AccountId: 011433970860
ContactId: 8db23f29-6b1e-4d14-ae8f-19066aed52ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380000 ms
Total Talk Time (AGENT): 157262 ms
Total Talk Time (CUSTOMER): 79058 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/8db23f29-6b1e-4d14-ae8f-19066aed52ea_20250515T21:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, so my name is [PII]. I'm calling to get claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And can I get the spelling of your name?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, [PII]. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] It is one Community Health.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, 02484303.
[AGENT][NEUTRAL] OK. Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Um, and this is for dental, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, for dental.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] [PII] for $430.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim, and that was [PII] for [PII]. Let's see what we have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right, let me pull up the COB.
[AGENT][NEUTRAL] Mm. I'm waiting on the EOB. I'm sorry, it's taking a little bit.
[CUSTOMER][POSITIVE] OK. Oh, no, no problem.
[AGENT][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] All right. Let's see.
[AGENT][NEUTRAL] Mhm. OK, so it looks like the last time we processed this claim was [PII] and the claim was denied. Um, the reason for this denial is that the policy does not provide benefits for any procedures or service not listed on the schedule of covered dental services or procedures.
[CUSTOMER][NEGATIVE] OK, so wait, what does that mean? You kinda lost me there.
[AGENT][NEUTRAL] It means it was uh yeah because that we're um uh charged for they're not listed on the schedule benefits basically they're not covered under the member's plan. This particular plan is a
[CUSTOMER][NEUTRAL] The CPT codes?
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Yes, um, this particular dental plan is a basic dental. Yes, mhm.
[CUSTOMER][NEUTRAL] OK, and was an EOB sent to? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Basing them to plan.
[AGENT][NEUTRAL] Yeah, it doesn't have any major services. Uh, any endodonics or periodontics are under, um, major service, so they're not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK, um, because we didn't receive an EOB. Are you able to fax over a copy of the EOB?
[AGENT][NEUTRAL] Mhm. Yes. Mhm. What is the fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. That's [PII].
[CUSTOMER][NEUTRAL] And, and do
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] And can I get the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3481278.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let me go ahead and send this out to you. Do you mind holding for me while I send this fax out to you right now so I got you on the line?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yeah, you're welcome. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding and being patient. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Just need a reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK. All right. Well, thank you so. I really appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good afternoon, Ms. [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Mm thank you. Bye-bye.