AccountId: 011433970860
ContactId: e2351a73-0f3f-47b0-b85c-45a47b1581bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215460 ms
Total Talk Time (AGENT): 77376 ms
Total Talk Time (CUSTOMER): 118472 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/e2351a73-0f3f-47b0-b85c-45a47b1581bc_20250227T16:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from regions of the University of Michigan. I'm calling in regards to some denied medical claims. Can you assist?
[AGENT][NEUTRAL] Sure, I can take a look at those claims for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then uh do you have the policy number?
[CUSTOMER][NEUTRAL] It's 0233552152. So 02335152.
[AGENT][NEUTRAL] Got it, thank you. And then uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII], birthday [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. I know you said there were a few claims we needed to look at are they all for the same uh member?
[CUSTOMER][NEUTRAL] Yes, yes, uh, one member of 4 different dates of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gotcha. OK. And um let's, bear with me just a moment. This was for dental, correct?
[CUSTOMER][NEUTRAL] So first
[CUSTOMER][NEUTRAL] Uh, no, it's not, but can you tell me, is this, uh, workers' comp? Is this, um, what kind of insurance is this?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No. OK. So, um, the policy number you gave me was actually their dental policy. Um, they did have a medical policy with us, it's a limited indemnity medical plan. However, both policies did terminate [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII]. Is that right?
[AGENT][POSITIVE] Yeah, correct.
[CUSTOMER][NEUTRAL] Uh, let's see if I can spell the term.
[CUSTOMER][NEUTRAL] On [PII], hm, so then.
[CUSTOMER][NEUTRAL] Uh, the, the, so I have data service in [PII] and also um let's see uh well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see, I see, I see.
[CUSTOMER][NEUTRAL] She hasn't been paying because obviously OK um.
[AGENT][NEUTRAL] If I could still check to see if we received those claims if you needed um an EOB that shows the the mal reason.
[CUSTOMER][NEUTRAL] I guess that's all I need to know.
[CUSTOMER][POSITIVE] For sure, for sure.
[CUSTOMER][NEUTRAL] Uh, sure, [PII] for $218. I, I do have the EOB and it just says uh our records indicate, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Data service was not received therefore benefits are not payable or a premium.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] For the data service, so yeah.
[AGENT][NEUTRAL] OK, so yes, I do have that claim, and I, I can send you an EOB, but it would essentially say the same thing as it denied it basically he didn't have coverage at the date of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] Oh, that's all I needed. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] All right, you're very welcome. I hope you have a great rest of your day. Thanks for calling APL.
[CUSTOMER][NEUTRAL] You as well, you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.