AccountId: 011433970860
ContactId: 03bbbf99-2cf2-4f43-973a-c41d67bb9e3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1520859 ms
Total Talk Time (AGENT): 491989 ms
Total Talk Time (CUSTOMER): 303312 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/03bbbf99-2cf2-4f43-973a-c41d67bb9e3b_20250220T20:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from service to your client status. How are you doing today?
[AGENT][NEGATIVE] I'm fine. I'm having difficulty hearing you. You sound very far away.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Can you able to hear me now?
[AGENT][NEUTRAL] Um, that is a little better. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, I'm [PII] calling from products office to check on a client status. How are you doing today?
[AGENT][NEUTRAL] OK, [PII], you have one I'm doing fine. You have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Can check status.
[AGENT][NEUTRAL] OK, how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I do have 4 plans.
[AGENT][NEUTRAL] OK, your 4 claims, are they for the same patient or 4 different patients?
[CUSTOMER][NEUTRAL] No, 2 for the same patient and 2 other patients.
[AGENT][NEUTRAL] OK. So yes, [PII], I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] To progress.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's it.
[AGENT][NEUTRAL] Thank you and what is, OK, so first off, [PII], you would use my name along with today's date as each of your call reference numbers.
[AGENT][NEUTRAL] Also, any information that I.
[CUSTOMER][NEUTRAL] Yeah. Could you please spell it?
[AGENT][NEUTRAL] My name is [PII]. It is spelled [PII]
[AGENT][NEUTRAL] And also like any information that I provide for you, you're welcome. On the claims today will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits for any of them, you may print them by going to our portal at [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] It's 02550028.
[AGENT][NEUTRAL] Thank you one moment while I get all of the members' information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient's name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the date of first date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $1,137 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you did say that that first data service is 12/24 of 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes, that's right, [PII].
[AGENT][NEUTRAL] And this is on a dental policy, is that also correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, and again you said that the bill amount is 1137 even, is that correct? Because I don't have a claim for for 1137.00.
[CUSTOMER][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] It was 11:37.76.
[AGENT][NEUTRAL] OK, let me check that bill amount. Just one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date was on [PII] and it was processed and denied the same day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354-7131.
[AGENT][NEUTRAL] The reason for the
[CUSTOMER][NEUTRAL] May I know the reason for the internet?
[AGENT][NEUTRAL] I made. Our records indicate that premium for this state of service was not received. Therefore, benefits are not payable. If premium is being paid through COR, please contact, then it gives out the phone number. As of now we have not received premium for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a copy of arbitration?
[AGENT][NEUTRAL] Yes, I explained to you that you could print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you, thank you, perfect.
[AGENT][NEUTRAL] You're welcome. And did you say that you have another data service for this number also?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No, no. I do have a different number. Can you try with the next next number?
[AGENT][NEUTRAL] OK, so you don't need any other information on this policy, is that correct?
[CUSTOMER][POSITIVE] Yeah. Yes, that's right.
[AGENT][NEUTRAL] OK, so give me a moment to finish what I have to do on this policy first, please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Yeah, sure, take it.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then your next policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's 02518581.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth for this policy?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And the date of service and total bill amount for her please.
[CUSTOMER][NEUTRAL] The of service is 11-8-2024 and the total bill amount is
[CUSTOMER][NEUTRAL] $4,134 even.
[AGENT][NEUTRAL] OK, again, you said the date of service is [PII] for $4,134 even, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, that's right.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] What is the provider's name for this claim?
[CUSTOMER][NEUTRAL] One moment, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The product name is.
[CUSTOMER][NEUTRAL] Even Lashan Ramsa.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do not have one claim on file for this number for that total billed amount.
[CUSTOMER][NEUTRAL] Can you please verify the payer ID and mailing address?
[AGENT][NEUTRAL] Was it
[AGENT][NEUTRAL] Yes, so give me a moment to look at a couple of things. So this was one claim for the total bill amount of $4,134. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] I'm just double checking some things, [PII], so bear with me, please.
[CUSTOMER][POSITIVE] Yeah, sure. Please take your time.
[AGENT][POSITIVE] Mhm, thank you.
[AGENT][NEUTRAL] OK, so the claim was not submitted as one total bill charge for that. We received two separate claims.
[AGENT][NEGATIVE] For that provider totaling the amount that you gave me, but it is not one.
[AGENT][NEUTRAL] Actually no, it's not for the same build amount. I'm sorry.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claims mhm the claims mailing address is going to be PO Box.
[AGENT][NEUTRAL] Are you, I'm sorry, are you ready?
[CUSTOMER][NEUTRAL] Yeah, give me a moment.
[AGENT][NEUTRAL] Yes, if you want to double check the billed amount, but I do not have a bill for a claim or claims for that provider for the bill amount you're giving me.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yeah, just confirm me the mailing it.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the tax ID number?
[CUSTOMER][NEUTRAL] Yeah, the tax ID number is.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so yes sir, I do have claims for this provider but not for the billed amount that you're giving me.
[CUSTOMER][NEUTRAL] OK, perfect. Could you please confirm me the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Thank you. May I know the time returning limit for the client?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, I'm sorry to see I miss, I wrongly, uh, sorry, provider's name and patient's name and confused, uh, but there is actually is the same provider or another patient.
[CUSTOMER][NEUTRAL] Can you check with that question now?
[AGENT][NEUTRAL] OK, you had said you had 2 patients and they each had 2 dates of service. So this is, so that's not.
[CUSTOMER][NEGATIVE] Yeah, that's what I wrongly said.
[CUSTOMER][NEUTRAL] I saw the product name and uh and said that this was any patient.
[AGENT][NEUTRAL] So you have a different patient.
[CUSTOMER][NEUTRAL] But it's for different patients.
[AGENT][NEUTRAL] So just a moment
[CUSTOMER][NEUTRAL] Yeah, for the same provider.
[AGENT][NEUTRAL] OK, so you'll need to give me a moment to finish my note on this one before I can move on to the next policy number.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] The next policy number is 02550181.
[AGENT][NEUTRAL] That is the one that we just did.
[CUSTOMER][NEUTRAL] I think it's 02518581.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, sir. Your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Mhm. So the service and total build amount.
[CUSTOMER][NEUTRAL] It's 1015, 2024, and the bill amount is $29 even.
[AGENT][NEUTRAL] $39 even. Is that correct?
[CUSTOMER][NEUTRAL] 29 $29.
[AGENT][NEUTRAL] 29
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, so give me just one moment to look at something, [PII].
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, that's not the same policy that we just did. It was a very similar number, so just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date you said the data service is gonna be [PII] for $29 is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, there is no claim on file for this member for that data service.
[CUSTOMER][NEUTRAL] Banksy.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh, what was the time responding limit for this plan?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Thank you, [PII]. Can we go on to the next question?
[AGENT][NEUTRAL] You're
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is your last patient, is that correct, [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, and what is that policy number?
[CUSTOMER][NEUTRAL] It's 02507943.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah. The patient's name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total total bill amount for her place.
[CUSTOMER][NEUTRAL] It's 1710 [PII] and the bill amount is $240 even.
[AGENT][NEUTRAL] 240 is the bill amount for 7-10-2024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received on [PII], processed the same day.
[AGENT][NEUTRAL] The claim number is 349-5195.
[AGENT][NEUTRAL] What is the provider's name?
[CUSTOMER][NEUTRAL] Yeah, the brother's name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Tax ID number?
[CUSTOMER][NEUTRAL] Yeah, one moment. The tax ID is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so again this claim I gave you the received date and the process date and the claim number, correct? Mhm. there was a benefit paid in the amount of $69.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] That was paid on single check 186-9144.
[AGENT][NEUTRAL] That check did clear on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What was the paid amount for the 40,150?
[AGENT][NEUTRAL] I'm sorry, I didn't understand you.
[AGENT][NEUTRAL] What was your question again?
[CUSTOMER][NEUTRAL] Yeah, it's code 15.
[CUSTOMER][NEUTRAL] What was the paid amount for the card [PII]?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, your voice cut out. On which code?
[CUSTOMER][NEUTRAL] Uh, the code 150.
[CUSTOMER][NEUTRAL] [PII], are you there?
[AGENT][NEUTRAL] [PII], I'm not. I'm not able to hear you.
[AGENT][NEUTRAL] Yes, I am here. What was the code? Your voice is cutting out.
[CUSTOMER][NEUTRAL] Yeah, because the code 0150, what was the paid amount?
[AGENT][NEUTRAL] On [PII], the paid amount was $49.
[CUSTOMER][NEUTRAL] But the code 01.
[CUSTOMER][NEUTRAL] OK. What was the allowed amount?
[CUSTOMER][NEUTRAL] And patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was the amount?
[AGENT][NEUTRAL] That is the allowed amount, that is the benefit amount?
[CUSTOMER][NEUTRAL] Thank you. What was the paid amount and another amount for the code [PII]?
[AGENT][POSITIVE] OK, that a portion of that benefit.
[AGENT][NEUTRAL] Was applied to the calendar year deductible $50 was applied to the deductible and there was a benefit paid in the amount of $20 on the check.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, I do want a copy of UB to be patched for this plan. Is there any possible way?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[AGENT][NEUTRAL] It's still loading.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][NEUTRAL] What is it, but you can go ahead and give me the fax number to send this to, and again, you can also print it yourself by going to that portal website that I gave you.
[CUSTOMER][NEUTRAL] That's true.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] It's not necessary.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Mhm, you're welcome.
[AGENT][NEUTRAL] And again, that fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, so that explanation of benefits has been faxed. So provided that you're able to receive it, you should be receiving that within the next few minutes.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your time. Have a great day.
[AGENT][POSITIVE] You're very welcome. Yes, sir. OK, well, you too, [PII], if that's all I can help you with, and thank you again for calling APL today.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Uh huh bye bye.