AccountId: 011433970860
ContactId: f1013ac6-9cd1-494d-a338-afffaf882375
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269350 ms
Total Talk Time (AGENT): 115470 ms
Total Talk Time (CUSTOMER): 56468 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/f1013ac6-9cd1-494d-a338-afffaf882375_20250516T13:14_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] I was calling um to uh check on a denial on a claim that we had sent in.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims. And 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 from my notes?
[CUSTOMER][NEUTRAL] Lexington Facial and Oral Surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. May I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is 02518369.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And amount.
[CUSTOMER][NEUTRAL] Of the claim.
[CUSTOMER][NEUTRAL] Looks like 1080.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me see if I can find it. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah, I have the EOB. I have the status of the claim. I just need to know why.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, do you have the claim number?
[CUSTOMER][NEUTRAL] 359-636-0
[AGENT][NEUTRAL] OK, bear with me, let me pull the image on that one.
[AGENT][NEUTRAL] OK, so it's been processed several times. OK.
[AGENT][NEUTRAL] One moment, let me find the original one.
[AGENT][NEUTRAL] That duplic, OK.
[AGENT][NEUTRAL] OK, so it's gonna be this one.
[AGENT][NEUTRAL] OK, I'm waiting on the EOB to pull up. I, I found the original one, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the original claim was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied and the reason for this denial is that
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No benefits are payable for any loss resulting from uh or caused by dental, vision, including treatments, surgery, extractions, or X-ray.
[CUSTOMER][NEUTRAL] OK and your name?
[AGENT][NEUTRAL] My name is [PII]. Its So last initial M. Do you need a copy of this EOB or is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yeah, a call reference number you said?
[AGENT][NEUTRAL] A copy of the EOB. Do you need me to fax over a copy of the EOB? You need the claim number?
[CUSTOMER][NEUTRAL] No, I just need a call reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we don't have reference numbers. 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][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] You too.