AccountId: 011433970860
ContactId: 575d4160-55dc-47f1-9b7f-296931df3a6e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483929 ms
Total Talk Time (AGENT): 235677 ms
Total Talk Time (CUSTOMER): 104007 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/575d4160-55dc-47f1-9b7f-296931df3a6e_20250117T18:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the product office surfing on our claims. How are you?
[AGENT][NEUTRAL] I'm good, [PII]. And you said that you're needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Extension is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims today, [PII], do you have to check status?
[CUSTOMER][NEUTRAL] I have only one.
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] It's 023-91937.
[AGENT][NEUTRAL] OK, thank you, give me a moment, [PII] to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Yeah, sure. May I know your name, please?
[AGENT][NEUTRAL] Again, my name is [PII].
[AGENT][NEUTRAL] And [PII], any informa oh, you're welcome. Any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And is this a dental claim that you're checking on?
[CUSTOMER][NEUTRAL] No, it's medical claim.
[AGENT][NEUTRAL] OK, the policy number you gave me is dental.
[AGENT][NEUTRAL] Give me a moment to
[CUSTOMER][NEUTRAL] This is the dental plan.
[AGENT][NEUTRAL] Uh-huh. For that policy number, 02391937. Yes, sir. That's a dental policy.
[CUSTOMER][NEUTRAL] OK. Could you please check whether the members having any medical plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, give me a moment please.
[AGENT][NEUTRAL] OK, so there had been a policy, uh, let me see, just one moment.
[AGENT][NEUTRAL] OK, so there had been a limited benefit plan with this for this member with APL that had an effective date of [PII].
[AGENT][NEUTRAL] And a term date of [PII]. What is your um date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date is [PII].
[CUSTOMER][NEUTRAL] And the charge amount we have uh $333 even.
[CUSTOMER][NEUTRAL] May I know the medical policy number?
[AGENT][NEUTRAL] 02342056
[CUSTOMER][NEUTRAL] 02342056, right?
[AGENT][NEUTRAL] 02342056. Is that what you said?
[CUSTOMER][POSITIVE] I got it, yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 0747.
[AGENT][NEUTRAL] If there was a benefit paid in the amount of $75?
[CUSTOMER][NEUTRAL] What is the allowed amount?
[AGENT][NEUTRAL] $75. This is not a major medical insurance plan?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the remarks state with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Yes, sir, the $75 allowed and paid and the payment amount is $75. And may I know the check number or the EFT number?
[AGENT][NEUTRAL] 2004975.
[CUSTOMER][NEUTRAL] What is the check date?
[AGENT][NEUTRAL] The check date is 9-27-2024. Can you verify the address for the provider?
[CUSTOMER][NEUTRAL] Yeah, sure. I just need to check your date.
[AGENT][NEGATIVE] It is not cleared as of now.
[CUSTOMER][NEUTRAL] OK, I'm providing that just give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, the address we have [PII].
[AGENT][NEUTRAL] Yes, sir, and that is where this check was mailed to.
[CUSTOMER][NEUTRAL] Yeah, but the check is still outstanding, so is it possible to void and reissue the payment?
[AGENT][NEUTRAL] Yes, sir, I will can send a request.
[AGENT][NEUTRAL] To verify that the check has not cleared and request a reissue.
[CUSTOMER][NEUTRAL] Yeah, I just need to know what is the check, uh, the validity period? How long the check is valid?
[AGENT][NEUTRAL] Um, I believe it's 180 days.
[CUSTOMER][NEUTRAL] 180 days from the check date, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, but still it's not, uh, clear. So is it possible to widen reissue the new payment?
[AGENT][NEUTRAL] OK, I just, yes, sir. I explained that I would send a request to verify that it is indeed still outstanding and if so, to request that the policy have to have the check voided and reissued. I cannot authorize that. I will have to send it.
[AGENT][NEUTRAL] To verify first.
[CUSTOMER][NEUTRAL] OK. So you're saying for which department?
[AGENT][NEGATIVE] I'm saying I will submit the request to verify that the check is still outstanding and if so, to void and reissue.
[CUSTOMER][NEUTRAL] Yeah, I'm just asking for that. You're sending a request to which department?
[AGENT][NEUTRAL] It will be affiliated with our claims division.
[AGENT][NEUTRAL] I have to send it to our accounting department first, yes.
[CUSTOMER][NEUTRAL] Affiliated with the Claims division.
[AGENT][NEUTRAL] They're the only ones that can authorize a reissue.
[CUSTOMER][POSITIVE] OK, thank you so much. I just uh need to know how long it will take.
[AGENT][NEUTRAL] 7 to 10 business days.
[AGENT][NEUTRAL] And then the check will have to be mailed?
[AGENT][NEUTRAL] Which can be another approximate 10 business days to be received. We will not be able, once the check has been reissued, it would be.
[AGENT][NEGATIVE] 30 days before another check could be voided and reissued if this one is still not received as well.
[CUSTOMER][NEUTRAL] OK, please put the call on this.
[AGENT][NEUTRAL] My name and today's date and if you need a copy of this explanation of [PII]efits, [PII], you may print that by going to our portal which is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for the information. Yeah, that's it for and have a nice day. Bye-bye.
[AGENT][POSITIVE] Yes, sir. OK. Well, thank you for calling APL [PII], and I hope that you have a nice um afternoon as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.