said [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Still waiting on the system.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] OK, so it looks like this one is uh once every 6 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so, and there is one that we paid in [PII].
[AGENT][NEUTRAL] So [PII] of
[CUSTOMER][NEUTRAL] You said [PII], OK.
[AGENT][NEUTRAL] Uh-huh, yeah.
[CUSTOMER][NEUTRAL] So it it was just uh they weren't eligible because of the um frequency.
[AGENT][NEUTRAL] The date of service, because of the date of service, mhm yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, OK, well, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today, this morning?
[CUSTOMER][NEUTRAL] That was all.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.