AccountId: 011433970860
ContactId: 1d4a2a0a-ac07-4eed-b3ed-f2ddf1eafcce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556940 ms
Total Talk Time (AGENT): 209969 ms
Total Talk Time (CUSTOMER): 183319 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/1d4a2a0a-ac07-4eed-b3ed-f2ddf1eafcce_20250328T15:11_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] from Boy Family Dentistry. I was just calling uh regarding, um.
[CUSTOMER][NEUTRAL] A claim status for a patient of ours that had a cleaning done back in October of last year.
[AGENT][NEUTRAL] OK, you're needing to check claim status on a member, is that correct?
[CUSTOMER][NEUTRAL] Correct, we um submitted a claim and we just haven't received a payment for it.
[AGENT][NEUTRAL] OK, and I'm sorry, what was your name again?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII]. OK. And [PII], my name is [PII].
[CUSTOMER][NEUTRAL] Oh, I thought you said [PII]. I do apologize.
[AGENT][NEUTRAL] That's OK. That's all right. And what I can help you with this, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Um, yes, ma'am. It is 43872.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, OK, maybe you said 43872?
[CUSTOMER][NEUTRAL] Correct, do you need his social?
[AGENT][NEUTRAL] Mm, OK. Yeah, because that's not a valid policy number for.
[AGENT][NEUTRAL] Yeah, what's the full social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have [PII].
[AGENT][NEUTRAL] OK, so see that's the first part of what you gave me is the first part of his social.
[CUSTOMER][NEUTRAL] Right, it's.
[CUSTOMER][NEUTRAL] Right, so.
[CUSTOMER][NEUTRAL] Um, let me look.
[AGENT][NEUTRAL] OK, so just one moment I can try.
[CUSTOMER][NEUTRAL] Because I know I have this insurance.
[AGENT][NEUTRAL] Yeah, give me just a moment. I believe I've located it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His name is [PII] if that um helps any.
[AGENT][NEUTRAL] OK, so, um, what is his date of birth first off?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is [PII].
[AGENT][NEUTRAL] OK, thank you. So any information that I do provide for you [PII] would be a verification of benefits and not a guarantee of payment. The correct policy number for him is 617.
[AGENT][NEUTRAL] 281.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so policy number is 6, repeat that one more time.
[AGENT][NEUTRAL] 617.
[AGENT][NEUTRAL] 281.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect and I'll update that on the chart.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, that
[CUSTOMER][NEUTRAL] It's um the date of service is from [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] The total fee service was 225. It's for uh by correct.
[AGENT][NEUTRAL] 225.
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Do you need the procedure codes?
[AGENT][NEUTRAL] No, ma'am. Not yet. Mm mm.
[AGENT][NEUTRAL] Let me just see if I can locate a claim for that data service.
[AGENT][NEUTRAL] OK, so for [PII] we did not have a claim on file for him [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what I can do is I can resubmit it to you guys because it says um that y'all received it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um it was in process so but like we sent it submitted it electronically.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, what?
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] For [PII], we do not have, we did not receive it. Mm mm I don't, I'm not sure what that is about, but we don't have anything on him for that data service at all.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because it says, um, we electronically submitted on the [PII] at [PII] that morning.
[AGENT][NEUTRAL] Using the payer ID?
[CUSTOMER][NEUTRAL] The payer ID.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Is that when you say like, or did you fax it?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] We, we submitted it electronically through um the service that we used in Trix.
[AGENT][NEUTRAL] Mm, and what payer ID do you have for APL?
[CUSTOMER][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] And I wanna also make sure you have the correct claims mailing address as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The payer ID that we have was 60801.
[AGENT][NEUTRAL] Mhm. So I'm not sure what happened with that, but
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then um let me look real quick.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the the claim mailing address I have on file is uh [PII] zip code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that is an
[AGENT][NEUTRAL] OK, so that is our old PO box, so let me give you the correct PO box, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me um get a pen and paper real quick.
[AGENT][NEUTRAL] Just let me know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, repeat that um to.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so [PII]?
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK perfect well I will um let me update that in his chart.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] Because it's probably also another thing could possibly happen too.
[CUSTOMER][NEUTRAL] Um, but I'll send that to you guys.
[AGENT][NEUTRAL] OK. Now,
[AGENT][NEUTRAL] OK perfect yeah because there's not a timely filing limit.
[AGENT][NEUTRAL] And then one last thing, uh, [PII], are you familiar familiar with our portal called the online service center that you should be able to check claim status in once we have processed a claim for a member.
[CUSTOMER][NEUTRAL] Um, no, ma'am, I do not.
[AGENT][NEUTRAL] OK, so our portal website the self registering would be secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] AM [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So secure. [PII].
[AGENT][POSITIVE] That is correct. That's our portal website, yes ma'am.
[CUSTOMER][POSITIVE] All righty.
[AGENT][POSITIVE] All righty. And is there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Um, no, ma'am, I really appreciate you.
[AGENT][POSITIVE] Oh, you're certainly very welcome. It was my pleasure and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] OK, yes ma'am, thank you.
[AGENT][POSITIVE] Yes, and you too.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.