AccountId: 011433970860
ContactId: b31546cf-a767-474f-bbb0-08fee679dad7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246940 ms
Total Talk Time (AGENT): 83901 ms
Total Talk Time (CUSTOMER): 61303 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b31546cf-a767-474f-bbb0-08fee679dad7_20250402T14:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for claim status please.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim today. Do we have the policy number?
[CUSTOMER][NEUTRAL] I do that is 01196681.
[AGENT][NEUTRAL] All right, thank you for that. And then do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[CUSTOMER][NEUTRAL] This card does say plan group voluntary dental, so I'm not sure if this is just a dental card or if it covers both medical and dental.
[AGENT][NEUTRAL] OK. I was just gonna ask, are we looking for medical or dental claim?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, so the member did have
[AGENT][NEUTRAL] Um, a medical policy with us. What's the date of service?
[CUSTOMER][NEUTRAL] Very old [PII].
[AGENT][NEUTRAL] OK, and then the bill amount?
[CUSTOMER][NEUTRAL] $11,801.32.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1,0801.
[AGENT][NEUTRAL] OK, so it looks like we did get a claim for this state of service and that billed amount. Uh, looks like the claim was denied. The benefit maximum for the date of service had already been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and what's that claim number please?
[AGENT][NEUTRAL] The claim number is 339.
[AGENT][NEUTRAL] 4872.
[CUSTOMER][NEUTRAL] And when did you receive that claim and denied it, process it?
[AGENT][NEUTRAL] Uh, let me check, yeah, let me get that for you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] A claim was denied on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, uh, what's the first initial to your last name please?
[AGENT][NEUTRAL] It's gonna be [PII] and that's the my name with with today's date is a call reference.
[CUSTOMER][NEUTRAL] And you can have
[CUSTOMER][NEUTRAL] And do you spell your [PII] at the end?
[AGENT][POSITIVE] Yes ma'am I do.
[CUSTOMER][POSITIVE] OK, alright, I appreciate your help thank you.
[AGENT][POSITIVE] You're very welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.