AccountId: 011433970860
ContactId: a67bb70c-0b2d-4187-a188-873882b1c605
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227779 ms
Total Talk Time (AGENT): 92977 ms
Total Talk Time (CUSTOMER): 75361 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/a67bb70c-0b2d-4187-a188-873882b1c605_20250326T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, I need to get a claim status please.
[AGENT][NEUTRAL] OK, and may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your callback number [PII].
[CUSTOMER][NEUTRAL] [PII] and that's direct.
[AGENT][NEUTRAL] Thank you. What is the policy number?
[CUSTOMER][NEUTRAL] 02295000.
[AGENT][NEUTRAL] OK, and to repeat and confirm, I have that as 02295000.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, and again you're calling for claim status.
[AGENT][NEUTRAL] Um, give me one second please.
[CUSTOMER][NEUTRAL] Mm sure.
[AGENT][NEUTRAL] Is this for medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] You know it's actually a dental policy number. I'm checking to see if the member had a medical policy number with APL.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I looked at their card. I saw that on one card.
[CUSTOMER][NEUTRAL] It well actually it does say it on the card, but I just another person had worked this claim and she faxed the claim in so I thought well.
[CUSTOMER][NEUTRAL] I'll try
[CUSTOMER][NEUTRAL] But I couldn't find a medical card either, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Um, let's see, what was the date of service maybe.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEGATIVE] The day the service is I just lost it hold on.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the total charge is $456.
[AGENT][NEUTRAL] OK, that was [PII] of $2023456 a month.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], thank you.
[CUSTOMER][NEUTRAL] Yeah, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I think he's, let me see, I was gonna look at some other claims and see.
[AGENT][NEUTRAL] Oh, actually, I was able to find it under a an accident policy and the
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, um, so it was received, um, now the policy that he had with us, the accident policies as well as the dental policy, both have termed. The accident policy termed as of [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, but we did receive that claim and it was processed.
[AGENT][NEGATIVE] And denied as services rendered um basically after the policy term.
[CUSTOMER][NEUTRAL] Would it have been covered under that accident policy? uh.
[AGENT][NEUTRAL] No, no, ma'am. If it was not accident related.
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] Right, that's OK. Well, I need to find out who he's got the insurance with. OK, um, do you have a call reference number?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] We do not provide our reference numbers. You can use my name [PII] last initial [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK I appreciate thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too bye.