AccountId: 011433970860
ContactId: 8ac8df16-d91c-4745-a941-fef6308c6660
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641479 ms
Total Talk Time (AGENT): 176275 ms
Total Talk Time (CUSTOMER): 184200 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/8ac8df16-d91c-4745-a941-fef6308c6660_20250602T18:44_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]. I'm calling from a dental provider's office, and I have two outstanding claims for a patient I'm trying to follow up on.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status. May I have a good contact number and the policy number?
[CUSTOMER][NEUTRAL] Yes, my um phone number is [PII].
[CUSTOMER][NEUTRAL] And the policy number I have is 599963.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claims?
[CUSTOMER][NEUTRAL] OK, first one is [PII] for $243.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the second one is [PII] for $666.
[AGENT][NEUTRAL] You said 660.
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] OK, hold on one moment. And do you mind if I place you on just a brief hold while I locate the claims?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for the wait. So I checked for both dates of service, but I'm not showing a claim on file for either date.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, cause
[CUSTOMER][NEUTRAL] I called um.
[CUSTOMER][NEUTRAL] I called [PII] about these and there was no claim on file at that time. We verified all the information. I did have an incorrect address at that time but we fixed that and the claims were resent.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Where, where was it sent to? Like was it mailed or?
[CUSTOMER][NEUTRAL] Uh, they were, let me double check before I say that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second here.
[CUSTOMER][NEGATIVE] Uh, they should have been sent electronically.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To what payer ID?
[CUSTOMER][NEGATIVE] The one I have on file is 60801. Now sometimes the clearing house changes it, which makes me very annoyed.
[CUSTOMER][NEGATIVE] Let me see, oh, it's so aggravating, like.
[CUSTOMER][NEUTRAL] If I wanted y'all to change things, I would tell you, but, you know.
[AGENT][NEUTRAL] I would say that, right.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Click through what I tell you to do. Don't go thinking you know what's supposed to happen.
[AGENT][NEUTRAL] Right, because then we end up like this.
[CUSTOMER][NEUTRAL] Yeah, because like I have the correct information in my system, but if y'all mess with it, that it was actually sent to the same 1 60801.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and when do you know when it was sent?
[CUSTOMER][POSITIVE] Yep, I can tell you that a second here do do do do.
[CUSTOMER][NEUTRAL] Uh, submission date was [PII]. That was the second submission date.
[AGENT][NEUTRAL] And you said the date of birth is [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm just making sure I'm under the right part of the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me try one more time, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So why?
[AGENT][NEUTRAL] I'm just gonna check again. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah, no, that's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] We have it there I see.
[AGENT][NEUTRAL] OK, I just want to make sure that I was um looking at everything correctly. Thank you for holding. But no, ma'am, I'm still, I don't see anything here. Um, now there's no timely filing or anything, so you don't have to worry about like a deadline, but I'm not sure why it's not receiving to us. Are they getting confirmation that it's been sent?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Successfully?
[CUSTOMER][NEUTRAL] Uh, yes, I, the status in my clearing house says received.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And give me, let me see everything, uh, let's see.
[CUSTOMER][NEUTRAL] Um, OK, so I show received by the clearing house, and then it says entity acknowledges receipt of claim.
[AGENT][NEUTRAL] Oops, I'm sorry, I was having a whole conversation on mute. I'm sorry. Um, what date was that? You said it was May?
[CUSTOMER][NEUTRAL] So it's OK, it happens to me all the time.
[CUSTOMER][NEUTRAL] Um, yes, the, uh, the second submission was [PII], or I'm sorry, [PII], [PII].
[AGENT][NEUTRAL] OK, let me check the faxes. They should have been um populated by now, but let me check the faxes and see if there's anything in there. Um, if not, we may have to do mail or um you said you sent it with the payer ID though, right, not a fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so we may have to try the fax or the um mail. There's no way for me to check with the electronic payer ID. Let me
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] OK, I mean you don't have attachments. It's just for a cleaning for one visit, and then the next visit is just some fillings, so there's not any attachments.
[AGENT][NEUTRAL] OK, um, I would say because there's no way for me to check like if it was a fax, I could check the documents that came in, but electronic, we don't have a way to check it, um, but it's not, it has not populated here in our system. So you can definitely mail it or fax it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What's the fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK perfect and is there a reference number for the call, [PII]?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're very welcome and I'm sorry for that inconvenience. Um, was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all I needed thank you.
[AGENT][POSITIVE] You're welcome have a good day. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye bye.