AccountId: 011433970860
ContactId: 84053ae9-35e6-4dd1-9c1d-f4dee479cf0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342750 ms
Total Talk Time (AGENT): 156066 ms
Total Talk Time (CUSTOMER): 116087 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/84053ae9-35e6-4dd1-9c1d-f4dee479cf0e_20250113T22:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling because I received, um, I'm calling from the dental office. I received an EOB for a patient, um, with 0 payments, just stating we are awaiting information to confirm eligibility for benefits and a card, and it gave a number to call if there's questions. So I just called benefits and a card. They said he was eligible on the date of service and that I should call you guys and let you know that they said he was eligible on the date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Oh, OK. Um,
[CUSTOMER][NEUTRAL] Um, I, I said I think that they need to provide something, and they said, no, this is how it works. So I'm very confused, but I wanna make sure that this patient's claim gets processed so we can get paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes. Absolutely, Ms. [PII]. Um, can you please give me the patient's name?
[CUSTOMER][NEUTRAL] Yes, patient is [PII].
[AGENT][NEUTRAL] OK, and then real quick, Ms. [PII], what is your callback number just in case our call is dropped.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Thank you. And then what is?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02439172.
[AGENT][NEUTRAL] OK, and the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull in that patient real quick.
[CUSTOMER][NEUTRAL] And the date of service was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um, Doctor [PII]'s office.
[AGENT][NEUTRAL] OK, I do see that.
[CUSTOMER][POSITIVE] Also my show is innovative endedonics. Yeah, it's Doctor [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so when um.
[AGENT][NEUTRAL] When we get those um.
[AGENT][NEUTRAL] Request the claim request and the data service needs to be checked as far as benefits in a card goes our claims department checks them daily to see if um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, they do check them daily. So I don't see any other remarks other than the one that you received on the EOB is the claim number that's on the EOB can you verify that for me, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, claim number is 3546093.
[AGENT][NEUTRAL] Yes, ma'am, that's the one I have pulled up. So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The only other thing that I can suggest is to resubmit the claim.
[AGENT][NEUTRAL] But if
[AGENT][NEUTRAL] The insured was
[AGENT][NEUTRAL] Um, eligible on the data service like I said, our claims department check it daily they would reprocess the claim themselves if they were eligible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, because I just called benefits in the card and she said yes, he was eligible on that day.
[AGENT][NEUTRAL] Oh my. OK. Um.
[CUSTOMER][NEUTRAL] Um, on the date of service.
[AGENT][NEUTRAL] Right, and what is the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. You, you told me that already. [PII].
[CUSTOMER][POSITIVE] Correct. That's OK.
[AGENT][NEUTRAL] What I'm going to do.
[AGENT][NEUTRAL] Because I'm going to go ahead and put in a request with the claims department to investigate this further and to call you back within 24 hours that way we can be on top of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, that'll work for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, that'll be great just because it seems like it's kind of stuck in limbo. Benes in a card since they don't provide the information and then you guys are saying you look it up, but they're saying he was eligible on that on the date of service they checked their records.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right, correct. OK, so I'm gonna put in um a request with the claims department to search on this one further, um, research it further for you, and then somebody will call you back within 24 hours.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that would be great. Is there a reference number for our call today, [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], in today's date.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, perfect. Thanks so much for your help. I appreciate it. OK. Have a good afternoon.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. You have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] You too. Sure. Bye-bye.
[AGENT][NEUTRAL] Mhm. Bye-bye, ma'am.