AccountId: 011433970860
ContactId: ba03d947-bce4-42bd-9872-06c9ef751a46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290799 ms
Total Talk Time (AGENT): 64714 ms
Total Talk Time (CUSTOMER): 93381 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/ba03d947-bce4-42bd-9872-06c9ef751a46_20250107T21:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon. My name is [PII], and I'm calling from West Haven Pediatric Dentistry. I was calling to check, um, on the status of two claims for a patient. I tried using the online um portal, but it's, I entered the claim number that's on the EOB and it says, um, no claim found.
[AGENT][NEUTRAL] OK, sure, [PII], I can assist you with claim status. Um, first, could I get a callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] That is 02504682.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient is um [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Um, the first date of service is [PII], and the total charge is $4,896.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] OK, it looks like this 1 may have been broken up um into a few it looks like it it broke up into 3 on my end.
[AGENT][NEUTRAL] And I'm still waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] OK, ma'am. Thank you for your patience. Um, yes, I'm actually showing that under this policy, we're actually waiting on the premium, so the policy is on hold at this time and therefore, the processing of this claim is also on hold. So you can give us a call back in about a week or so and it should be updated in our system.
[CUSTOMER][NEUTRAL] OK, I was just confused because on the back of the um EOB it says we're awaiting information to confirm eligibility. Um, is this common? Do you does this uh because I have a note from the last claim and it says that I called and then um with the same note and so but then the claim was paid.
[AGENT][NEUTRAL] Right. Yes, ma'am. This is common.
[AGENT][NEUTRAL] So that's why I said it'll update.
[CUSTOMER][NEUTRAL] OK, so we'll always receive an EOB first with no payment just stating like you did receive it's just basically stating that you did receive the claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I just need clarification. Can I get a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] and my last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, ma'am, that was all. Thank you so much.
[AGENT][POSITIVE] OK OK, thank you, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.