AccountId: 011433970860
ContactId: d65ff668-8aed-48de-9920-f070fea08c54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401630 ms
Total Talk Time (AGENT): 127864 ms
Total Talk Time (CUSTOMER): 54410 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/2025/06/13/d65ff668-8aed-48de-9920-f070fea08c54_20250613T13:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling regarding a claim for a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Pediatric dentistry of Central Georgia.
[AGENT][NEUTRAL] OK thank you and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It's 02477823.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The first one is [PII] [PII].
[AGENT][NEUTRAL] OK. And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I have that on file.
[AGENT][NEUTRAL] OK, let me pull the explanation of benefits on this 11 moment.
[AGENT][NEUTRAL] I'm still waiting on the system, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like um we processed this claim on [PII] and the claim was denied. The reason for this denial is that.
[AGENT][NEUTRAL] Our records indicate the premium for the date of service was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there was like a lapse in coverage.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was just the month of December?
[AGENT][NEUTRAL] Um, let me check exactly what is that.
[AGENT][NEUTRAL] Range, um, yes, these ones are paid weekly.
[AGENT][NEUTRAL] Let me see one moment.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, let's see December.
[AGENT][NEUTRAL] It was for a week, but it was that week.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But yeah, there's been a lapse of coverage constantly, so, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, do you have like the.
[AGENT][NEUTRAL] I'm sorry you broke up. Can you repeat what you said?
[CUSTOMER][NEUTRAL] Yeah, did you have like the dates that it was inactive like.
[CUSTOMER][NEUTRAL] The range
[AGENT][NEUTRAL] Let's see, it was from the [PII].
[CUSTOMER][NEUTRAL] To the [PII]?
[AGENT][NEUTRAL] To the [PII].
[CUSTOMER][NEUTRAL] So [PII]
[CUSTOMER][NEUTRAL] And that was due to an unpaid premium?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do you have a reference number?
[AGENT][NEUTRAL] We don't have reference numbers now you can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a good day, Miss. Hey. Did you have another one that we need to check on or no?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um, it's the same family.
[AGENT][NEUTRAL] Oh, got you. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good weekend. Bye bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.