AccountId: 011433970860
ContactId: f8d9f0a0-3772-4ce5-93a7-04b2ab8c29ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322190 ms
Total Talk Time (AGENT): 82770 ms
Total Talk Time (CUSTOMER): 176526 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/f8d9f0a0-3772-4ce5-93a7-04b2ab8c29ac_20250204T18:04_UTC.wav
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[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] the hernia.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I can't.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, hey, Ms. [PII], uh, my name is [PII] and I was needing some help please with an ELB that we received and some.
[CUSTOMER][NEUTRAL] Insurance information this is for dental.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 00623765
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII] with the birthday of [PII]. I am so sorry. I got a frog in my throat.
[AGENT][POSITIVE] And thank you. No problem.
[AGENT][POSITIVE] And thank you so much Miss [PII] for verifying the policy. How may I assist you?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes ma'am, I have gotten an EOB for a payment uh for a claim uh for [PII] for number 28 Crown. Hold on just a moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Get a sip of water and um it came back and there was no coverage.
[CUSTOMER][NEUTRAL] Uh, for this procedure, but I see in the list it's got the ADA code as a 22,740 and the description is benefit name not found, so I'm wondering if it just got entered incorrectly in your system and that for it got kicked out. I don't know, just asking.
[AGENT][NEGATIVE] OK, I do see you denied this policy does not provide.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Benefits for any procedure service not listed.
[AGENT][NEUTRAL] Let me check that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the procedure code is 22,740?
[CUSTOMER][NEUTRAL] Well that's what is listed, but it should be actually D 2740 which is a crown.
[CUSTOMER][NEUTRAL] And that's what is was sent in on our hard copy. I mean, I'm looking at what we sent in.
[CUSTOMER][NEUTRAL] Uh, actually it's not a D, it's a 0. Some say 0 and some don't say D. So this one was a 02740, which is a porcelain crown.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm pulling that claim image up.
[CUSTOMER][POSITIVE] Thank you ma'am.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And I'm gonna check the benefits as well and then I will send it back if it's listed on there for the examiner to review it.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Yeah, we've done a lot of work on this patient and I, I saw where you paid on a bridge at some point in time that was last last year maybe [PII] and I thought well.
[CUSTOMER][NEUTRAL] Let me just check into this.
[AGENT][NEUTRAL] And I do see that that code is listed on here.
[AGENT][NEUTRAL] So what I'm going to do is send this back to that examiner and have them to review and or process that claim if eligible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] I think that's it. Could I get a reference number please, ma'am?
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], last initial of H and today's date.
[CUSTOMER][NEUTRAL] OK, and [PII] is [PII]?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] Well, that's what I get for thinking [PII]
[AGENT][POSITIVE] Oh, it's no problem.
[CUSTOMER][NEUTRAL] [PII] uh uh now.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] EK there we go. I, there we go.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and today's date, which is what 24, you know what I had been writing [PII], 0 well.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you trying to give us, when you trying to move us on today, that's fine.
[CUSTOMER][NEUTRAL] I know, hey, I'm trying, hey, I'm trying to move off so I can be off the rest of the week, I guess, OK.
[AGENT][NEUTRAL] I could, I'll take it.
[CUSTOMER][POSITIVE] I know what I'm liking this working two days a week after I've been working since I was [PII] full time and I like this, um.
[AGENT][NEUTRAL] Oh, I know you do. Oh.
[CUSTOMER][POSITIVE] Correct, uh, corrected code. OK, thank you, ma'am, [PII], and you have a wonderful day. OK, alright, bye bye.
[AGENT][POSITIVE] You're welcome. Same to you.