AccountId: 011433970860
ContactId: 6ea4d103-fd22-405e-a1df-872e6b8e5b55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545049 ms
Total Talk Time (AGENT): 186331 ms
Total Talk Time (CUSTOMER): 243839 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/6ea4d103-fd22-405e-a1df-872e6b8e5b55_20250224T19:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I am calling about a dental, uh, claim.
[AGENT][NEUTRAL] OK, I just need to check on that claim.
[CUSTOMER][NEUTRAL] Well, I have a um there's a, I got the EOB and then there is a remark on here that I just don't, I don't understand because I've never seen this type of remark before and I've been doing insurance for a long for a while now.
[AGENT][NEUTRAL] Sure, OK, OK, I could take a look at that and get some clarification. um, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], OK, and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is 02584090.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] So the um let me get, let me bring up this chart. The name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And let me get his date of birth.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII] OK and uh what was the name of the provider that you're with?
[CUSTOMER][NEUTRAL] Uh, it's Doctor uh [PII].
[AGENT][NEUTRAL] Um, let's see, do you happen to have that tax ID by chance?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you. We have it as uh [PII]. So thank you for that. Give me just a minute, let me take a look here.
[CUSTOMER][NEUTRAL] Um, it is, I mean, we're part of the [PII], she's our clinical director, so it's the same. We have two doctors that work here, yeah.
[AGENT][NEUTRAL] Sure, no, that's, that's fine. Just wanted to make sure I'm looking at the right one. Sure. OK. All righty, so I got this claim pulled up. Looks like the one.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[AGENT][NEUTRAL] Code, let's see that was $0330 for $15 that amount went towards their uh deductible and then we did pay that $40 benefit uh for the $0150.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because I got an EOB that states the total patient responsibility is $55 and I don't have a check with this, and then on the back of that it says.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They're waiting information to confirm eligibility for benefits in a card.
[AGENT][NEUTRAL] I'm not sure uh this is the only claim on file that I have for this member, but I can definitely send you this correct uh EOB that shows this information.
[CUSTOMER][POSITIVE] Yes, I would love to have that because I think this is just so I didn't get a check, does it come in check or does it come in?
[AGENT][NEUTRAL] Let me get that pulled up there. Of course, yeah, I don't know where that confusion came from.
[AGENT][NEUTRAL] Yeah, um
[AGENT][NEUTRAL] Yes, it would be a paper check, mhm and that information of course will be all on the EOB, but I can give you that information if you need it now, that check number and all of that.
[CUSTOMER][NEUTRAL] Like direct deposit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I would like
[CUSTOMER][NEUTRAL] Uh, well, I don't have to have the check number because I can wait on there. I just like making sure I don't close this claim, you know, until we get the check, but I just, I just didn't understand that explanation and so I've never seen that before.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah, I'm not sure either. I'm pulling up our official EOB right now, um, just to make sure there wasn't any.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Could you email me that EOB?
[AGENT][NEUTRAL] Sure you don't have a fax number?
[CUSTOMER][NEUTRAL] Oh, I do have a fax number. Yeah, you can fax it to me if you'd like.
[AGENT][NEUTRAL] OK, um, yeah, the only remark I have on our EOB is that the benefit had been applied uh to their calendar year deductible.
[AGENT][NEUTRAL] So I'm not quite sure. That is very weird. That's a, a bit concerning, actually.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] It's weird because the number is right there on the back and I'll read the whole description because I called the number it has on the back of this COV so it says this.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] We are awaiting information to confirm eligibility for benefits in a card. Upon receipt of this information, we will continue processing your claim. If you have any questions, please call benefits in a card at and they gave me this number.
[AGENT][NEUTRAL] OK, yeah, so on the EOB I know this is gonna sound funny, but does it say APL or American Public Life?
[CUSTOMER][NEUTRAL] Yes, on the front page is the American Public Life, and it has [PII].
[AGENT][NEUTRAL] Huh.
[AGENT][NEGATIVE] Yeah, that's us. That is bizarre. I'm definitely not seeing that at all. Um.
[CUSTOMER][NEUTRAL] I, I don't know either. And I had the correct policy number, so I was just like, I got a call about this cause like this is weird.
[AGENT][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] No kidding. Yeah, I mean, well, that the only thing I could think with that is, of course, if maybe, you know, they were behind on a payment or something like that, but I'm showing they're all good to go and, you know, of course, on this EOB it's all gravy, so I'm not quite sure. All right.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] OK, well, we haven't got the check yet. Has the check been sent? Can you tell?
[AGENT][NEUTRAL] Um, yes, and, um, let me see when that was issued. It's most of the time it's around when it did finish processing, so let me just check that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, so that, um, issued [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh well we should have gotten it by now I think don't you think? Well, let me see let me look, let me, let me see if it's been posted here. Let me just check and see maybe this is something I don't know.
[CUSTOMER][NEGATIVE] Yeah, no, we haven't received it.
[AGENT][NEUTRAL] OK, um, and it really does depend. We're not able to do that until it's been at least 30 days from the issue date, um, and then of course, you know, mail it it could be the weather, it could be anything, but hopefully you get it soon. But if not after 30 days from that issue date you can give us a call back and we'll get it voided and reissued to you. um, what was that?
[CUSTOMER][NEUTRAL] Do they wanna cancel and reissue?
[CUSTOMER][NEUTRAL] I got you, OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, well, what check number was it?
[AGENT][NEUTRAL] Sure, that's 202-796-1.
[CUSTOMER][NEUTRAL] And then OK and then can you, you'll fax me the correct DOB?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, yes, because they pay. Yes, uh, no, I don't think he, he doesn't really need to sign it, but, um, FP FEP gives that to them and so we'll have to put it on their account. They do other bills, uh, oh, yeah, that's fine, and I'm, I'll put it. I'll post it they got close claim.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] It won't be the top part of it. OK, sure. Let me, let me see again, OK.
[CUSTOMER][NEUTRAL] You know today's schedule pretty just.
[CUSTOMER][NEUTRAL] He's an adjust or so on.
[CUSTOMER][NEUTRAL] Yes, because you have to be, we're, we're not network with this, so that's why we, uh.
[CUSTOMER][NEUTRAL] We, uh, they send the check sent to the patient and then they have to come back.
[CUSTOMER][NEUTRAL] But we have to, we have to, um, scan the ED that tells us the information that.
[CUSTOMER][NEUTRAL] Try to tell everybody I if you pay that but.
[CUSTOMER][NEUTRAL] you do.
[CUSTOMER][NEUTRAL] This is the 2 in room 12.
[CUSTOMER][POSITIVE] Decent up on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6, OK. There you go. I see it. Just put that next to the door, yeah.
[CUSTOMER][NEUTRAL] Hello?