AccountId: 011433970860
ContactId: a290f117-638c-49c4-baa3-84953fb41834
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681630 ms
Total Talk Time (AGENT): 182517 ms
Total Talk Time (CUSTOMER): 77553 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/a290f117-638c-49c4-baa3-84953fb41834_20250311T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm trying to follow up on a claim for a patient.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][POSITIVE] Thank you and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02549625
[AGENT][NEUTRAL] OK thank you one moment please while I get all of the members information pulled up.
[AGENT][NEUTRAL] And [PII], the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] Um, data service is 1211 24 build amount I have is 360, um, but it may show up different on your end because it looks like the claim split or something like that.
[CUSTOMER][NEUTRAL] For um, code 2392 and 3120 on tooth number 12.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK, so yes, ma'am, that claim was received.
[AGENT][NEUTRAL] The received date was [PII] and it was processed on the same date.
[AGENT][NEUTRAL] The claim number is 356-7010.
[AGENT][NEUTRAL] And this claim was denied, [PII]. The reason for the denial on the claim states our records indicate that premium for this service date was not received. Therefore, benefits are not payable.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you can print it by going to our portal.
[AGENT][NEUTRAL] Which is located at [PII].
[CUSTOMER][NEUTRAL] Um, I don't have a login for this. Would it, would you be able to fax it to me?
[AGENT][NEUTRAL] Uh, it's a self-registered.
[AGENT][NEUTRAL] I can, one moment.
[CUSTOMER][NEUTRAL] He should have 2 claims for that data service. Could you fax them both?
[AGENT][NEUTRAL] OK, what's the other bill amount? I, I need the other billed amount to check that.
[CUSTOMER][NEUTRAL] $456?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And I'm sorry, what? 466, is that correct?
[CUSTOMER][NEUTRAL] 456.
[AGENT][NEUTRAL] 0, 456. I'm sorry.
[AGENT][NEUTRAL] OK. Give me just one moment, please.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, bear with me just a moment, [PII]. 456. OK.
[AGENT][NEUTRAL] OK, so you need both of the claim, the claim number for that is 356-700-008.
[AGENT][NEUTRAL] And you need both ELBs?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Just one moment, because I'll have to fax them separately to you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No I I I I'd rather.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And while this information is still loading on the first claim, what is go ahead and give me your fax number please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And does it need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Um, it's not necessary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And again, you said your fax number is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] And again, thank you for your patience.
[AGENT][NEUTRAL] You could have probably set up your profile by this as long as it's taking me to pull up these to fax me.
[CUSTOMER][NEUTRAL] We have a corporate office we're not able to set up our own logins or else I would have.
[AGENT][NEUTRAL] Oh, OK, I understand.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now [PII], on this, on the second claim for the 456, it was denied for a different reason and the reason for the denial on that states this policy does not provide benefits for any procedure or service not listed in the schedule of covered dental services and procedures.
[CUSTOMER][POSITIVE] OK sounds good thank you.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] You're welcome
[CUSTOMER][NEUTRAL] I don't know
[AGENT][POSITIVE] OK, [PII], so I have that both of those explanation of benefits to you so provided there's not any technical mishap, you should be receiving those very shortly. So is there anything else that I could help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.