AccountId: 011433970860
ContactId: 2acd9cc2-125a-4931-bc13-932232a73b17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 943719 ms
Total Talk Time (AGENT): 320150 ms
Total Talk Time (CUSTOMER): 201582 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/2acd9cc2-125a-4931-bc13-932232a73b17_20250421T20:02_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 regarding a claim.
[AGENT][NEUTRAL] OK, [PII], are you needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. What is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Say that one more time, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] It is going to be 02606022.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It was [PII]. Date of birth was [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the day of service and total bill amount please.
[CUSTOMER][NEUTRAL] The data service is going to be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the bill amount was $530.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] And the name of the provider group?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the name of the provider group?
[CUSTOMER][NEUTRAL] Lakewood Family Dental.
[AGENT][NEUTRAL] Uh, what is the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so this claim was received. The received date on the claim was on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 359016.
[CUSTOMER][NEUTRAL] Just a second, OK, give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You received this claim on [PII] and uh insurance pay how much it was paid.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] It wasn't paid. I said it was received on [PII] and it was processed on [PII]. The claim number is 3590167.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And at this time it has been denied and the reason for the denial states we are awaiting information to confirm eligibility.
[AGENT][NEUTRAL] From benefits and a card. Upon receipt of this information, we will continue processing your claim.
[CUSTOMER][NEUTRAL] Uh, what do you guys need exactly? Can you tell it once again?
[AGENT][NEUTRAL] We're waiting from to confirm that that the patient was eligible.
[AGENT][NEUTRAL] From benefits in a card, which is the.
[CUSTOMER][POSITIVE] Yes, the patient was eligible. We got eligible.
[AGENT][NEUTRAL] The enrollment company that handles all enrollments for this member's policy.
[AGENT][NEUTRAL] And handles their deductions.
[AGENT][NEUTRAL] For premium, we are waiting to confirm eligibility with them.
[CUSTOMER][NEUTRAL] So, so you were waiting for the member, members to to to patient to call to you?
[AGENT][NEUTRAL] Yes, sir. It's essentially, yes, sir.
[AGENT][NEUTRAL] Not the patient we're waiting to confirm from the employer that they were eligible for this data service.
[AGENT][NEUTRAL] And upon receipt of that information, we will continue reviewing the claim.
[CUSTOMER][NEUTRAL] What are the, hold on, hold on.
[CUSTOMER][NEUTRAL] So you are waiting from home. May I know what can I
[CUSTOMER][NEUTRAL] You are waiting from
[AGENT][POSITIVE] I will read the remark to you again.
[AGENT][NEUTRAL] We are awaiting information.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] To confirm eligibility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From benefits in a card.
[AGENT][NEUTRAL] Upon receipt of this information.
[AGENT][NEUTRAL] We will continue processing your claims.
[AGENT][NEUTRAL] And if
[AGENT][NEUTRAL] And we do have a portal, [PII], in which you can print that explanation of benefits.
[CUSTOMER][NEUTRAL] Go on.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] No, we don't have portal.
[AGENT][NEUTRAL] OK, so we're waiting to confirm eligibility and then we will continue reviewing the claims.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just a second, OK.
[CUSTOMER][NEUTRAL] And this is the American public, uh, American public life, right?
[AGENT][POSITIVE] That is correct, yes, sir.
[CUSTOMER][NEUTRAL] OK, so, OK, I just put it on my system stating that and you guys received this on [PII] and profit on position of [PII]. Right now the claim is denied, right? And you guys are waiting for eligibility.
[CUSTOMER][NEUTRAL] Uh, eligibility from.
[AGENT][POSITIVE] Confirmation, that is correct.
[AGENT][POSITIVE] Benefits in a card.
[CUSTOMER][NEUTRAL] From company, which company?
[CUSTOMER][NEUTRAL] Which company?
[AGENT][NEUTRAL] Benefits and a car again benefits and a card is the name of the company that we're.
[CUSTOMER][NEGATIVE] You're, you're, you're breaking out.
[AGENT][NEUTRAL] Waiting.
[AGENT][POSITIVE] Benefits in a card.
[CUSTOMER][NEUTRAL] benefits and.
[CUSTOMER][NEUTRAL] OK, can you tell, can you speak it out like the benefits of that one?
[AGENT][NEUTRAL] In a card.
[AGENT][NEUTRAL] The next word is I, the next word is the letter A, the next word is C A R D.
[CUSTOMER][NEUTRAL] Eligibility of benefits.
[CUSTOMER][NEUTRAL] In a call
[AGENT][NEUTRAL] Do you want me to read it again to you? I've read, uh.
[CUSTOMER][NEUTRAL] Yes, yes, slowly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the remark on the claim states, we are awaiting.
[AGENT][NEUTRAL] Information
[AGENT][NEUTRAL] To confirm eligibility.
[CUSTOMER][NEUTRAL] Just waiting.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Go on to confirm availability.
[AGENT][NEUTRAL] From
[CUSTOMER][NEUTRAL] From
[AGENT][POSITIVE] Benefits in a card.
[CUSTOMER][POSITIVE] Benefits and benefits and in a card, that's what that is the one.
[AGENT][NEUTRAL] I spelled it for you. Benefit, the next word is I, uh-huh, the next word is A, the next word is card, period. After that, it says upon.
[CUSTOMER][NEUTRAL] OK, benefits in a card.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Receipt.
[AGENT][NEUTRAL] Of this information.
[CUSTOMER][NEUTRAL] Sorry sir, hold on hold on hold on.
[AGENT][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you get all of that this time, [PII]?
[CUSTOMER][NEUTRAL] OK, OK, yeah. After benefits in a card after that one?
[AGENT][NEUTRAL] After the, after the part about benefits in a card and a period.
[AGENT][NEUTRAL] Next sentence states upon.
[CUSTOMER][NEUTRAL] Period
[AGENT][NEUTRAL] Seat
[AGENT][NEUTRAL] Of this information.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] We will continue.
[AGENT][NEUTRAL] Processing your claim.
[AGENT][NEUTRAL] So again, the full remark, we are awaiting information to confirm eligibility from benefits and a card. Upon receipt of this information, we will continue reviewing your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Or I'm sorry, we will continue processing your claim. I'm sorry.
[CUSTOMER][NEUTRAL] Just, just hold on, just hold on, hold on, hold on.
[CUSTOMER][NEUTRAL] So is there anything so we get the providers need to do?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] So, so, so you, you're saying that you're waiting from the eligibility or receiving information.
[CUSTOMER][NEUTRAL] Until you will not process, right? So how many days it will take?
[AGENT][NEUTRAL] I would give it an approximately 2 weeks.
[CUSTOMER][NEUTRAL] 2 weeks.
[AGENT][NEUTRAL] Approximately.
[CUSTOMER][NEUTRAL] Did you mail it or send them, send you mail, did you mail to them so they get this information?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, so this is something they will provide to us and once, yes, the explanation has been mailed, the explanation of benefits has been mailed out to the provider with that remark on there that I read to you.
[CUSTOMER][NEUTRAL] Did you mail anything?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, uh, no, I'm just asking you that, uh, you, do you guys need information about the patient eligibility, uh, eligible on that date, uh, did you guys mail anything to to any any information that you guys that you want from anything? Did you, did you mail information?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, all right.
[AGENT][POSITIVE] Yes, sir. Correct, we did.
[CUSTOMER][NEUTRAL] OK, what is the call reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] Your name?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And is there anything
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with today?
[CUSTOMER][NEUTRAL] Uh, can you send me the U will be through fax?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Can I keep this claim is under process? Is it OK?
[AGENT][NEUTRAL] This claim is in a holding pattern. I've read you the remark. It will be on the explanation of benefits, [PII], that I am sending to you exactly what I've read to you.
[CUSTOMER][NEUTRAL] Mhm. OK, send it
[AGENT][NEUTRAL] One moment while that information is loading.
[AGENT][NEUTRAL] Does it need to put put to your attention? Does it need to say a text?
[CUSTOMER][NEUTRAL] Yeah, yeah, [PII] my name.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hey, did you say [PII]?
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, that has been faxed to you so provided that there's.
[AGENT][POSITIVE] Not any type of technical issue you should be very soon.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, nothing. Thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a nice day as well.