AccountId: 011433970860
ContactId: d860c0cd-f028-4e65-bced-1afd12883eb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614969 ms
Total Talk Time (AGENT): 216116 ms
Total Talk Time (CUSTOMER): 301499 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/d860c0cd-f028-4e65-bced-1afd12883eb0_20250620T18:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from dental provider's office and I'm looking for a claim inquiry for a patient.
[AGENT][NEUTRAL] OK, then you're trying to check claim status on a dental policy, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy.
[CUSTOMER][NEUTRAL] And uh beg your pardon, you said, uh I'm sorry, you said your name is [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII] for confirming that.
[AGENT][NEUTRAL] You're welcome. And the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is going to be hold on let me pull that up real quick.
[CUSTOMER][NEUTRAL] It is going to be 147744411.
[AGENT][NEUTRAL] OK, I'm sorry, [PII], but that is not a policy number for our company. What company were you trying to reach?
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Yes, sir, that's an invalid policy number.
[CUSTOMER][NEUTRAL] OK, can you try with the name and date of birth?
[AGENT][NEUTRAL] I can't search by the date of birth. Do you have the full social for the subscriber?
[CUSTOMER][NEUTRAL] Hold on, let me.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let me take a look. OK, bear with me please, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I have here is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] No no worries, take your time.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Did you pull up the patient list time?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient name is going to be uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] And the member ID which I provided you this time is the right one, correct?
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] That is correct. The 2nd number you gave me is the correct policy number. Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And what is the date of service and total bill amount then?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, yeah, the date of service is [PII], and the total bill amount is $375. There are three procedure codes in this claim.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, don't you need any, uh, provider information like the tax ID or anything like that?
[AGENT][NEUTRAL] No, sir, I don't.
[CUSTOMER][POSITIVE] Oh perfect. The first insurance that I'm not asking for that. OK.
[AGENT][NEUTRAL] Not, not yet. Just a moment. Uh, yes, just a moment for me to get some additional information pulled up and then I'll verify a couple of additional things with you. So just one moment.
[CUSTOMER][NEUTRAL] Sure, sure. OK.
[AGENT][NEUTRAL] OK, so if you could provide the tax ID number?
[CUSTOMER][NEUTRAL] Oh, you asked for that. It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] So this claim was received and the received date on the claim then is [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] [PII], uh, I'm sorry to interrupt you in the middle. Uh, if I need this information in a specific sequence, if you can provide me that, you don't have to repeat.
[AGENT][NEUTRAL] You do not
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] No, there's not a specific sequence.
[CUSTOMER][POSITIVE] Yes, I apologize.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] No, I'm asking for that. Do you have a claim number first for me?
[AGENT][NEUTRAL] 3608929.
[CUSTOMER][NEUTRAL] 3608929. Thank you so much and is this claim paid or not?
[AGENT][NEGATIVE] Denied.
[CUSTOMER][NEUTRAL] OK, what's the reason?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] All 3 codes were denied for the same reason. These services were rendered following the termination of coverage.
[CUSTOMER][NEUTRAL] Following determination of coverage, I didn't get that. Can you just elaborate it a little bit, please?
[AGENT][NEUTRAL] The denial remarks states these services.
[AGENT][NEUTRAL] were rendered.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Following.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The termination.
[AGENT][NEUTRAL] Of coverage.
[AGENT][NEUTRAL] This policy turned on 4-6-2025.
[CUSTOMER][NEUTRAL] OK. What are the
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, so it means this claim is denied because the policy already got terminated, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Oh perfect, bear with me please. I have to document that.
[CUSTOMER][NEUTRAL] And just wanted to confirm, is there any other active policy for this patient apart from this one?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][POSITIVE] Mm perfect.
[AGENT][NEUTRAL] And if you need a copy of that explanation of.
[CUSTOMER][NEUTRAL] So, can you repeat that for me?
[CUSTOMER][NEUTRAL] Yeah, I need that uh just uh tell me the termination date one more time.
[AGENT][NEUTRAL] Yes, you can print it by using.
[AGENT][NEUTRAL] Yes, the termination is [PII].
[AGENT][NEUTRAL] And you can use the claim number that I gave you to print it, the printed explanation of benefits then from our portal by going to secured.
[CUSTOMER][NEUTRAL] 46 2025.
[CUSTOMER][POSITIVE] Mhm. OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect, thank you so much. And do you have that policy's effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], the policy is activated, uh, not for a month hold, right? For some, some days.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And uh OK. And currently no other active plan. So can you, can you uh send me the UOB through fax or something like that?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, did you take down the website that I gave you to be able to print it yourself?
[CUSTOMER][NEUTRAL] Uh, let me, can you repeat the website one more time?
[AGENT][POSITIVE] Secured
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] secured. [PII].
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, let me.
[CUSTOMER][NEUTRAL] Let me see if we are registered on this website it is log in OK.
[AGENT][NEUTRAL] So you would just, it's a self registering portal and you would register and then you will use that claim number that I provided for you.
[CUSTOMER][NEUTRAL] OK uh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you should be able to print it.
[CUSTOMER][NEUTRAL] Um, actually, I tried, but we are.
[CUSTOMER][NEUTRAL] Yeah, we are not registered on this website. Oh yeah, so for this time I want you to send me through fax and for the next time I will uh register on this one. Is it OK?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][POSITIVE] Thank you so much I really appreciate it.
[AGENT][NEUTRAL] Mhm, certainly. Does it need to be put to your attention?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] on it. Just let me know when you need the fax number.
[AGENT][NEUTRAL] Yes, I'm not ready for that yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Really.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the, what is your fax number, [PII]?
[CUSTOMER][NEUTRAL] Do you have my callback number which I provided you earlier?
[AGENT][NEUTRAL] You gave me a callback number of [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's right. This is also our uh fax number. You can fax that you'll be on this number.
[AGENT][NEUTRAL] OK, um.
[AGENT][POSITIVE] OK then, so that has been sent to you so you so you should be receiving that very soon. Yes.
[CUSTOMER][NEUTRAL] And I have.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, and one more thing here, uh, [PII], that I have the previous date of service for you, and this date of service is from last, last year, I'm sorry, the year before [PII]. Can you tell me about that claim, please? There's the date of service [PII], yeah, for this member, yep.
[AGENT][NEUTRAL] For this number?
[AGENT][NEUTRAL] For this member, there is no claim on file under this policy number for that member.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was the date of service again? I'm sorry, what was the date of service one more time?
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is there any claim that you have?
[AGENT][NEUTRAL] OK, this policy went into effect [PII].
[CUSTOMER][NEUTRAL] Mm sorry? You said [PII]. Yeah, yeah. Thank you so much for that information, [PII]. And what is the call reference number for this one?
[AGENT][NEUTRAL] I did.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much, [PII], for your assistance. I hope you have a lovely rest of your day. Bye for now.
[AGENT][NEUTRAL] OK, wait.
[AGENT][POSITIVE] I hope you do too, and thank you for calling APL. It was my pleasure in speaking to you, [PII].
[CUSTOMER][NEUTRAL] You too same here bye bye.
[AGENT][NEUTRAL] Mm. Bye-bye.