AccountId: 011433970860
ContactId: dac3876b-9be8-4e0b-9679-5ec68f9bfd5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246970 ms
Total Talk Time (AGENT): 108400 ms
Total Talk Time (CUSTOMER): 81190 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/dac3876b-9be8-4e0b-9679-5ec68f9bfd5a_20250109T20:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling. I'm sorry, good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII]. Last initial is [PII] calling from provider's office checking on claim status.
[AGENT][POSITIVE] Well, [PII], it would be a pleasure to help you with that claim status. What is a good callback number?
[CUSTOMER][POSITIVE] Thank you. [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number is 02329990.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Ordinance [PII].
[AGENT][NEUTRAL] All right, thank you, and you're needing claim status for dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking to see if they have medical coverage, bear with me.
[AGENT][NEUTRAL] Is that's a dental policy. Now, they do not have a medical policy with our company.
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So, actually,
[AGENT][NEUTRAL] Now, I can check to see if we received it on this dental policy if you'd like.
[CUSTOMER][NEUTRAL] OK. Uh, actually, we made the medical claim and we received, uh, denial, but there is no clear, uh, denial is listed on here.
[AGENT][POSITIVE] Do you have that claim number? I'll be happy to check that for you, [PII].
[CUSTOMER][NEUTRAL] I, uh, yes. Claim number is 3514272.
[AGENT][NEUTRAL] OK, so they put that on her accident policy. Let me get that policy pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the facility name and build amount please?
[CUSTOMER][NEUTRAL] Mercy Hospital Springfield.
[CUSTOMER][NEUTRAL] $395 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm getting that pulled up. Bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive that claim on [PII] and processed on [PII].
[AGENT][NEUTRAL] And the denial reason is our in our records indicate the premium for the service date was not received, therefore benefits are not payable. [PII], her policy termed on 7-16-2023.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, during the date service member was not active.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And um when was the policy started?
[AGENT][NEUTRAL] 410-2023.
[CUSTOMER][NEUTRAL] OK, so 4, 1023 27 1623.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. May I know the call reference number, please?
[AGENT][NEUTRAL] The call reference number is my name and today's date. I spell my name. I spell my name [PII]
[CUSTOMER][NEUTRAL] Can you please
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] That's all for now.
[AGENT][POSITIVE] Yes. Well, [PII], it was a pleasure to help you with that claim status and thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Mm bye-bye.