AccountId: 011433970860
ContactId: 7f3741ba-d389-4263-b97a-79ffc7a65fad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520780 ms
Total Talk Time (AGENT): 207669 ms
Total Talk Time (CUSTOMER): 149182 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/7f3741ba-d389-4263-b97a-79ffc7a65fad_20250122T17:54_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check the general claim status.
[AGENT][POSITIVE] Well, it would be my pleasure to.
[CUSTOMER][NEUTRAL] And I'm sorry, I missed your name.
[AGENT][NEUTRAL] My name is [PII]. And I missed your name also. Do you mind repeating your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Last initial will be [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] The callback number will be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] 01221549.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth, [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And you're needing dental claim status?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Medical.
[AGENT][POSITIVE] OK, thank you. And I can help you with that.
[AGENT][NEUTRAL] And Dev, what is the date of service or claim number?
[CUSTOMER][NEUTRAL] Um, date of service will be [PII] and the bill amount will be $355 a month.
[AGENT][NEUTRAL] Thank you. And what is the facility name please, sir?
[CUSTOMER][NEUTRAL] Only Cross Medical Group.
[AGENT][POSITIVE] All right, thank you. And it would be a pleasure to assist you with that claim status today, Dev. Now this claim, my pleasure. We received this claim on [PII].
[CUSTOMER][POSITIVE] You so much.
[AGENT][NEUTRAL] And processed on [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, I'm sorry, I missed that date. [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] And process them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for this.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] And that denial reason?
[CUSTOMER][NEUTRAL] It was
[AGENT][NEGATIVE] Yes, it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And benefits are only payable if the primary insurance provider provides benefits.
[AGENT][NEUTRAL] So does this policy only pays toward the deductible, co-pay, or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And according to the EOB that we received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Nothing was applied.
[AGENT][NEGATIVE] Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, no benefits uh are payable for this month, so it was denied.
[AGENT][NEUTRAL] That is correct, and it's denied due to the EOB did not show a deductible co-pay or co-insurance applied to the services.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Can you please repeat me once again, uh, because of EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's right. Primary insurance did not apply a benefit toward the deductible, copay, or co-insurance.
[CUSTOMER][NEUTRAL] For pay or coinsurance.
[CUSTOMER][NEUTRAL] Or deductible, is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah. Thank you so much for this one. And when it was denied, it was denied on the same day, [PII].
[AGENT][POSITIVE] Yes, sir, that's right.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][POSITIVE] Uh, I'm so sorry about that. Can I know the primary is the zero balance for this one?
[AGENT][NEUTRAL] Let me see if I can get that claim pulled up. Bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a copy of the primary EOB?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] And on that EOB there's nothing applied to the deductible copay or co-insurance, correct?
[CUSTOMER][NEUTRAL] Yes, uh, just give me a moment.
[CUSTOMER][NEUTRAL] Uh, our primary OB shows as co-pay paid as 98.59 cents. Can you please check this information?
[AGENT][NEUTRAL] That is not the EOB that we have.
[CUSTOMER][NEUTRAL] OK. If you don't have this year we, can I resubmit this claim again?
[AGENT][NEUTRAL] So if you have an
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely, please submit that updated EOB. You can fax it referencing the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, before that, can I get the fax number?
[AGENT][NEUTRAL] The claims fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 23. And what will the mailing address for this one?
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Can you please spell your
[AGENT][NEUTRAL] You want me to spell [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then city, and then [PII], and the abbreviation for [PII] is OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And ZIP
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And what is the time for for this one?
[AGENT][NEGATIVE] No timely falling for updated EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, thank you so much for this one. And can I get the full reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[AGENT][POSITIVE] And it was a pleasure to assist you with that claim status. Anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] OK, thank you so much for this.
[CUSTOMER][POSITIVE] Uh, no, thank you so much. Have a wonderful day.
[AGENT][POSITIVE] I hope you have a wonderful day as well. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you bye bye.