AccountId: 011433970860
ContactId: a4db7b39-1513-4563-9159-08412bc3b7bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1129619 ms
Total Talk Time (AGENT): 448996 ms
Total Talk Time (CUSTOMER): 697711 ms
Interruptions: 32
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/a4db7b39-1513-4563-9159-08412bc3b7bb_20250307T13:34_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm looking for the claim status.
[AGENT][POSITIVE] And it would be my pleasure to assist you with claim status. What is the callback number?
[CUSTOMER][NEUTRAL] Uh, just give me one minute.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Uh, you need a member ID, right?
[AGENT][NEUTRAL] Uh, the policy cert number or claim number.
[CUSTOMER][NEUTRAL] Uh, actually I don't have a claim number. Actually I'm looking for the claim status.
[AGENT][NEUTRAL] OK. And what policy number do you have for the patient?
[CUSTOMER][NEUTRAL] Yeah, it's 02486015.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Is this for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] No [PII], I can help you with that claim status. What is the patient's name and date of birth, please?
[AGENT][NEUTRAL] Alright thank you and the date of service please ma'am?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And what is the dental provider name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So the name is uh
[CUSTOMER][NEUTRAL] That's.
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] [PII], yeah, provider number is 10 Abdullah and that bill amount is $29.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Is that also Christian Dental Limited?
[CUSTOMER][NEUTRAL] Yes, Christian Dental Limited.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, [PII], I do see that we received that claim. Claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah. Mm.
[AGENT][NEUTRAL] [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] And it was denied because the calendar year a benefit.
[AGENT][NEGATIVE] Has been exhausted.
[CUSTOMER][NEUTRAL] Uh, what this, uh, can you please explain in detail? I mean, what is the reason, denied because the calendar year. Uh, you mean the patient is max out, right? OK, benefit has been matched.
[AGENT][NEUTRAL] The calendar year benefit has been met.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so when the patient is maxed out, I mean before, after you receive the claim and before the
[AGENT][NEUTRAL] That's correct. We, the benefits were maxed out prior to receiving your claim.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK. So before those uh [PII], the patient is already maxed out and when you receive the claim, it had been already.
[CUSTOMER][NEUTRAL] Max out, right?
[AGENT][POSITIVE] That's right. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK. And the patient is currently active?
[AGENT][NEUTRAL] Now, the policy termed on 10-13-24.
[CUSTOMER][NEUTRAL] What is the date of another policy?
[AGENT][NEUTRAL] Now, uh, they do not have another policy with us. The effective date on this policy was [PII].
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] One second. [PII]. So this patient is uh active now, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the policy termed on 10-13-2024.
[CUSTOMER][NEUTRAL] One second, [PII].
[CUSTOMER][NEUTRAL] 1032024. The patient is come on at [PII], right? OK. OK. If patients have any other active policy?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] 1013, [PII].
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] Oh, OK, and can you give me the claim number?
[AGENT][NEUTRAL] Claim number is 353.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 0941.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what is the reference number?
[AGENT][NEUTRAL] The reference number is my name and today's date, and I spell my name, [PII].
[CUSTOMER][NEUTRAL] And what's your name?
[CUSTOMER][NEUTRAL] [PII], right? Her name is [PII].
[AGENT][POSITIVE] That's correct. Mhm.
[CUSTOMER][NEUTRAL] OK. And your name and today's date is uh the reference number, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And can you please provide me the UV on my fax number?
[AGENT][NEUTRAL] One moment now we also have a provider portal.
[AGENT][NEUTRAL] Um, you can.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Check claim status, have access to our EOBs as well as submit claims and that is that secured.
[CUSTOMER][NEUTRAL] It's gonna be uh 1112411.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, what did you just say?
[AGENT][NEUTRAL] It's secured, that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, AFA computer. Can you
[AGENT][NEUTRAL] And Aetna.
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Secure.a.m. right?
[AGENT][NEUTRAL] Mhm. No, it's just secure. I'll do it [PII].
[CUSTOMER][NEUTRAL] Um, OK, so it's payment, how much payment.
[CUSTOMER][POSITIVE] Good good.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, OK. Thank you. Thank you to provide me the, yeah, thank you very much. You're so, so sweet. Thank you very much. Yeah.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] It's my pleasure.
[AGENT][NEUTRAL] Yeah, and if you
[CUSTOMER][NEUTRAL] Yeah, and uh
[AGENT][NEUTRAL] If you create a login and password, you would just use the tax ID number and the patient's account number listed on the claim with the facility, and you have instant access to EOBs.
[CUSTOMER][NEUTRAL] Yeah, yeah, go ahead.
[CUSTOMER][NEUTRAL] So, uh, the user name is user name will be the tax ID, right?
[AGENT][NEUTRAL] To create the account you use the tax ID number and the patient's account number with the facility.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] OK, so I can download the, yeah, I can download the your, yeah, yeah, uh.
[AGENT][NEUTRAL] You wanna
[AGENT][NEUTRAL] You can download the EOB.
[AGENT][POSITIVE] Yeah, and you don't have to wait for that fax.
[CUSTOMER][NEUTRAL] OK. And once again, the EOB will be on the [PII], right? Am I right?
[AGENT][POSITIVE] That's right, that's right. If you wanna go there real quick, [PII], we can go ahead and I can assist you with creating that account so you get that EOB.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, just give me one minute, just give me one minute.
[AGENT][NEUTRAL] All right. Just tell me when you're ready for the patient account number I can give it to you.
[CUSTOMER][NEUTRAL] OK, OK, sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] The site is not open. I mean, the [PII] is not opening in my tab. Uh, is there any [PII].
[AGENT][NEUTRAL] It should.
[AGENT][NEUTRAL] No, it's just secured. [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Secure. A public.
[CUSTOMER][POSITIVE] Yeah, I can try one. the open is the APL secure.
[AGENT][POSITIVE] Mhm. That's right.
[CUSTOMER][NEUTRAL] I can open it. OK.
[AGENT][NEUTRAL] Yes you can and you're going to click new user.
[CUSTOMER][NEUTRAL] OK, just one minute.
[CUSTOMER][NEUTRAL] OK. On a log in, right? Yeah, OK.
[AGENT][NEUTRAL] Right, you're gonna do new user and then you're going to choose the bottom option that you are a dental or medical provider.
[CUSTOMER][NEUTRAL] Yes, yes. OK. And then go to the next, right?
[AGENT][NEUTRAL] That's right, and then put in your tax ID number and then I can give you the patient account number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just one minute. Uh, there is the
[CUSTOMER][NEUTRAL] OK, the tax ID21888535.
[CUSTOMER][NEUTRAL] So responsible for that responsible for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You ready
[CUSTOMER][NEUTRAL] OK. And what is the patient account number? Yeah.
[AGENT][NEUTRAL] D as in Delta. N as in November, T as in Tango.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 477.
[CUSTOMER][NEUTRAL] OK, so 23037, right?
[AGENT][NEUTRAL] 23037.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and then go to the next. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, and there is open to create an account. I mean, username, password, confirm password. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh there is, I need to use, uh, my I mean, username and I want, I have to create a new password and I have to get my email ID and phone number. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the login is created, right? And after that, I can find the OUP for this insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] So I, I'm gonna give you that claim number. So there is a quick access, meaning that you have the claim number, you're just going to put in the patient's name and date of birth and the claim number and that EOB will generate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, OK. And you already provided me the claim number so I can find the easily patient. I can easily find, yeah.
[AGENT][NEUTRAL] Right, the 3353-0941.
[CUSTOMER][POSITIVE] OK, OK, OK. Thank you, thank you. And yeah.
[AGENT][POSITIVE] It's a lot quicker than waiting for a fax.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][POSITIVE] It's a lot faster than waiting for a fax.
[CUSTOMER][POSITIVE] Yeah, yeah, right, right. And you, you helped me very well, right. Thank you. Uh, and can we
[AGENT][NEUTRAL] Yeah. And also, [PII], you can, you can check claim status on that portal.
[AGENT][NEUTRAL] Now you will have to have the last four of the social.
[CUSTOMER][NEUTRAL] OK. And can I check the eligible and can I check the eligibility also on this portal? So this can be?
[AGENT][NEUTRAL] Eligibility is not available yet, only claim information, but you can also submit claims online as well.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's an option for you to file a claim.
[CUSTOMER][POSITIVE] OK, OK. Yeah, it's, it will be more helpful for me. Yeah, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Yeah, can you give more on another patient?
[AGENT][NEUTRAL] OK. Give me just one second. Let me get ready for that next patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And I'm ready for the next policy number.
[AGENT][NEUTRAL] If you want to go ahead and create that account.
[CUSTOMER][NEGATIVE] There is a 0.
[AGENT][NEUTRAL] I can wait a minute and then we can do a claim status on that.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] But um
[AGENT][NEUTRAL] as well.
[CUSTOMER][NEUTRAL] Uh, actually I created the lead after this call, yeah.
[AGENT][NEUTRAL] OK, OK, that's fine. All right. What's, alright, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, it's uh 019925272.
[AGENT][NEUTRAL] 19925272
[CUSTOMER][NEUTRAL] Yeah, but it's uh 0019925272.
[AGENT][NEUTRAL] OK, it's got one extra number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's try
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Are you looking at the ID card?
[CUSTOMER][NEUTRAL] Just, just give me one minute. I shoot it. Yeah, on the ID card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the, I think I've got it. What's the patient's name?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] That didn't work, I thought.
[AGENT][NEUTRAL] OK, that wasn't it. I apologize.
[CUSTOMER][NEUTRAL] OK. And so the, what is the correct member ID? I mean, if
[AGENT][NEUTRAL] I'm gonna have to
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Look it up. Hang on just a second. We'll do a name search. How about that? Can you repeat that last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh last name is uh [PII], yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name was [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know what state [PII] was, and this is for dental also?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Is this for dental also?
[CUSTOMER][NEUTRAL] Mm, yeah, yeah. I'm looking for the claim status for this one.
[AGENT][NEUTRAL] OK. Do you happen to have his social?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] That is the only name I have. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was his date of birth?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII], uh, one second. [PII], and the initial is [PII]. I mean, the middle name is [PII].
[AGENT][NEUTRAL] I don't think this is him. What was the date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm not pulling it up under [PII]. What was the middle initial?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That policy number was so close.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] But it's just had too many numbers.
[CUSTOMER][NEUTRAL] And let's see 5.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, tell you what, let's do, give me that policy number again. I'm gonna try different.
[CUSTOMER][NEUTRAL] OK. It's uh uh it's 01.
[AGENT][NEUTRAL] Numbers to see if I can get it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 99
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] 272.
[AGENT][NEUTRAL] Tucson.
[AGENT][NEUTRAL] OK, let me just try a couple of combinations of that number and see what, see if I can find it and see if there's an ex where I can figure out that extra numbers coming from.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] When did you receive it?
[AGENT][NEGATIVE] Yeah, I'm just not able to come up with [PII] in our system.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, so what should we do now?
[AGENT][NEUTRAL] And you don't have a copy of the ID card.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Do you happen to know his employer?
[CUSTOMER][NEUTRAL] Mm sorry, I didn't get it. Sorry, what did I say?
[AGENT][NEUTRAL] Do you happen to know who his employer is?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mm, the patient is safe. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, everything I try with that, with those numbers, I'm not pulling up a [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then maybe in the member ID some, there is some error, right? Maybe one or two digit um incorrect.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, there's something off and our policy numbers are 7 digits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, there is extra digit uh we have yeah OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, if you find out.
[CUSTOMER][NEUTRAL] So first we have to.
[AGENT][NEUTRAL] Yeah, if you can find that policy, the correct policy number.
[CUSTOMER][POSITIVE] Yeah good.
[CUSTOMER][NEUTRAL] 877024.
[AGENT][NEUTRAL] Um, I'll, you know, give us a call back so we can check that claim status for you.
[CUSTOMER][POSITIVE] Yeah, I know. I also I can find a portal which is you provide me, yeah, yeah.
[AGENT][POSITIVE] They certainly can. That's right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Yeah, and yeah, just give me one minute if I want the patient, so, yeah, just give me one minute.
[AGENT][NEUTRAL] Anything else I can help you with, [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they just go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the patient.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEGATIVE] Yeah. I have no patience. Yeah.
[AGENT][POSITIVE] All right, well, it has been a pleasure to assist you with that claim status.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] And thank you for calling APL and uh you need a reference number or anything?
[CUSTOMER][MIXED] Nice. No, no, no, no.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. I hope you have a wonderful day and a happy weekend.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, yeah. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.