AccountId: 011433970860
ContactId: 9a757a7a-31c6-4965-a8f3-0295ced8db73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251559 ms
Total Talk Time (AGENT): 63590 ms
Total Talk Time (CUSTOMER): 121701 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/9a757a7a-31c6-4965-a8f3-0295ced8db73_20250320T18:44_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Fine. I just got my claim back, um, on, on, on my, um, claim I put in. I had a procedure done on my tongue which is medical, but when I called in to say that I was submit the claim, I was wondering the on the dental part of it, cause it was an oral surgeon, and I thought maybe the medical, the dental part, the oral exam would be covered under my plan.
[AGENT][NEUTRAL] OK, I'd be happy to take assist or take a look at the claim. May I have the policy number, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um 450719.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm not, that's not.
[AGENT][NEUTRAL] I'm not showing that's a valid policy number. Do you have a social?
[CUSTOMER][NEUTRAL] Yeah, [PII]. It's my, my policy number is 000450719.
[CUSTOMER][NEUTRAL] you don't.
[AGENT][NEUTRAL] 000450719
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] 00450719.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] things.
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Because that's not that policy number. That's not, I don't have that in my system.
[CUSTOMER][NEUTRAL] I'm giving my social, ready?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] So [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the, do you know the procedure code that they um did on?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know. I just got the the decline. The code remark was D1D0086.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yeah. Uh-huh.
[AGENT][NEUTRAL] OK. All right, one moment please.
[CUSTOMER][NEUTRAL] There are 2 calls. One was done work for the exam.
[CUSTOMER][NEUTRAL] And one was for the medical procedure.
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] They um
[AGENT][NEUTRAL] Submitted this as.
[AGENT][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] They didn't, they, they submitted this as medical.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But wouldn't the exam, wouldn't the exam be covered?
[CUSTOMER][NEUTRAL] In my dental plan.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] Not if it's due to a medical diagnosis.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I thought that, that, I thought, I thought the getting the exam would cover that.
[AGENT][NEUTRAL] Not for a medical diagnosis.
[CUSTOMER][NEUTRAL] would be covered.
[CUSTOMER][NEUTRAL] All right, all right, thank you. What about, let me, I got, I got a couple of fillings coming. I had to get some fillings done in a couple of weeks. Would that, that, that I should have that be covered, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, now that's a dental, that's dental, yes.
[CUSTOMER][POSITIVE] All right. All right, thank you.
[AGENT][NEUTRAL] OK. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] All right, thank you. No, bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.