AccountId: 011433970860
ContactId: f8f890ae-d117-4d67-9322-2d29b8bd1643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277010 ms
Total Talk Time (AGENT): 116837 ms
Total Talk Time (CUSTOMER): 71358 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f8f890ae-d117-4d67-9322-2d29b8bd1643_20250410T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling from a dental office.
[AGENT][NEUTRAL] Hi, [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Uh, I'm checking the status of the claim.
[AGENT][POSITIVE] All right, well, I can definitely help you with the claim status. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, [PII]. Uh, policy number, I have a subscriber ID. Is that OK? I, I have a policy certificate number.
[AGENT][NEUTRAL] Yes, policy certificate number.
[CUSTOMER][NEUTRAL] OK, uh, 02514596.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] showing the view, showing uh 3 1163.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] of this year, $246.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3561528.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy was
[AGENT][NEUTRAL] Hold on.
[AGENT][NEGATIVE] That doesn't look right. Hold on one second.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] Oh, OK, OK, data service. OK. So it was terminated at the what was confusing me was when we received it, but the um services were rendered after the coverage was terminated, so this policy was active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEGATIVE] That still doesn't make any sense. So [PII].
[AGENT][NEUTRAL] I'm gonna send this back to be reprocessed.
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, it's funny because I have it. Let me look at.
[CUSTOMER][NEUTRAL] See, my system says that it was submitted on the [PII] and that it was acknowledged receipt of encounter on [PII], so yeah, and then.
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][NEUTRAL] Yeah, I don't know about that. I'm gonna definitely, yeah, I'm gonna have this sent back to be reprocessed. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I would still give it to the 7 to 10 business day turnaround just to be on the safe side, but it could definitely be less time that you receive the explanation of benefits since it's already started.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great, I'll make a note to uh check back in uh 10-11 business days. Thank you.
[AGENT][NEUTRAL] Alright
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there a reference number for this call in case I have to call again?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and today is uh [PII].
[CUSTOMER][POSITIVE] Uh, [PII]. Great. Thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.