AccountId: 011433970860
ContactId: 3e8d7370-7277-42bb-9514-6aa6fc9c8f09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 854859 ms
Total Talk Time (AGENT): 261811 ms
Total Talk Time (CUSTOMER): 297518 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/3e8d7370-7277-42bb-9514-6aa6fc9c8f09_20250611T16:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from a dental office for a claim status for one of our patients.
[AGENT][POSITIVE] Alright, I'm happy to check on a claim. Do we have their policy number?
[CUSTOMER][NEUTRAL] 02625526
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] Uh, for the first one it's [PII] and then [PII].
[AGENT][NEUTRAL] On the [PII], uh, what's the bill amount?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] 162.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] OK, so, uh, we did receive a claim it looks like for this state of service, uh, the member has benefits through a staffing agency we're just awaiting eligibility, um, so we haven't heard anything back from them as of yet on that so claim has not been processed at this point.
[CUSTOMER][NEUTRAL] Um, I had called about this, I believe last week or 2 weeks ago.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII] actually I called and.
[CUSTOMER][NEUTRAL] I also called the other company.
[CUSTOMER][NEUTRAL] And they said that they already sent over his eligibility.
[CUSTOMER][NEUTRAL] It's from the benefits in a card, right?
[AGENT][NEUTRAL] Mhm. Benefits in a card, yeah.
[CUSTOMER][NEUTRAL] The BIC
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, they already sent it over. I have spoken to a rep on [PII].
[CUSTOMER][NEUTRAL] And so then I called back. I called American um Public Life Insurance Company back on [PII].
[CUSTOMER][NEUTRAL] And she said any day now it's gonna be finalized.
[CUSTOMER][NEGATIVE] I'm just calling back because I received another uh denial.
[AGENT][NEUTRAL] Yeah, because I don't show that we've received anything from them like I'm checking.
[CUSTOMER][NEUTRAL] Is there any way to maybe like do a conference call or like we can reach out to them?
[AGENT][NEUTRAL] Yeah, do you have um
[AGENT][POSITIVE] A good call back number in case something happens.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's your first name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, give me just a second, let me see if I can get somebody on the line over there.
[CUSTOMER][POSITIVE] Thank you, what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol precion. Your call may be recorded for quality control purposes.
[CUSTOMER][POSITIVE] Thank you for calling Benefits and a card. My name is [PII]. How can I assist you?
[AGENT][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from American Public Life Insurance. Uh, we have a mutually insured, um, person who I have a provider on the other line checking on a claim, and it looks like we've been awaiting some eligibility information, so I'm wondering if that's something maybe you could help me with or look at.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what's the member's first and last name?
[AGENT][NEUTRAL] First name is [PII], which is spelled [PII]
[AGENT][NEUTRAL] And the last name, I'll give it to you phonetically because I can't pronounce it. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's fine.
[CUSTOMER][NEUTRAL] OK, thank you. And that was [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK and then um are they the policy holder?
[AGENT][NEUTRAL] Yeah, he shows that he's the insured, yeah.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And then what was their date of birth just so that I'm sure that I'm on the right pile.
[AGENT][NEUTRAL] No problem. It's [PII].
[CUSTOMER][NEUTRAL] OK, yes, and then when was his service for?
[AGENT][NEUTRAL] So this claim I'm looking at.
[AGENT][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] OK, um, and then what was it for?
[AGENT][NEUTRAL] Uh, let's see, and there was another one also.
[CUSTOMER][NEUTRAL] Cause he only, cause he only has dental coverage and he only has um the MEC standalone, which is only a preventative plan that doesn't cover no doctor visits is sick, hospital visits of injured, urgent care emergency room neither surgeries. So it will only cover preventative visits such as like a physical, some vaccines, some estoy and cancer screening, but it doesn't cover any of his hospital indemnity services.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So yeah, this was just for dental coverage it appears um like this one claim is from a margarita DDS I'm showing procedure codes like 0220.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 02.
[CUSTOMER][NEUTRAL] And that was for the [PII]?
[AGENT][NEUTRAL] Mhm. [PII], yeah, yeah.
[CUSTOMER][NEUTRAL] Of this year.
[CUSTOMER][NEUTRAL] So for um [PII] of this year, he did have active dental coverage.
[AGENT][NEUTRAL] OK, and then there was one for the [PII] too, so.
[CUSTOMER][NEUTRAL] Was it for dental also?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that for [PII] of this year, yeah. So for that, um, he's been active since [PII] and coverage is still active at this moment. So yeah, both of those states are active coverage.
[AGENT][NEUTRAL] Have you guys
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, have you guys gotten anything from us to verify the eligibility because we have the claims, but they say they're pending um eligibility from you guys.
[CUSTOMER][NEUTRAL] So typically when that happens we usually just direct them back to you guys since you guys are the carrier we don't get any of that information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But like I said, like on my end it seems like they're active typically when they get those letters we just direct them back to you guys, which is APL since you guys are the dental carrier.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For that plan
[AGENT][NEUTRAL] Um, give me just a second.
[CUSTOMER][NEUTRAL] Cause we wouldn't get any of that information. Um, the only thing I could think of is maybe like they wanted to make sure that they were active for that date, but to actually know if it's covered or how much is covered, um, we typically direct it to APL.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But like I said, for [PII] of this year and the [PII], the member did have active dental coverage.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] OK. Um, yeah, I don't know.
[AGENT][NEUTRAL] Because that's what she had said, the provider on the other line, she said that she called you guys and you guys just send her back to us and I'm like, oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, because I got in situations in the past where people call because they get those letters saying that they're waiting for eligibility from benefits and a card, um, but typically we just let them know that they were active for whatever date of service it was and we actually tried to see that they had, um, that plan that covers that service and if they do, we just direct them to the carrier um to see if that's something that's covered or not.
[CUSTOMER][NEUTRAL] Whenever they went for that visit.
[AGENT][POSITIVE] Right, I got you.
[CUSTOMER][NEUTRAL] Because we wouldn't have that information.
[AGENT][NEUTRAL] OK. All right, [PII], well, I appreciate all your help with that. Then if there's nothing you can send me on that, then I will just reach out to my claims department to see how we need to proceed forward on this.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's fine. And then if you have any other questions, we're open from [PII] Monday through Friday Eastern time.
[AGENT][POSITIVE] All right, thank you so much. I appreciate you.
[CUSTOMER][POSITIVE] You're welcome have a nice day.
[AGENT][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] I'm sorry for the long hold. Yes, so I spoke with [PII] over at Benefits and a card and I'm trying to get it figured out what we need to do to process the claim.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, I'm gonna have to reach out it looks like to claims department to see what they need. Um, benefits on a card, I mean, confirm that the patient was active on the date of service for both the claims, so it's just what we need to do to get them processed on our side at this point.
[CUSTOMER][NEUTRAL] OK, can I have um a reference number, sir?
[AGENT][NEUTRAL] Yeah, you can use my name with today's date as a call reference.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] 61125 is the reference number, right?
[AGENT][NEUTRAL] Yep, with my name. Uh-huh.
[CUSTOMER][NEUTRAL] How many days should we allow for the claim to be finalized?
[AGENT][NEUTRAL] Well, claims generally take like 5 to 7 to process, but we've had this one for some time, so I would give it through uh the end of the week.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I'll call back then next week Monday.
[AGENT][POSITIVE] OK, not a problem.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Oh, you