AccountId: 011433970860
ContactId: 660b81bb-05bb-469b-a53d-fefcdcfec274
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 650190 ms
Total Talk Time (AGENT): 203015 ms
Total Talk Time (CUSTOMER): 131633 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/660b81bb-05bb-469b-a53d-fefcdcfec274_20250108T13:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, this is [PII] calling from provider office. Can you help me the claim status?
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh, just the one, yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Uh, one second. That's the direct line [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] That is 02079999 if you want, it's not good, so just try the patient first and last name.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] You said the policy number is 0200799?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, 02507999.
[AGENT][NEUTRAL] OK, one more time.
[CUSTOMER][NEUTRAL] 025073 consecutive 9. That is 999.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is your and any information first off [PII] that I provide for you will be a verification of benefits and not a guarantee of payment. Also, if the claim is on file with APL and you need a copy of the explanation of benefits, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Gosh.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Secure. A public, right?
[AGENT][NEUTRAL] secured. [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. So, what's you need, uh, patient name?
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And this is for a dental claim?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] Uh, yeah, date of services.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII] and the bill amount is 1526, 1,526.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, this claim was received on [PII].
[AGENT][NEUTRAL] Process the same date.
[AGENT][NEUTRAL] The claim number is 353-474-2.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $161.60.
[AGENT][NEUTRAL] And that was paid on single check, 2020411.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the remarks.
[CUSTOMER][NEUTRAL] What's the check date?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[AGENT][NEUTRAL] And on
[CUSTOMER][NEUTRAL] That's [PII], you said, right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh sorry, sir, my bad. Yeah. OK, go ahead.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEGATIVE] And then on code code 3330 that was denied, this policy does not provide benefits for any procedure or service not listed in the schedule.
[AGENT][NEGATIVE] That is not covered under this policy.
[CUSTOMER][NEGATIVE] So basically, it's not covered.
[AGENT][NEUTRAL] It is not covered. That is correct.
[CUSTOMER][POSITIVE] And it's still outstanding?
[AGENT][POSITIVE] I will check that for you. I'm sure that it is since it was just issue, but I will be happy to check. Yes, it is still outstanding. Mhm.
[CUSTOMER][POSITIVE] Oh, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that. And just help me with, yeah, just help me with your name, how do you spell that and the reference number.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] My name in today's date will be the call reference number. My name is [PII]. It is spelled [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] can just do 11 thing for me. You can just fax me the copy because we don't have any access for that.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Portal.
[CUSTOMER][NEUTRAL] And we need the COB to send secondary.
[AGENT][NEUTRAL] You don't have access to the internet? OK.
[CUSTOMER][NEUTRAL] Like we never register the portal. It takes time and we need to send this as, as soon as possible to secondary.
[AGENT][NEUTRAL] OK, so just a moment while I get that information pulled up. It's gonna take me a few minutes for that, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for that, yeah.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] And while this information is loading, you can go ahead and give me the fax number.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh sorry, ma'am, my question. That is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment to look at something in this claim place.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] It just takes a moment, [PII], for this information to load.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Thank you. Well, the facts need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yes. That's totally fine, definitely.
[AGENT][NEUTRAL] Put your name on there.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh. OK.
[AGENT][NEUTRAL] And again, that fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Oh, yeah, that's correct.
[AGENT][POSITIVE] OK, so I have just faxed that explanation of benefits to you, so provided there's not any type of technical problem there, you should be receiving that within just the next several minutes.
[CUSTOMER][POSITIVE] Uh, thank you so much for that. And how about those, it's still outstanding, you said, right? Or something that you say?
[AGENT][NEUTRAL] I did. Mhm. Yes, ma'am.
[AGENT][NEUTRAL] It was only issued just a few days. Yes, ma'am, it was only issued just a few days ago. Mhm.
[CUSTOMER][POSITIVE] It's still outstanding?
[CUSTOMER][POSITIVE] Oh, OK, no worries, no worries.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Yes, and if, if that's all I can help you with, [PII], thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.