AccountId: 011433970860
ContactId: 6ea050d8-573b-4213-af92-6d32794b1b57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 585320 ms
Total Talk Time (AGENT): 305104 ms
Total Talk Time (CUSTOMER): 161097 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/6ea050d8-573b-4213-af92-6d32794b1b57_20250422T12:39_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] Hey [PII], my name is [PII]. I'm calling from a provider's office. I'm just calling to follow up on the status of the claim.
[AGENT][NEUTRAL] OK [PII], you're needing to check claim status, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. Did you say [PII]? Is that correct?
[CUSTOMER][POSITIVE] Yes ma'am. Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. Alright, so give me just a moment, [PII], I'm gonna have to reopen one of my screens. I'm so sorry.
[CUSTOMER][POSITIVE] No worries, honey.
[AGENT][NEUTRAL] OK, and what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Do you need all the zeros in the front?
[AGENT][NEUTRAL] Well, there shouldn't be very many zeros. There should only be one.
[CUSTOMER][NEUTRAL] OK, there's 5 according to my computer screen.
[AGENT][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me look up something and see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] We have filed some claims for her spouse before with the same ID number.
[CUSTOMER][NEUTRAL] But I was gonna look and see if I had an actual photocopy of the insurance card.
[AGENT][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] I do OK, 02498731.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah, we have lots of extra zeros for some reason.
[AGENT][NEUTRAL] Well, that, I mean, that may just be the way your system fills in extra space, you know. So, give me just a moment.
[CUSTOMER][NEUTRAL] True, maybe.
[AGENT][NEUTRAL] Give me just a moment to get the information pulled up, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Just for dental.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII] I'm sorry [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] It was 324 25 for 305.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we have received this claim. The claim number is 358.
[AGENT][NEUTRAL] 4324 it was received on 327.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Reviewed on [PII].
[AGENT][NEUTRAL] The claim number again is 3584324.
[AGENT][NEGATIVE] And at this time, it has been denied. The reason for the denial on here, [PII] states that we are
[AGENT][NEUTRAL] To confirm
[CUSTOMER][NEGATIVE] I lost you. I, I thought I heard the reason for the denial is, and then it broke up.
[AGENT][NEUTRAL] Excuse me, to confirm eligibility.
[AGENT][NEUTRAL] OK, to confirm.
[AGENT][NEUTRAL] Eligibility
[AGENT][NEUTRAL] OK, let me start over. We are awaiting information to confirm eligibility from benefits and a card. Upon receipt of this information, we will continue processing your claim.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEGATIVE] So what the heck does that mean and what are benefits in a card?
[AGENT][NEUTRAL] Benefits in a card is the company that they enroll for any for their employer, her husband's employer, they enroll through this company called Benefits and a card, and then that company provides the different companies that they sign up for their products for.
[AGENT][NEUTRAL] Their enrollment information. They are also who handles their deductions for premium.
[AGENT][NEUTRAL] And we receive electronic reports.
[AGENT][NEUTRAL] Regarding that, so at this time we are waiting our report to confirm that they were indeed still eligible for this data service.
[CUSTOMER][NEUTRAL] Do they have to do this for every data service for both parties every time?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] My goodness, OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] I just, it just takes forever.
[AGENT][NEUTRAL] Right, unless it's yes, because this was for.
[AGENT][NEUTRAL] For 324 and it does take, you know, a little time for us to receive that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We receive reports weekly.
[AGENT][NEUTRAL] Um, [PII], and maybe twice a week, but it just depends on how.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you know, I don't understand all that piece of it obviously because I'm with a different.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Company. I just know I just know that they handle all of that.
[CUSTOMER][NEGATIVE] Yeah, it took almost 6 weeks to get payment for her husband.
[AGENT][NEUTRAL] And then right, then they have to provide us showing that you know they were eligible payment was received for premium and then once we receive that this report that you know that with that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] That gets worked showing that. So at this point, we're just waiting on that information.
[CUSTOMER][NEUTRAL] OK, so like it, it follows it, it like pops up on our follow up every 7 days or whatever, but it's almost like if I call to follow up on it this is the this is the response that I get it's just kind of hard to track because.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] There's almost too many hands in the cookie jar if that makes sense.
[AGENT][NEUTRAL] Right. And it's just how their TPA handles.
[CUSTOMER][NEUTRAL] Um, OK, so there's really nothing we can do. It's not that, OK, so it's not like the employer needs to contact for like coordination benefits or anything like that.
[AGENT][NEUTRAL] No. No.
[AGENT][NEUTRAL] No, no, because if you were to contact benefits and a card, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They're just gonna tell you to call back to APL, but there is nothing we can do until we receive the information showing that they were eligible or not.
[CUSTOMER][NEUTRAL] So this is like a monthly paid premium and depending on whether they paid their premium on time determines whether they were still active on the data service.
[AGENT][MIXED] Essentially. That's a, that's a good kind of overview. Granted, we get the report more than once a month, you know, and I don't know, I don't have access to how they pay their premiums.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know if it's weekly, but you know, I just don't know that.
[CUSTOMER][NEUTRAL] Because imagine us having to try to explain this to a patient, they're gonna be like, huh?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. Right. So it's just that we're, it's, it's somewhat of a holding pattern essentially at this point.
[CUSTOMER][NEUTRAL] You know what I mean? OK.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] OK, then I'll keep waiting.
[AGENT][NEUTRAL] And then [PII], yeah, I'm sorry. Um, I do, if you need a copy of this explanation of benefits that has that on there, uh, you can go to our portal at [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] And you should be able to print that out.
[AGENT][NEUTRAL] Now that you have the claim number. OK. Oh, OK. Yeah. Yeah, so essentially holding pattern.
[CUSTOMER][NEUTRAL] I have one. I just didn't really understand what it was saying yeah, um, does the patient get a copy of those as well?
[AGENT][NEUTRAL] Uh, yes, they should. Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alrighty well I appreciate your help I appreciate it.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. And is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] Well, OK, [PII]. Well, thank you so much for calling APL and I hope that you have a very nice day.
[CUSTOMER][NEGATIVE] You too dear bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you.