AccountId: 011433970860
ContactId: 8abbcd9c-d621-48e6-b81d-2ef27d5a4493
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532760 ms
Total Talk Time (AGENT): 199357 ms
Total Talk Time (CUSTOMER): 143223 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/8abbcd9c-d621-48e6-b81d-2ef27d5a4493_20250403T17:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status. And did you say your name is [PII] or [PII]?
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] [PII], OK. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, uh, the contact number is [PII].
[AGENT][POSITIVE] Thank you for that. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Uh yeah, the member ID is 023351152.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] And that was 3, I'm sorry, 233-511-52?
[CUSTOMER][NEUTRAL] 233-5152
[AGENT][NEUTRAL] And can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] In the beginning, it is.
[AGENT][NEUTRAL] Can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Yeah, so the first name.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] First name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] for the total charge amount of $144 even. And may I know your name?
[AGENT][NEUTRAL] My name is [PII], [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that was you're welcome, and that was [PII]?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what is the name of the um office on the claim, the facility?
[CUSTOMER][NEUTRAL] It's regions of University of Michigan.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Is this a, well, let me just do it this way. So I'm showing that we received the claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 5916.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this is a dental-only policy, there are no medical benefits.
[CUSTOMER][NEUTRAL] So patient has only dental policy.
[AGENT][NEUTRAL] Um, the patient had a hospital indemnity policy as well. This policy that it was processed under with dental. However, both policies terminated on [PII]. So there was no active coverage with APL on your date of service.
[CUSTOMER][NEUTRAL] OK, one.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So the claim is denied as uh dental policy is covered, not medical policy, right?
[AGENT][NEUTRAL] Right, this is a dental-only policy. There are no medical benefits.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so till which date the patient was having the medical policy?
[AGENT][NEUTRAL] Um, hold on one moment. Let me go back to that. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] And again, just for the call, all the information provided was a verification of benefits, not a guarantee of payment. So the policies were active from [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] is when the policy is terminated.
[CUSTOMER][NEUTRAL] OK. So, patient uh uh medical policy was active from [PII] until April, I'm sorry, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much for clarifying that. Just give me one moment.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][NEUTRAL] OK. Uh, so could you please send the, uh, so this is non-covered service under the plan, right?
[AGENT][NEUTRAL] Correct, um, this is a, yes, because it's a dental only and this is a medical claim.
[CUSTOMER][NEUTRAL] OK. Uh, could you please just verify me with the patient's account number on your end?
[AGENT][NEUTRAL] The dental account number is [PII].
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] The medical policy is to
[CUSTOMER][NEUTRAL] No, no, no. The patient's account number with
[CUSTOMER][NEUTRAL] Uh, no, and uh, so the patient's account number which starts with, yeah, with the P as in Paul letter.
[AGENT][NEUTRAL] Oh, on their claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I understand. I thought you meant their account number with us. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So a patient account number is sent over with the claim, but there's no claims on file, so we don't have a patient account number that's given to us from the provider.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. Uh, so could you please send a copy of OB through fax?
[AGENT][NEUTRAL] So let me see, hold on.
[AGENT][NEUTRAL] Hold on one moment, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEGATIVE] My apologies, it didn't go over to the 2nd.
[AGENT][NEUTRAL] Patient, it was on the policyholder. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] The patient account number is [PII].
[AGENT][NEUTRAL] 31
[AGENT][NEUTRAL] 700.
[CUSTOMER][NEUTRAL] OK, thank you. And uh could you please send a copy of UB through fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh yeah, it is uh [PII].
[AGENT][NEUTRAL] And that[PII] [PII]?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] And should I put it to your attention or the patient account number?
[CUSTOMER][NEUTRAL] Uh, to the patient's account number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and uh what will be the call reference number for this claim?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] All right. So when will you be receiving this UVA?
[AGENT][NEUTRAL] Um, for faxes, you typically, um, have like about an hour turnaround, at least wait an hour. If you don't receive it by end of day today, just give us a call and we'll be able to um resend it for you, but at least an hour for a fax.
[CUSTOMER][POSITIVE] All right, yeah, OK. Thank you so much for assisting me. Have a good day and bye for now.
[AGENT][POSITIVE] You're welcome, sir. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, I know. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.