AccountId: 011433970860
ContactId: 2e5c566a-3fc8-47e7-9d9d-a8badbf0dba0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248619 ms
Total Talk Time (AGENT): 124937 ms
Total Talk Time (CUSTOMER): 74349 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/2e5c566a-3fc8-47e7-9d9d-a8badbf0dba0_20250103T16:16_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] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I hope you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's 02363839.
[CUSTOMER][NEUTRAL] Please give me another 55 minutes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, we have to book for the dental related. We have to check the provider.
[AGENT][NEUTRAL] And any information that I provide for you today, hope will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name is uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge is $23,398 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so this claim has been received more than once. The most recently received claims have been denied as duplicates. Uh, the original claim information, is that what you need?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The original claim was received on [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3485205.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the reason for the denial on this claim states to please provide copies of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, can you please verify the
[AGENT][NEUTRAL] We have
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Whether you have received the primary UB from your, we have submitted it already.
[AGENT][NEUTRAL] So, are you still there?
[AGENT][NEGATIVE] We have not received it. We've only received the claim again.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh the attention?
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] OK, uh, timely filing limit?
[AGENT][NEUTRAL] And again, we only need the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] There is not one for this?
[AGENT][NEUTRAL] And then once the claim has been processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can also access and you can already access this explanation of benefits with the claim number that I provided for you by going to secured. [PII].
[CUSTOMER][POSITIVE] OK. Yeah, OK. Thank you.
[AGENT][NEUTRAL] And I hope if you need a call reference number from, oh I'm sorry, yeah, if you need a call reference number it would be my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Absolutely. You too. And if that's all I can help you with, thank you again for calling APL and I hope you have a nice weekend as well.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.