AccountId: 011433970860
ContactId: 233e5376-10b6-498a-9424-03be5ca3c0a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340670 ms
Total Talk Time (AGENT): 173316 ms
Total Talk Time (CUSTOMER): 121661 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/233e5376-10b6-498a-9424-03be5ca3c0a9_20250428T18:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I work for a dentist in [PII]. I have a claim that um came back unpaid stating that they're waiting for information to confirm eligibility from benefits in a card.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I, I don't understand.
[AGENT][NEUTRAL] OK, so yes ma'am, so you have a question regarding the claim that we are waiting to confirm eligibility on, is that correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, yes ma'am, I like you.
[CUSTOMER][NEUTRAL] And I mean, I went online and I got the information.
[AGENT][NEUTRAL] Mm, when you say you went online and got the information, what do you mean by that?
[CUSTOMER][NEUTRAL] Well, I called and had them fax it. I called the number that I found online for APL and they I had them fax me the benefit information for the patient before the appointment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And so I, I, I don't understand why they're not paying on the claim I guess is.
[AGENT][NEUTRAL] OK, so I can help you um with this, [PII]. I can take a look at this claim. What is a good call back number for you please?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Um, policy certificate number 02585058.
[AGENT][NEUTRAL] OK, thank you, one moment please while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information that is provided would be a verification of benefits and not a guarantee of payment. What is the patient's name and their date of birth?
[CUSTOMER][NEUTRAL] That would be [PII] and his date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and what is the, um, excuse me, the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] That would be um [PII] and the uh total bill charges are 42,240.
[AGENT][NEUTRAL] OK, thank you and the claim number?
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] 3591278.
[AGENT][NEUTRAL] Mhm. OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so yes, ma'am, um, this policy, that is correct. We are still awaiting to confirm eligibility from benefits in a card.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And once that has been received, we will continue processing the claim.
[CUSTOMER][NEUTRAL] So I don't need to do nothing we're just that this is just saying that you got the claim.
[AGENT][NEUTRAL] It's just kind of an, yes, ma'am. It's, it's essentially, I'm gonna, I'm gonna call it a holding pattern.
[AGENT][NEUTRAL] This policy is, yes, this policy, yeah, I mean, that's my term. um, so yes, ma'am, we did receive the claim. The policy is showing it's active, but we are awaiting the confirmation to confirm eligibility from benefits in a card for that data service.
[CUSTOMER][POSITIVE] That's a great name for it.
[CUSTOMER][NEUTRAL] OK, and so is that like his work is supposed to verify his eligibility or who who who who is the person that they're waiting for the card from?
[AGENT][NEUTRAL] Yes, benefits in a card is the enrollment company for his employer. They're like a third party, so they handle.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, deductions and that type of thing and then they provide the different carriers with the information. So we do still show this member's policy is being active, but we just have not received.
[AGENT][NEUTRAL] Our information confirming the eligibility for this data service.
[CUSTOMER][NEUTRAL] OK, OK, well then I will wait to hear back from you.
[AGENT][NEUTRAL] OK, and then, um, yes ma'am, once that is confirmed, then yes, would the claim would continue to be processed and then, you know, another EOB would go out and you can also, I don't know if the person you spoke with before told you about our portal, but we do have a portal that you should be able to check claim status in as well.
[AGENT][POSITIVE] And the website for that Carol is secured.
[CUSTOMER][NEUTRAL] OK and what's
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Secured. [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][POSITIVE] [PII] OK.
[CUSTOMER][POSITIVE] Website OK perfect thank you so much I really appreciate your help.
[AGENT][NEUTRAL] OK. Well, you, oh, yes, ma'am. Certainly. So is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's all I needed.
[AGENT][POSITIVE] OK, well, thank you again for calling APO and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Yes ma'am, thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.