AccountId: 011433970860
ContactId: 7c910e5b-f2f3-4d23-80ae-c421ae9ada4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315480 ms
Total Talk Time (AGENT): 79815 ms
Total Talk Time (CUSTOMER): 122685 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/7c910e5b-f2f3-4d23-80ae-c421ae9ada4e_20250520T14:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from, uh, Oinia Healthcare, and I'm calling about some claims that's not being paid for a patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] Mhm my name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It is 023-388-00.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], his date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the data service and amount of the charge?
[CUSTOMER][NEGATIVE] That's ridiculous.
[CUSTOMER][NEUTRAL] The first one is um this was [PII] and I have another one for.
[CUSTOMER][NEUTRAL] [PII]. 0 wait, you said what's the charge? So the [PII], the charge is 128.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The uh [PII], the charge was.
[CUSTOMER][NEUTRAL] $353.75.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] And this is for dental
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Ofenia Healthcare.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, uh, show that both claims processes premium was not received for the data service, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Hold on, so when we call hold on.
[CUSTOMER][NEUTRAL] So he didn't pay his premium.
[AGENT][NEUTRAL] So the patient would need to contact benefits in a card um for any kind of eligibility and if they were eligible for that date, then they will send us information so the claims could be reprocessed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I ain't gonna pay that this last year claim.
[CUSTOMER][NEUTRAL] OK, so I want, OK, so is he a victim now?
[AGENT][NEUTRAL] Well, we're showing the policy is active. It's just for those two dates of service, they were not eligible.
[CUSTOMER][NEUTRAL] This is one of the.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] OK, um, let me see before I say he owed this money.
[CUSTOMER][NEUTRAL] What about um because I see he came in on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] This one was hold on let me make sure.
[CUSTOMER][NEUTRAL] Kind
[CUSTOMER][NEGATIVE] Why has this been sent out so many times.
[CUSTOMER][NEUTRAL] It was $353.75.
[AGENT][NEGATIVE] And I don't show that claim has been received.
[CUSTOMER][NEUTRAL] Not as yet, but it's, was he active?
[AGENT][NEUTRAL] Uh, the policy is active, but I don't show he was eligible for that data service.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] So he, he's not paying for this, OK, he's not paying for this, so we're gonna take this out.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got it. Alright, is it a reference number for the phone call?
[AGENT][NEUTRAL] Uh, no, ma'am. If you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, and what's your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, got it. All right, thank you so much for your help and your time. Enjoy the rest of your day. Stay safe.
[AGENT][POSITIVE] Uh, yes, ma'am. You too. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] OK, OK, bye bye.
[AGENT][NEUTRAL] Mhm.