AccountId: 011433970860
ContactId: 5e3f7272-a671-4254-8421-c5bbd4fcf4bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551799 ms
Total Talk Time (AGENT): 122949 ms
Total Talk Time (CUSTOMER): 188002 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/5e3f7272-a671-4254-8421-c5bbd4fcf4bf_20250319T14:18_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII], I'm [PII] calling from Friday's office. Uh, I need to check on one of my patients' claims, [PII].
[AGENT][NEUTRAL] Sure, [PII], I can assist you um with claim status. First, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 02053112.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And is this for medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Mhm. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Uh, for the date of service, uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing a claim on file um with that date of service.
[CUSTOMER][NEUTRAL] Oh, OK, so, uh, this APL is the, uh, secondary plan, right? It's a, it's a supplementary plan.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, under this, for this policy, this is the primary plan.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you uh verify the patient's eligibility for me?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] OK, and I'm still waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII], and the policy expired on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, [PII]. And you said the plan is uh primary, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Uh, but, uh, in, in this station for the dentist, I do see all my claims has been, uh, initially got paid from Medicare's primary.
[AGENT][NEUTRAL] Uh, for this policy, this is primary.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That's strange. OK. Uh, can you check another data service for me, for the same patient, uh, for 729-2024, 155.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, yes, we received that claim on [PII].
[CUSTOMER][NEUTRAL] OK, give me one second. [PII], right?
[AGENT][NEUTRAL] Yes, that's when we received it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3540.
[AGENT][NEUTRAL] 904.
[AGENT][NEUTRAL] And the claim is denying because we didn't receive the premium, so the member was ineligible for benefits.
[CUSTOMER][NEUTRAL] Claim denied because uh.
[AGENT][NEGATIVE] Premium was not received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Premier.
[CUSTOMER][NEUTRAL] Uh, so, uh, how did you receive this claim? Can you check how did you receive this claim?
[AGENT][NEGATIVE] No, it doesn't show how we received it.
[CUSTOMER][NEUTRAL] Is it a
[CUSTOMER][NEUTRAL] Uh, is that a Medicare crossover claim?
[AGENT][NEUTRAL] No, it isn't.
[CUSTOMER][NEUTRAL] So, the claim has been sent from the provider.
[AGENT][NEUTRAL] Yes, as far as we know, yes, it came from the provider.
[CUSTOMER][NEUTRAL] Uh, is it by electronically or paper mail or fax?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This was faxed from the provider's office.
[CUSTOMER][NEUTRAL] Facts
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK, give me one second, let's see who has sent this fax.
[CUSTOMER][NEUTRAL] One second, did you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, just the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's our fax number. That's the number it was faxed to. Mhm.
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] OK, OK, so.
[CUSTOMER][NEUTRAL] So as you're saying until [PII], the primary insurance is going to be the APL, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So, mm, so when I'm going to send you the claim, you don't need the Medicare, UB or anything else, just the claim form, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Uh, OK, so this one, right, can you, can you send me the, uh, denied EOB for the 729-2024 to my fax number.
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] Uh, uh, it's [PII].
[CUSTOMER][NEUTRAL] 237
[CUSTOMER][NEUTRAL] 66668 and uh please attention it to my name, [PII].
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, so, uh, yeah, um, so the claim for the.
[CUSTOMER][NEUTRAL] Uh, [PII], you don't have received it. Um, right, OK. Then I will fax the claim to you. Uh, well, um, mm mm mm mm mm mm. Uh, do you need my, uh, uh, cover letter of my, uh, hospital, uh, along with the claim form?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Uh, OK, did you, right, uh, I do have all the information with me, right. Can, uh, can I have call number?
[AGENT][NEUTRAL] Yeah, the reference number is my name and today's date and my name is [PII]. Um it's spelled [PII] My [PII] [PII] and today's date.
[CUSTOMER][POSITIVE] Where we to this day. Go you TV. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You do the same. I thank you for calling APL bye.