AccountId: 011433970860
ContactId: 1df1607b-8d10-4074-a3e4-ba9e5cd336d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560359 ms
Total Talk Time (AGENT): 285780 ms
Total Talk Time (CUSTOMER): 240960 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/1df1607b-8d10-4074-a3e4-ba9e5cd336d8_20250129T17:19_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from Highline Dentistry.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] I'm how are you?
[AGENT][POSITIVE] I'm good, thank you.
[CUSTOMER][NEUTRAL] Thank you. Good, I'm calling because I've been having trouble with the patient's claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I know that they say that she didn't have insurance that day, but when I called, um, it looks like it was.
[CUSTOMER][NEGATIVE] It was there and it looks on the top it says um that I have to call the [PII] it says option two that the premier is supposed to be paying for the patients uh I'm so confused on this.
[AGENT][NEUTRAL] OK, let me take a look at what we have in our system. Um, I, I'm not sure about who Premier is. We're American Public Life, but let me look and see what the coverage looks like with us. Uh, could I get a callback number for you?
[CUSTOMER][NEUTRAL] OK, let me take a look.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes, of course, [PII]. My name is [PII]. I'm calling from a dentist's office.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And [PII], what is the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number of this patient is 02472456.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, her name is.
[CUSTOMER][POSITIVE] I'm gonna spell it for you just in case I say it wrong. It's [PII]
[CUSTOMER][NEUTRAL] And then last name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much for verifying the policy. And this is regarding dental benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and so it looks like this policy was effective from [PII]. It did turn on [PII].
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] We see.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Um, so are your charges within the effective date of the policy?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um, come again. I'm sorry, I had to open the door for a patient. Uh, when did you say she, um, was active?
[AGENT][NEUTRAL] Active from [PII] and termed on [PII].
[CUSTOMER][NEUTRAL] OK, so it looks like um.
[CUSTOMER][NEUTRAL] Uh, give me one second. The date of service was [PII], but I called and they told me that she still had insurance.
[AGENT][NEUTRAL] Hm, let me look at the notes.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate you taking your time on this.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] And you know what? I also got some information that says here [PII]. If it says um day estimate is [PII]. I got a form here. Can you give me one second? Let me just get my patience.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][POSITIVE] So much for holding so yeah.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the, uh, it may have been, um, I do show the notes when you called, benefits were provided, um, and it looks like you called on [PII] and was uh provided benefits. However, our policy, if there is no uh
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Hm?
[AGENT][NEUTRAL] Set term date in the system, we will still give benefits, of course, with the disclaimer.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But it does look like um the policy could have possibly still shown active until the end of that month and once premiums were not
[AGENT][NEUTRAL] Uh, we never received, you know, once we received the eligibility information, it showed that they were not covered past [PII] because it looks like their dental and their um medical also canceled on [PII]. Um, now, is that, if that's an issue, like if the
[CUSTOMER][NEUTRAL] OK, so you're.
[AGENT][NEGATIVE] In short is stating I should have been covered. I should have been covered then we, you know, if if her employer sends us updated information, but based on what we have received at this time from the employer, uh, they do not show her uh covered past [PII].
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Oh my goodness, so you're telling me, so if I call in November or if I call and then you guys are telling me she's active, but the patient knows that they're not working no more and it looks like you guys need a form sent for October basically you guys can tell me she's active but she's not active that day.
[AGENT][NEUTRAL] If we have not received anything, uh, definitive from the employer stating that there's an actual term date.
[CUSTOMER][NEGATIVE] If we have not received.
[CUSTOMER][NEUTRAL] His lawyer stated that
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, we still, we will still in our system show them active until.
[CUSTOMER][NEUTRAL] Yes, we we still in our system.
[CUSTOMER][NEGATIVE] That's horrible because us as an insurance we take them because you guys gave us uh and I get it, you guys have to get a form from their job saying they're terminated, but the patient knows all that information we don't.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, um, I do apologize for that, but that is how our system until we, yeah, get something from the employer stating they are no longer covered, there will be no reason for us to terminate their.
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] Their policy.
[CUSTOMER][NEUTRAL] Yeah, so basically you guys can give me the OK, but it has to do with her work when she got terminated.
[AGENT][NEUTRAL] Right, as far as being eligible. So if we're receiving eligibility information after the date, um, and let's just say the employer comes back and says, like we just show the policy effective still. There's no uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] different like.
[AGENT][NEUTRAL] Date showing that, you know, and the policy is about about to lapse or.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah I'm like OK.
[AGENT][NEUTRAL] We just, we on our end show the insured is still active. Now, we can get something from the employer later saying, oh, we, you know, this coverage stopped at this time.
[CUSTOMER][NEUTRAL] So basically,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how do I do about this? Do I call the
[CUSTOMER][NEUTRAL] The patient or do I send her a bill or what, what, what, because I mean the thing is.
[AGENT][NEUTRAL] Now, we do not determine patient responsibility, that is up to the provider. So if the provider decides to reach out to the patient, send them a bill, that is up to the provider. We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I have a question. I got a letter that says, um, I don't know, do you see that on your stuff? It says, um, claim number 3542872. Do you see that? Um, they sent me a form saying that a Premier being paid through and it says COBRA, so what is that?
[AGENT][NEUTRAL] Mm, now, what I'm showing, um,
[AGENT][NEUTRAL] Let me pull this because what I showed is it's just letting you know the policy is no longer active. I don't show anything additional about.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let's see DC 75. Let me take a look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, not eligible for benefits weekly premium, not received our records indicate the premium for this service.
[AGENT][NEUTRAL] Different benefits are not paying that.
[AGENT][NEUTRAL] OK, so basically, as I stated, we did not receive premiums showing that this patient was uh still eligible for the data service, which is why the claim denied. It's basically saying if if premium, premium is being paid through COBR.
[CUSTOMER][NEUTRAL] OK, so based
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you would call the [PII] option too if the insured has COR insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then that would be the next step.
[CUSTOMER][NEUTRAL] OK, OK, so.
[CUSTOMER][POSITIVE] OK dokey thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome. You have a wonderful oh go ahead.
[CUSTOMER][NEUTRAL] 00 hold on, uh, you know what, give me two seconds. I'm sorry to bug you one more time, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, give me one second.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you so much I really appreciate it.
[AGENT][POSITIVE] You're welcome. Have a wonderful day. Thank you for calling APO. Bye-bye.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.