AccountId: 011433970860
ContactId: a36d61e1-33b3-4515-b4c4-677ae04c1516
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 513390 ms
Total Talk Time (AGENT): 230440 ms
Total Talk Time (CUSTOMER): 218909 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/a36d61e1-33b3-4515-b4c4-677ae04c1516_20250130T19:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII] from West Mattery Dental Care out of [PII]. I'm trying to make sure my patient still has this coverage this year.
[AGENT][NEUTRAL] OK, so you're wanting to verify a dental policy is still active. Is that correct?
[CUSTOMER][POSITIVE] Yes, yes ma'am.
[AGENT][NEUTRAL] OK. And are you also gonna need a fax back or do you already have the fax back of benefits?
[CUSTOMER][POSITIVE] Um, I, I have the benefits and everything. I just wanna make sure [PII], yes.
[AGENT][NEUTRAL] OK, oh OK, you just want to verify the fact.
[AGENT][POSITIVE] Sure, I'll be happy to help you. And did you say your name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], no [PII] like [PII]
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, there, I'm so sorry about that. Thank you though.
[CUSTOMER][POSITIVE] Yes ma'am, that's that's no problem.
[AGENT][NEUTRAL] And what is your callback number, please?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] OK, the policy certificate is 02478118.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, there any information I provide you would be a verification of benefits and not a guarantee of payment. Uh, what is your patient's name again and date of birth? Or what?
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I thought, I'm sorry. I'm OK. Yes, that is correct. So, yes, ma'am, he is the subscriber on this general policy and it is still active, effective 5-12024.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, and it's still OK, so according to the breakdown we got last year, OK, so 100% um preventive 80% on X-rays and basic expenses, um.
[AGENT][NEUTRAL] It is still active.
[CUSTOMER][NEUTRAL] And then 40% he still he's still within his 12 months wait period for um major and everything else then.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] That is correct. There have not, none of those benefits have changed that are on that fax back that you are reading from.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright then thank you that's all I needed.
[AGENT][NEUTRAL] Oh you are OK, and then one last thing there, I don't know if you've been given this before, but if you will file a claim with us once it's been processed, we do have a portal that you should be able to check claim status in and that portal.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I did. I went into the APL, um, but it, when I put in his information it came back saying that, uh, patient account number could not be let let's see, uh.
[AGENT][NEUTRAL] OK, so if we don't have a claim on file for him, you went to the [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so if there's not a claim under him for you all, then that would be the reason. You can't check eligibility there would only be for claim status at this point.
[CUSTOMER][NEUTRAL] But y'all paid on a claim for September of last year.
[AGENT][NEGATIVE] There must have been a piece of, I mean, a piece of the information there that did not match.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the data service that you tried to check?
[CUSTOMER][NEUTRAL] That was on 9-4-2024.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, we don't have a claim on file. Well, give me just a second. Let me now my screen is hold on.
[CUSTOMER][NEUTRAL] I paid 112.
[AGENT][NEUTRAL] Yeah, my my something's going on with my screen too. Just a moment, please.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, yes, ma'am.
[AGENT][NEUTRAL] OK, and what is the claim number that you were pulling that up, we're trying to pull that up with?
[CUSTOMER][NEUTRAL] OK, let's see claim policy claim numbers, OK.
[AGENT][NEUTRAL] Cause
[AGENT][NEUTRAL] And how much was the total, what what was the total bill amount?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 178.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we paid.
[AGENT][NEUTRAL] Yes, we paid $50 on that.
[AGENT][NEUTRAL] Let's say 50 supplied to the deductible. OK, so do you have that claim number?
[CUSTOMER][NEUTRAL] Yes ma'am, 3505948.
[AGENT][NEUTRAL] OK, and you were not able to put that claim number in and pull the explanation of benefits up?
[CUSTOMER][NEUTRAL] OK, was asking, OK, because on the screen that I'm at, I was signed logging in as a new user.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then provide the following information. I'll put the tax ID number, the patient account number, which is his member ID, right?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] No, no, that is, uh, that's the account number that you all have for the member that you.
[CUSTOMER][NEUTRAL] No, OK then.
[AGENT][NEUTRAL] In your system.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] How would
[CUSTOMER][NEUTRAL] How would y'all know that?
[AGENT][NEUTRAL] I thought it said provider.
[AGENT][NEUTRAL] Because it's on the claim form that you all submit, so that's why I was saying if you, there's no claim on file, we won't, you wouldn't be able to access that.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright, so let me copy that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Paste.
[AGENT][NEUTRAL] And I'm gonna have to refresh one of my screens. I'm so sorry why you're doing, while you're trying to do that.
[CUSTOMER][NEUTRAL] Uh I still saying oops there seems to be a problem no user.
[CUSTOMER][NEUTRAL] Sound so maybe I'm not signed in properly I don't know but.
[AGENT][NEUTRAL] And you did create stuff I use your name and a password.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Um, well, I told him I was a dental provider and then it asks for the tax ID number and the patient account number, and that's where I got.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's see here
[AGENT][NEUTRAL] OK, so what are you showing as the patient account number?
[CUSTOMER][NEUTRAL] 009.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] 009099.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well that's not what we have in the system.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So let me look at this client. Mhm.
[CUSTOMER][NEUTRAL] OK, well, it, it's OK because I mean as long as his coverage is still effective because they were telling me he changed so I took it out and then it was medical that had changed but not the dental but um.
[AGENT][NEUTRAL] Because I
[AGENT][NEUTRAL] Yeah, it does.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, OK. Yeah, um, I was just wanting to make sure that
[CUSTOMER][NEUTRAL] Yeah, but it
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you can use it. I mean, you're always welcome to call us, but that would when it's.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] You know, so anyways, OK, well, you all got the payments and if you need any help with this portal in the future to try to sort through this, you know, we'll be certainly happy to try and do that with you.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes ma'am. All right, well thank you so much. OK.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. Is there anything else at the moment that I can help you with?
[CUSTOMER][NEUTRAL] No, not that I could think of. OK. OK.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. Have a great afternoon.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Bye-bye.