AccountId: 011433970860
ContactId: d30a651a-8c58-46fd-bbff-3c79cb96f04b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394089 ms
Total Talk Time (AGENT): 151081 ms
Total Talk Time (CUSTOMER): 79535 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/d30a651a-8c58-46fd-bbff-3c79cb96f04b_20250521T18:25_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Kalamazoo Oral Surgery, and I was trying to follow up on a predetermination that I sent in.
[AGENT][NEUTRAL] OK, I'm so sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and you're calling to follow up on a predetermination that was sent in, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that [PII] and what is your callback number please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] your name
[CUSTOMER][NEUTRAL] 02615283
[AGENT][NEUTRAL] OK, thank you, one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Oh, I'm gonna butcher this.
[CUSTOMER][NEUTRAL] [PII], I don't know. [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Maybe it's [PII] or [PII]. I have no idea.
[AGENT][NEUTRAL] OK. So just one moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And I'm sorry, what is the name of the provider group again?
[CUSTOMER][NEUTRAL] Um, so I'm calling on behalf of [PII], but we're um, it's [PII] Oral Surgeries, uh.
[AGENT][POSITIVE] OK, thank you. OK.
[CUSTOMER][NEUTRAL] Office, mhm.
[CUSTOMER][NEUTRAL] 5213
[AGENT][NEUTRAL] OK, so I show that it's under claim number 360.
[AGENT][NEUTRAL] 1782.
[CUSTOMER][NEUTRAL] Expires
[CUSTOMER][NEUTRAL] Today
[AGENT][NEGATIVE] We did receive that for her. um, it shows on here that it is denied.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] This is stating this policy does not provide benefits for any procedure or service not listed in the schedule of covered services, excuse me, covered dental services and procedures.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Extractions are not a covered benefit under her dental?
[AGENT][NEUTRAL] Let me pull
[AGENT][NEUTRAL] The code numbers provided.
[AGENT][NEGATIVE] are not covered under her policy.
[CUSTOMER][NEUTRAL] OK, and this is a dental policy, correct?
[AGENT][POSITIVE] Correct, and this policy has benefits for preventative and basic expenses.
[CUSTOMER][NEUTRAL] Preventative and basic only.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Can I get a copy of that?
[AGENT][NEUTRAL] Yes, you should be able to print this. Sure, you should be able to print this from our portal. I can give you that website.
[CUSTOMER][NEUTRAL] So I can put it in the patients.
[AGENT][POSITIVE] I can also fax this to you.
[CUSTOMER][NEUTRAL] Do I have to have uh some kind of account?
[AGENT][NEUTRAL] You would, it's a self registering portal, yes ma'am, but I can fax this also to you.
[AGENT][NEUTRAL] Give me just a moment to get that loaded, but the website for yeah for the future, the website that you would use is secured.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][NEUTRAL] I've never even heard of you guys.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then just give it a couple of moments while it's loading.
[CUSTOMER][NEUTRAL] I'm sorry, can I get your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is a good fax number for you please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And again you said your fax number. I'm just gonna repeat it is [PII] is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, so I have just faxed that to you, so give it just a little time and provided there's not a technical mishap of some sort, you should be receiving that very soon.
[CUSTOMER][NEUTRAL] OK, do we have a reference number?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] OK, well, you're very welcome. So is there anything else, [PII], that I can help you with?
[CUSTOMER][NEUTRAL] Nope, that should do it.
[AGENT][POSITIVE] OK, well, thank you very much for calling APO and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Uh, thank you. Bye-bye.