AccountId: 011433970860
ContactId: cda6a2ac-0c24-4fec-ba6f-c72fd016b6fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267940 ms
Total Talk Time (AGENT): 58329 ms
Total Talk Time (CUSTOMER): 112971 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/2025/03/12/cda6a2ac-0c24-4fec-ba6f-c72fd016b6fc_20250312T19:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Excuse me, [PII], it's [PII] from University Dental Care.
[AGENT][NEUTRAL] How may I assist you?
[CUSTOMER][NEUTRAL] Alright, I just wanna know if anybody with this patient's HR department ever reached out to you um to pay a claim.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] And you can have the policy number.
[CUSTOMER][NEUTRAL] 02495609
[CUSTOMER][NEUTRAL] Sunny [PII].
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Date of birth please.
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. May I have the date of service?
[CUSTOMER][NEUTRAL] The date of service is gonna be for.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total bill please.
[CUSTOMER][NEUTRAL] Total bill? Oh girl.
[CUSTOMER][NEUTRAL] Uh, 168 possibly a little bit more, hold on, because, OK, yeah, 168.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[AGENT][NEUTRAL] So it looks like that claim process and it had denied that the member's policy wasn't active at the time of service.
[CUSTOMER][NEUTRAL] Hm, because, uh,
[CUSTOMER][NEUTRAL] If the code is not on the fax, it is not a covered benefit so when looks like I verified it on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Looks like I verified it on [PII].
[AGENT][NEUTRAL] OK, so what is showing with this policy, this is a per weekly premium policy, so they weren't active at that doing that date of service so that's the reason why they claim denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that's that's the same day I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty then. I appreciate your help so much.
[AGENT][NEUTRAL] You're welcome. Did you uh receive that EOB?
[CUSTOMER][NEUTRAL] Um, I received, hold on, let me see what I received.
[CUSTOMER][NEUTRAL] I think I just received something.
[CUSTOMER][NEUTRAL] I see something in February.
[CUSTOMER][NEGATIVE] See, I was told that the uh his employer, the last time I called I was told his I was never told that he was not effective. I was told that his employer.
[CUSTOMER][NEGATIVE] Hasn't paid
[CUSTOMER][NEUTRAL] For him to get this process that's what I was told.
[AGENT][NEUTRAL] Yes, that's meaning that he didn't have any benefits eligible at that weekly.
[AGENT][NEUTRAL] During that week, so he wasn't eligible for that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, that's not how it was presented. I thought, I thought that you know the HR department, you know what I'm saying?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I didn't know it was like that.
[CUSTOMER][NEUTRAL] OK dear
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, no, actually.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well, I, you're welcome and I do wanna thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][NEGATIVE] You too dear.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye