AccountId: 011433970860
ContactId: eae5944d-e705-4061-883f-b44ff71e3f9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548210 ms
Total Talk Time (AGENT): 215280 ms
Total Talk Time (CUSTOMER): 176500 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/eae5944d-e705-4061-883f-b44ff71e3f9a_20250128T20:54_UTC.wav
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[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I am calling about a couple of claims.
[AGENT][POSITIVE] OK, yeah, um, I'd love to help you with this today. And can I have your name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII], and a good callback number?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][POSITIVE] Wonderful thank you and then the policy number today that we want to look at?
[CUSTOMER][NEUTRAL] It is the group number or the ID?
[AGENT][NEUTRAL] Uh, the ID please.
[CUSTOMER][NEUTRAL] OK, I have a social which is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, give me just a moment to try searching for them.
[CUSTOMER][NEUTRAL] You mind and it's the same thing that brought you that food earlier.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] and then he packed another bag. I went.
[AGENT][POSITIVE] All right, I appreciate your patience. What is your insured, what's your insured's name today, my friend?
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Um, the insured you're looking for, what is their name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like the company or the patient's name? OK, um, I am looking for [PII].
[AGENT][NEUTRAL] The patient
[AGENT][NEUTRAL] OK perfect and just to verify we're looking for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Awesome, and would you be able to verify for me pretty please [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] Perfect. And would you like his policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Sure that'd be great.
[AGENT][POSITIVE] Wonderful. I have his policy number as 607601.
[CUSTOMER][NEUTRAL] OK, so that's what I can use for the member ID?
[AGENT][NEUTRAL] Mhm yep, you bet you, and you said you wanted to check claim status on him. Did you have a claim number you wanted to look at or did you want me to search for it with date of service?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Data service.
[AGENT][NEUTRAL] All right and what is that data service, my friend?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEGATIVE] I can't my mom so that's the last that he just.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] If there was for somebody else, uh, I know who it was for.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But you gotta go to a truck.
[AGENT][NEUTRAL] All right, and the name of the provider for that claim?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you and.
[AGENT][POSITIVE] Awesome, I do have that claim here. I show that we've received your claim [PII]. We processed it [PII], and the claim number is 3544869.
[AGENT][NEUTRAL] Um, I show that the claim had benefits payable of $40 and it had a couple denial codes.
[CUSTOMER][POSITIVE] Thank you for choo
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Um, are you wanting information about like what was denied and why or um check details?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just trying to figure out like I don't have a payment on it um so I'm just trying to figure some things out. I had a payment for [PII] for the same date but not for [PII] and I'm just trying to see what's going on. I also got a letter for [PII] but not for [PII], so I don't know.
[AGENT][NEUTRAL] OK, yeah, let's take a look.
[CUSTOMER][POSITIVE] Awesome thank you.
[AGENT][NEUTRAL] All right, I show that that check did have the benefits of $40. It looks like it went to [PII]. I am I saying that right? [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, is it outstanding?
[AGENT][POSITIVE] It is still outstanding, yes, um, it's [PII].
[AGENT][NEUTRAL] It has been long enough that I could have them request a void and reissue for you if you'd like.
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] Let me check something real quick. Can you look at [PII]'s while I check something?
[AGENT][NEUTRAL] Um, yes, abs.
[CUSTOMER][NEUTRAL] Because I got a
[AGENT][NEUTRAL] Yeah, I can. Um, let me go back to her.
[AGENT][NEUTRAL] And you said she would have been for the same day of service or we wanting to check something on a different day of service for her?
[CUSTOMER][NEUTRAL] Same date of service, I we got paid and I have to check but then we also have a letter saying.
[CUSTOMER][NEUTRAL] We're awaiting information from your employer to confirm eligibility.
[CUSTOMER][NEUTRAL] Um, upon receipt of this information, we'll continue processing your claim, so I'm just trying to figure out if there's anything that we need to follow up on if it's all settled.
[AGENT][NEUTRAL] OK, so it is all settled now sometimes when we're waiting for like the eligibility reports from the employer and it's taking a while we'll send those out and we'll move the claim into pending status, um, but because it's been paid, uh, they must have pulled it out of pending status and had received that eligibility, so I would say you could probably disregard that original notice.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see, give me just a second.
[AGENT][POSITIVE] Yeah, take your time.
[CUSTOMER][POSITIVE] OK, yeah, I do not have the check for [PII], so if we could get that reissued, that would be fantastic.
[AGENT][POSITIVE] OK, perfect. I'm gonna have you hang tight with me just a second while I get that um request put in. Is that OK?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Um, it will not take too long.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] You said you wanted to check um a couple different claims. Was there more than just these two or were these two guys it for you?
[CUSTOMER][POSITIVE] Thank you for choosing
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Yeah, that'd be great we'll do the same and everything.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] All right, my friend, I am.
[AGENT][POSITIVE] Just got that request sent in through for you so hopefully here in a couple more days um at most they'll get it processed, get things reissued, and get that payment sent back out to you for um for [PII]'s claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And is there anything else I can do to take care of you, my friend?
[CUSTOMER][NEUTRAL] No ma'am, that is everything.
[AGENT][POSITIVE] Hey, well, I really appreciate your time today and I hope you have a wonderful, wonderful week.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Hey my pleasure you take care.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.