AccountId: 011433970860
ContactId: 88b9a27f-a429-42bd-ad13-f04ffa11255e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226789 ms
Total Talk Time (AGENT): 107122 ms
Total Talk Time (CUSTOMER): 77836 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/88b9a27f-a429-42bd-ad13-f04ffa11255e_20250206T15:44_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling because we received um.
[CUSTOMER][NEUTRAL] This is this is not a bill, but I'm just trying to see um what is it for? I mean, are you like if we're gonna get a payment it's saying something about a card.
[AGENT][NEUTRAL] OK, I can help you with that. On that um letter, do you see the reference number or policy number or claim number?
[CUSTOMER][NEUTRAL] Let me see, well, reference number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 001604489
[AGENT][NEUTRAL] And what is your name please, ma'am?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You're with the provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], I hold on, sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, [PII], sorry, is it this one or this one?
[AGENT][NEUTRAL] Oh, do you have the claim number? I can tell you.
[AGENT][NEUTRAL] It should be under the reference number.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] 355-6977.
[AGENT][NEUTRAL] 697-7
[AGENT][NEUTRAL] OK, so that's gonna be.
[CUSTOMER][NEUTRAL] 697-7, yes.
[AGENT][NEUTRAL] OK, so that's gonna be for the dependent meno.
[CUSTOMER][NEUTRAL] OK, Mino one. OK, Mino 11.
[CUSTOMER][NEUTRAL] Let me see
[AGENT][NEUTRAL] And that's for data service [PII]?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] And what is the provider name, the dentist's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So with this claim they're just letting you know that we received the claim, however, we are waiting for eligibility from the third party administrator. Now once that is received, we will automatically go back and reprocess the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's just to let you know that we're just waiting for that.
[CUSTOMER][NEUTRAL] OK, so we don't have to.
[CUSTOMER][NEUTRAL] So we don't have to do anything, right? Just wait?
[AGENT][NEUTRAL] That's correct. And we have contacted the third party administrative for eligibility for that data service and once received, we'll automatically reprocess the claim or continue processing.
[CUSTOMER][NEUTRAL] OK, I just had a question. Um, mm, I think I, I guess the code 0274 they're not gonna pay for because it says patients responsibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All I'm seeing for that claim is that it's pending for eligibility. Let me check something else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I I'm showing that it is uh.
[AGENT][NEUTRAL] That the whole claim is pending for eligibility.
[CUSTOMER][POSITIVE] OK, OK, then we'll just, I'll just wait then I'll let her know. OK, that was all. Thank you very much.
[AGENT][NEUTRAL] [PII], is your callback number just in case, is it [PII]?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Alright, yes ma'am. Once we receive that, it will automatically be reprocessed and you will receive an updated EOB.
[CUSTOMER][POSITIVE] OK all right thank you very much.
[AGENT][POSITIVE] Thank you, [PII] for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.