AccountId: 011433970860
ContactId: 49bd786e-9c73-4990-ad6f-2c8deefbb5bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318100 ms
Total Talk Time (AGENT): 147145 ms
Total Talk Time (CUSTOMER): 77876 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/49bd786e-9c73-4990-ad6f-2c8deefbb5bb_20250124T18:51_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from University Dental Care.
[AGENT][NEUTRAL] Hey [PII], how are you doing?
[CUSTOMER][POSITIVE] I'm all right how are you?
[AGENT][POSITIVE] I'm doing good.
[CUSTOMER][NEUTRAL] So I was calling about a claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and you said it was dental?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right. May I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Uh, phone number is [PII].
[CUSTOMER][NEUTRAL] And then the policy number?
[AGENT][POSITIVE] Thanks, OK.
[CUSTOMER][NEUTRAL] OK, I'm pulling that up. I have 024.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] 95609
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh first name is [PII], birthday [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it was for um.
[CUSTOMER][NEUTRAL] 12 9.
[AGENT][NEUTRAL] All right, and the total bill amount?
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, 165.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] 168.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 3782.
[AGENT][NEUTRAL] And on [PII], the claim was denied. I'm I'm getting the reason for you now. OK, so we're waiting for eligibility from their provider, or sorry, from their employer. The eligibility is just the type of um insurance that they have because it's a temp agency, we have to check weekly and we have not received the eligibility back from their um employer yet to continue processing.
[CUSTOMER][NEUTRAL] So you need eligibility.
[CUSTOMER][NEUTRAL] From
[AGENT][POSITIVE] Benefits in a card.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] From benefits in a card. So benefits in a card has to send us the eligibility and once it's received, we can continue processing, but there's no turnaround on that.
[CUSTOMER][NEUTRAL] So how how do you guys reach out to his.
[CUSTOMER][NEUTRAL] Provide, uh, you know.
[AGENT][NEUTRAL] So we notify them in writing with explanation of benefits, um, but they're also aware we have to do this for all of our um team members, so they, they know the process.
[CUSTOMER][NEUTRAL] Alright, so.
[CUSTOMER][NEUTRAL] It was he covered on that data service?
[AGENT][NEUTRAL] Um, let me see, what's the date of service? [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Yes, the policy has been active since [PII], so yes, it was um it was active.
[CUSTOMER][NEUTRAL] All right, so
[CUSTOMER][NEUTRAL] I shouldn't have to call the patient tell the patient call your boss.
[AGENT][NEUTRAL] Right, at this point, there's really nothing for anyone to do once we receive it, I mean, other than, you know, to expedite the claim they can reach out to the employer, but the employer is aware, it's the whole group, not just.
[AGENT][NEUTRAL] Um, this one member.
[CUSTOMER][NEGATIVE] Yeah, it's just I don't wanna do treatment if I have to wait, you know what I'm saying over a month, you know.
[CUSTOMER][POSITIVE] It's because we're going getting ready going to February.
[AGENT][NEUTRAL] Right, now that's true.
[CUSTOMER][NEGATIVE] And I don't like anything being over [PII] on my books, no.
[AGENT][NEUTRAL] Well, I mean, yeah, if, yeah, they can reach out to the um
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] They can reach out the benefits in the card or we provided their phone number for the insured on the explanation of benefits. I can give it, um.
[CUSTOMER][NEUTRAL] No, that's fine. I'll wait. you already did it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You sure?
[AGENT][NEUTRAL] All right, well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that was it, sweetie.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.