AccountId: 011433970860
ContactId: b55399f1-3911-46ee-94d2-8c7d747b8755
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313010 ms
Total Talk Time (AGENT): 65165 ms
Total Talk Time (CUSTOMER): 78175 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/b55399f1-3911-46ee-94d2-8c7d747b8755_20250312T13:32_UTC.wav
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[AGENT][NEUTRAL] To call, this is Shylo. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. How are you today?
[AGENT][POSITIVE] I'm great, thanks for asking, [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing good. I was calling today to check the status of a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I could assist you with that. Can I have a callback number for you and the spelling of your name and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And the, my name is [PII]
[CUSTOMER][NEUTRAL] And what else you needed? I'm sorry.
[AGENT][NEUTRAL] The policy number of the member?
[CUSTOMER][NEUTRAL] OK, the policy number is 606-764.
[AGENT][NEUTRAL] [PII], can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to check the status of claim of a claim for what data service and I'll be able to assist you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] It looked like there was no payment made on that claim and the reason why is because the benefits listed in the schedule are not covered.
[CUSTOMER][NEUTRAL] Hm, OK, so I have this I have a fax back and it shows y'all pay $72.
[AGENT][NEUTRAL] For the procedure.
[CUSTOMER][NEUTRAL] Yes, so that's why I was, I didn't know if y'all needed like more documentation.
[AGENT][NEUTRAL] Um, let me look at it and see.
[AGENT][NEUTRAL] Depending on what they said. Let me make sure nobody sent you the wrong schedule either.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Option A.
[CUSTOMER][NEUTRAL] It doesn't say what um.
[CUSTOMER][NEUTRAL] The person who sent it was [PII] maybe [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It doesn't say what what option it is.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But it says [PII] scaling and route planning per quadrant $72.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] May I place you on a brief hold while I review this information?
[CUSTOMER][POSITIVE] Yes thank you.
[AGENT][POSITIVE] Thank you. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding [PII]. So on the schedule it do it, it actually has $4341 we will pay up to $72 for.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So 4341, so y'all don't cover the 4342.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, ma'am, because it's a single tooth, but the 4341 is for the entire quadrant.
[CUSTOMER][NEUTRAL] That is just odd.
[CUSTOMER][POSITIVE] OK got it alrighty thank you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] The best
[CUSTOMER][NEUTRAL] Uh huh bye bye.