AccountId: 011433970860
ContactId: c2c75b0e-331a-4ee0-9f26-c1aaf9ebc1f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225100 ms
Total Talk Time (AGENT): 87921 ms
Total Talk Time (CUSTOMER): 73985 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/c2c75b0e-331a-4ee0-9f26-c1aaf9ebc1f8_20250502T16:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] My, I had an insurance claim that was denied and I'm trying to figure out why.
[AGENT][NEUTRAL] OK, well, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And Ms. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, it's under my dad, um, [PII].
[CUSTOMER][NEUTRAL] But it is 02596285.
[AGENT][POSITIVE] OK, thank you so much and do you have a callback number in case this call drops?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Well, um
[AGENT][NEUTRAL] Only claim I show we have for you is for data service of [PII] and it doesn't look like it was denied it looks like the claim that paid.
[AGENT][NEUTRAL] To the provider.
[AGENT][NEUTRAL] And the amount of 19,060.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, it should have been um [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, they said when they had tried to process the claim, they were showing that I wasn't a part of the insurance. This is what it sounded like.
[AGENT][NEUTRAL] No, ma'am, because I show that you are on the policy, um, like you became effective on [PII] when the policy became active. So there's no lapse in coverage. And like I said, that's the only claim I'm showing we received was for that date and it was paid to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, it's, and it would be a it would be a different.
[CUSTOMER][NEUTRAL] It'd be cause the one, the one that you're talking about I think is it was for X-rays probably. I went and I got a consult from this line, but the one that they're denying or they're saying was denied was for a cleaning.
[CUSTOMER][NEUTRAL] Um, it would be Pillar dental. I don't know if I need to have them just try to process the claim again.
[AGENT][NEUTRAL] Uh yes, ma'am. Uh, they can mail it, fax it, or submit it electronically, uh, but I don't show we received any claims for any, uh, for you for cleaning.
[AGENT][POSITIVE] And I can give you a fax number and they can fax that over to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, uh, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good. I will let them know that. Thank you.
[AGENT][NEUTRAL] OK. Yes, ma'am. And is there anything else I can assist you with today, Ms. [PII]?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Alright, that was all. Thank you.
[AGENT][POSITIVE] OK, uh, thank you so much for calling APL. Have a great day and weekend.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye