AccountId: 011433970860
ContactId: 8dc32aeb-0aa4-4c80-997e-545da41f3392
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 787859 ms
Total Talk Time (AGENT): 231807 ms
Total Talk Time (CUSTOMER): 274633 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/8dc32aeb-0aa4-4c80-997e-545da41f3392_20250305T23:58_UTC.wav
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[CUSTOMER][NEUTRAL] Sometimes you can.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling as a dental provider. Um, I just want to verify the, uh, eligibility and benefits of one of our patients.
[AGENT][NEUTRAL] OK, I'm happy to verify eligibility and benefits. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Their policy number is 02.
[CUSTOMER][NEUTRAL] 439552
[AGENT][POSITIVE] Thank you so much. And can I grab your first name, please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Uh, what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you so much. So patient plan is active. The effective date on this is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, perfect. And um
[CUSTOMER][NEUTRAL] So I, I was just trying to log in through the online portal and it's asking for a patient account number. Is that the same as a policy number or is it something different?
[AGENT][NEUTRAL] Um, with a provider, you wouldn't be able to log on to the site unless you've ever filed a claim with us. Have you guys filed claim with claims with us? Do you know?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yes, that would be my next um question. So we did file a claim back in um September and we got um a response back saying that uh our services wasn't paid because um apparently the member's premium was not received.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so, uh, yeah, so that's, that's what we got. But I couldn't find like an ID number on there. Just a policy number.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Are you able to uh look up the claim?
[CUSTOMER][NEUTRAL] It's the only claim we have for this patient.
[AGENT][NEUTRAL] Yeah, what's the date of service? It's for [PII], right?
[CUSTOMER][NEUTRAL] Yes, it is for [PII]. The date of service, um, [PII].
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK, let's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I get this.
[CUSTOMER][NEUTRAL] I can't.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's um
[AGENT][NEGATIVE] Yeah, I see the claim and I see that it was denied.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But I don't show that the patient had any sort of lapse in coverage.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So, then what is the reason? Do you know?
[AGENT][NEUTRAL] Yeah, I'm confused by that, honestly, [PII], because I was trying to see if there was like a lapse in coverage that we
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Maybe, you know, if there was a time where the premium wasn't paid, but not that I've seen. Um, let me see.
[CUSTOMER][NEUTRAL] So we have a um remark code maybe uh something you can look up and see.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, what's the code that you have?
[CUSTOMER][NEUTRAL] Um, so it's for D2C 7500.
[AGENT][NEUTRAL] Yeah, that's the same denial reason I see, which is our records indicate that premium for the service date was not received, therefore benefits are not payable, um.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] And the, the patient told me that he had a, a late bill that he never paid for that day or something.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, I'm I'm not sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, I mean, if
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If it's not covered, then can we or can you reprocess that claim?
[CUSTOMER][NEUTRAL] Since we verify that his uh uh policy is active currently?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, so I mean the claim can be resubmitted or I can submit this over to the examiner and have them reexamine it.
[AGENT][NEUTRAL] Um, to see if it was incorrectly processed.
[CUSTOMER][NEUTRAL] OK, yeah, uh, which, whichever you think would be, um, best would be better for us to get, um, you know, processed.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, yeah, so I can forward this on and see if um they can look at it again to see if there was any sort of lapse in coverage and see if it needs to be reprocessed, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So is it possible for us to get um the member ID number so that we can uh log into the online portal?
[AGENT][NEUTRAL] Oh yeah, so let's go, let me go back to that one second.
[CUSTOMER][NEUTRAL] Sure. Thank you. Oh yeah, sorry, just, uh, I'm just asking a question. You, you can just, you know, do, do your thing. They want you to jump back and forth.
[AGENT][NEUTRAL] So you need the patient account number is what you need.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so, so when we submit a claim, we, we do it, um, online through the cleaning house. Do, do we put in, is it correct that we put in the policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, I mean, our, our submission process works correct. OK. OK.
[AGENT][NEUTRAL] Mhm. Yeah, let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like when you go to the site and.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you're logging in, it's asking when you log in, is it asking for the member ID or the account number? because the account number is from you guys.
[CUSTOMER][NEUTRAL] From us? What do you mean the account number?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] Like whatever
[CUSTOMER][NEUTRAL] So it, it's, it's asking for the tax ID right? So our tax ID and then right that ask for the member um account number.
[AGENT][NEUTRAL] So it asks for tax ID and then patient account number, correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so the patient account number is the number that you guys assigned to the patient that's on the submitted claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] I can pull it up, the claim, let me see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the patient ID account number on the claim form is [PII] as in Frank, 64 U as in Uniform, JX417.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, you repeat that for me, sorry. [PII] [PII] [PII]
[AGENT][NEUTRAL] Yep, so
[AGENT][NEUTRAL] [PII] Frank, 64.
[CUSTOMER][POSITIVE] Oh that's great.
[AGENT][NEUTRAL] [PII] as in uniform.
[AGENT][NEUTRAL] [PII] as in John.
[AGENT][NEUTRAL] X as in X-ray.
[AGENT][NEUTRAL] 417.
[CUSTOMER][NEUTRAL] 417. I see, OK.
[CUSTOMER][NEUTRAL] Yeah, there's um, OK, let me try that real quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK. It works. OK, now I can make an account. Yes. OK. That makes sense. OK, thank you.
[AGENT][NEUTRAL] Did that work?
[AGENT][POSITIVE] OK, great, great.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Uh yes. So, so that claim will be uh reprocessed and [PII] is, um, policy is active. Um.
[CUSTOMER][NEUTRAL] OK. Does he have any, and can, can you get a, a fax for us for his um um benefits and coverage?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm I can send you a fax back. What's a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm, that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, I will send the fax back. It should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] Oh, perfect. OK. So should, so, um, [PII], um, came in today for, um, his sort of just cleaning recare appointment, but we have to send him away because we couldn't figure out the insurance. So when we have him back, um, do you think it's OK for, for us to
[CUSTOMER][NEUTRAL] I guess a claim, like make a claim again, the same way, because I don't know if it's gonna get denied the same as our previous claim.
[AGENT][NEUTRAL] Um, yeah, it should be. I don't show any sort of lapse in coverage. The policy is still active since [PII], so you should be able to submit a claim on his behalf.
[CUSTOMER][NEUTRAL] Anything we should
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] OK. Uh OK. So, one last thing to make sure we have everything correct. Um, what is the payer ID?
[AGENT][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Uh, for this standing uh claim. OK sorry.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. OK. Got you.
[CUSTOMER][POSITIVE] All right. I think that's all for now. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good night.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.