AccountId: 011433970860
ContactId: 5d5cddb9-dffd-4b91-804c-3599baf01db9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439040 ms
Total Talk Time (AGENT): 199895 ms
Total Talk Time (CUSTOMER): 226904 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/5d5cddb9-dffd-4b91-804c-3599baf01db9_20250415T18:29_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. I've got a provider on the back line that um is needing help with an EOB.
[CUSTOMER][NEUTRAL] She didn't really give details on what she needed with the EOB, but I guess she's checking to see if we got it and if we processed it. It's for [PII] date on a [PII].
[AGENT][NEUTRAL] OK, so she's needing to see if we've received an explanation of benefits that they sent.
[CUSTOMER][NEUTRAL] Well, she says she needs help with the EOB so she's gotten an EOB, but I don't think it's from us because we don't have anything but one thing, and she's saying the data service is [PII], but I can't see all that, so I don't know what she's really looking at, um, but her name is Ms. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, I can help her with that.
[AGENT][NEUTRAL] What what's her name? Wait, what's her name again?
[CUSTOMER][NEUTRAL] And the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Ms. [PII].
[AGENT][NEUTRAL] [PII]. OK. And what's your callback number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Her callback number is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] It's 258.
[CUSTOMER][NEUTRAL] 472-9. Jose Rivera is the insured and I did verify demographics.
[AGENT][NEUTRAL] You sound dental.
[CUSTOMER][NEUTRAL] Yeah, she did give me a claim number, but like I said, I don't think it's what we have. Let me look back and see if that's the same number.
[AGENT][NEUTRAL] That's OK. I mean, I can figure it out with her.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, it's that kind. She gave me 358-6834.
[AGENT][NEUTRAL] Um, let me look, just one second, [PII], let me look at something before.
[CUSTOMER][NEUTRAL] Oh, you're fine.
[AGENT][POSITIVE] OK, I can help her.
[CUSTOMER][POSITIVE] All right. Here she goes. Thank you so much for your help and have a good day.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Hi, [PII], you too.
[AGENT][NEUTRAL] Alright, bye bye.
[CUSTOMER][NEUTRAL] Yes, hello.
[AGENT][NEUTRAL] Hi. Hi, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is [PII]. How are you today?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Good. Is it [PII] or just [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Alright, thank you. Um, you're the 3rd person, [PII] I've spoken to, and this is regarding an EOB for patient [PII]. Can you help, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so what, um, [PII] indicated that, well, tell me what you're needing first off so I'll know if I can, if I am indeed who needs to help you.
[CUSTOMER][NEUTRAL] OK. I mean this is ridiculous like yeah so um it says here benefits on a card so I spoke with [PII] at benefits on a card and I told him we don't do um credit card payments we don't accept them we've opted out, he said no no he said you need to speak with [PII]. I said OK so then I spoke with [PII] at APL and then now they've transferred me to you so we have a claim for him claim number.
[AGENT][POSITIVE] How can I help you today?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] OK, so are you trying to
[AGENT][NEUTRAL] OK, so you're trying to check claim status for the member, is that correct?
[CUSTOMER][NEUTRAL] OK, I have an EOB but no payment, and then again [PII] wasn't listening to what I said she goes, well, uh, let me refer you over to this other department regarding your payment. I said, ma'am, they didn't pay the claim. I said it is an EOB.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Right, and [PII] doesn't have access to that information. So you ended up in customer service, which was not the correct department. They don't have access to this. So any information that I'm able to provide for you at this point, [PII] would be a verification of benefits and not a guarantee of payment. So if you'll verify the insured's name and date of birth with me.
[CUSTOMER][NEUTRAL] OK, so I need to find out what's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and let me go back again here and pull that up for um hold on a 3rd time here hold on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is [PII], total charges 266.
[AGENT][NEUTRAL] In total bills.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And you said that you do have the claim number, is that correct?
[CUSTOMER][NEUTRAL] Yes, it's 358-683-4.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] And it says patient responsibility is 266 and we had verified that the gentleman had coverage because otherwise if we don't have active coverage or eligibility for them they would have to pay the day of service so um I'm just really getting the runaround on this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, the payroll, OK, so the claim remarks on here, it's essentially in a holding pattern. This states that we are waiting to confirm eligibility from benefits and a card and upon receipt of this information, we will continue processing the claim.
[CUSTOMER][NEUTRAL] And we just need hey.
[AGENT][NEUTRAL] So at this point they provide us that information because they are the ones that collect premium for these policies through his employer and they provide us reports on a weekly basis so we have not received that information at this time that is what we are waiting on, but as soon as we do receive it then the claim will continue to be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because you know when it says here patient responsibility is 266 and we're like, you know, OK, so I mean they really shouldn't have even sent anything out on this yet if it's an eligibility or you're waiting for to confirm that so about what another week, 2 weeks, when will this claim be finalized?
[AGENT][NEUTRAL] That's just.
[AGENT][NEUTRAL] I would say, well, I can't guarantee that. It's gonna be depending on when we receive the information from benefits and a card.
[AGENT][NEUTRAL] So I would, you know, possibly give it another 2 weeks.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I can't say. I mean, we could receive that, yeah, you know, we could receive it much sooner than that, um.
[CUSTOMER][NEUTRAL] 2 weeks. OK, I'll.
[AGENT][NEUTRAL] But again, I can't, I just can't guarantee that.
[CUSTOMER][POSITIVE] OK, I'll document this. I do appreciate your help, [PII], and you have a very nice day.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] Yes [PII], you too and then just one last thing, one last thing [PII] in the future also I don't know if anyone has ever given you our portal website, but once we have fully processed the claim, we do have a portal that you should be able to access for the EOB.
[CUSTOMER][POSITIVE] Yep thank you uh huh.
[AGENT][NEUTRAL] And the website for that is [PII].
[CUSTOMER][POSITIVE] OK, very good. Thank you so much, [PII]. Have a good day.
[AGENT][POSITIVE] All right. Well, you're welcome. Yes, ma'am. You too, if that's all I can help you with. Thank you again for calling APL uh-huh, you're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thanks. Mhm. Bye-bye.