AccountId: 011433970860
ContactId: f61e8490-4402-4d72-90be-d1b8b34cb5ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223669 ms
Total Talk Time (AGENT): 84638 ms
Total Talk Time (CUSTOMER): 75007 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f61e8490-4402-4d72-90be-d1b8b34cb5ce_20250107T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm [PII] calling from provider's office. I would like to check on the claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it does.
[CUSTOMER][NEUTRAL] Uh, I do have the policyholder's number as 02295286.
[AGENT][NEUTRAL] OK, thank you. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, for the policyholder or the patient?
[AGENT][NEUTRAL] Um, the patient.
[CUSTOMER][NEUTRAL] All right, that's [PII] and uh the date of birth is [PII], which is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It is for [PII] and the total bill amount is $50 even $50.
[AGENT][POSITIVE] OK, got it, thank you one moment.
[AGENT][NEUTRAL] And this was for dental, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the provider?
[CUSTOMER][NEUTRAL] Uh it is uh the first name is spelled as [PII]
[CUSTOMER][NEUTRAL] And tapped off.
[AGENT][NEUTRAL] OK, got it, thank you. OK, so I did find this claim, [PII], uh, we were unable to pay a benefit is not a covered procedure under this policy.
[CUSTOMER][NEUTRAL] All right, all right, all right, uh, I would like, I do have a specific question, uh, whether the providers is is in network or out network.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so this plan participates in the Carrington PPO network, but utilization of that network is not required.
[CUSTOMER][NEUTRAL] So the network status of the provider would be?
[AGENT][NEUTRAL] I'm unable to see that if they participate in the Carrington PPO or not, but again it's not required that they are.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, so you are not able to see right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh are you able to fax COP?
[AGENT][NEUTRAL] Sure, uh, what's that fax number for you?
[CUSTOMER][NEUTRAL] It is 321.
[CUSTOMER][NEUTRAL] 234
[CUSTOMER][NEUTRAL] 5078.
[AGENT][NEUTRAL] OK, and when I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me read that fax number back just to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] It is perfect.
[AGENT][NEUTRAL] OK, I'll get that sent to you. You should get it here in maybe 10-15 minutes depending on how busy your machine is. Uh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Thank you bye bye.