AccountId: 011433970860
ContactId: b2c3303a-0038-416a-9452-4ad00ea6ccb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393399 ms
Total Talk Time (AGENT): 156112 ms
Total Talk Time (CUSTOMER): 114245 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/b2c3303a-0038-416a-9452-4ad00ea6ccb2_20250606T12:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] and I'm calling from the Cleveland Clinic, Florida.
[AGENT][POSITIVE] Yes sir. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, please. I just want to check on the dental status for a claim.
[AGENT][NEUTRAL] OK, you're wanting to check on a denial status for a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, that's right.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][POSITIVE] Thank you so much, [PII]. OK, that is [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Uh yes, [PII]. That is uh 02481583.
[AGENT][NEUTRAL] Thank you. One moment please while I get the member's information pulled up. Thank you.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][POSITIVE] Yes, take your time.
[AGENT][NEUTRAL] And [PII], any information that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, that is [PII]. That is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Yes. Data service is [PII] and the total charge is $396.75.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so [PII] for that data service 531 2024, I do not have a claim on file for this number for that bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check. I have a claim number.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, I have a claim number which is 3606975.
[AGENT][NEUTRAL] And you said date of service is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, yes, that's right.
[AGENT][NEGATIVE] OK, there is no claim number on file for that data service. Let me even see if that's a claim number for this, that's not even a claim number for this member on this policy. That's an invalid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Actually, we just billed the claim to the mail. OK. uh [PII], we just billed the claim to the mailing address of [PII]. Is that the mailing address?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fine, [PII], and can I get uh uh eligibility for this policy?
[AGENT][NEUTRAL] Uh, this policy was active from [PII].
[AGENT][NEUTRAL] To its term date of [PII].
[CUSTOMER][NEUTRAL] That means [PII] is the last active date, right?
[AGENT][NEUTRAL] No, the effective date is [PII].
[AGENT][NEUTRAL] Termination date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh just a moment. And may I know whether APL is a primary or secondary?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is a supplemental policy. It would not be a primary insurance. And when the claim is submitted to us for review, [PII], you must also send us a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We do have to have that when reviewing a claim and then once we have processed our claim we do have a portal [PII], that you should be able to check claim status in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK, just
[CUSTOMER][NEUTRAL] Is this an open portal or?
[AGENT][NEUTRAL] Yes, you would register. I mean, all you, all you will do is fill in the information that it asked for for a provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Well, thank you so much for the information, [PII]. And can I get the reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thanks a lot.
[AGENT][POSITIVE] OK, well, you're very welcome, [PII]. So is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all for today. Thank you.
[AGENT][POSITIVE] OK, well you're welcome and thank you again for calling APL have a great weekend.
[CUSTOMER][POSITIVE] You as well. Take care. Bye-bye and happy weekend.
[AGENT][POSITIVE] Uh, thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye.