AccountId: 011433970860
ContactId: a9ceea00-013d-43f0-8bea-47c4595af787
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441489 ms
Total Talk Time (AGENT): 145522 ms
Total Talk Time (CUSTOMER): 95183 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/a9ceea00-013d-43f0-8bea-47c4595af787_20250416T17:41_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to check on the general claim status. How are you doing today?
[AGENT][NEUTRAL] I'm good, [PII]. And did you say you have one dental claim to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] A callback number is [PII].
[AGENT][NEUTRAL] Thank you and the patient's policy number, please?
[CUSTOMER][NEUTRAL] Sure. Before that, could you please spell your name?
[AGENT][NEUTRAL] [PII] and my name was in today's date, [PII] will also be your call reference number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] number
[CUSTOMER][NEUTRAL] OK. The member ID number is 02545403.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you one moment while I get the information pulled up please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I guarantee payment. What is your patience?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is the the, um, again, any information provided would be a verification of benefits and not a guarantee of payment. What's the date of service and total bill amount that you're calling on, [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $555.06.
[AGENT][NEUTRAL] I'm sorry, can you give me the bills amount? 5?
[CUSTOMER][NEUTRAL] $555.06.
[AGENT][NEUTRAL] What is the name of the facility?
[CUSTOMER][NEUTRAL] The name is T A U C 28.
[AGENT][NEUTRAL] What is the tax ID number?
[CUSTOMER][NEUTRAL] The tax ID number is [PII].
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] This claim was received on.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 4720.
[AGENT][NEUTRAL] And this claim has been denied at this point, and the reason for the denial states to please provide copies of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The need for need of need of a primary explanation of benefit, right?
[AGENT][NEUTRAL] Correct, from the major medical insurance company.
[CUSTOMER][NEUTRAL] Of course
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you can print that by going to our portal, which is located at [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the denial date?
[AGENT][NEUTRAL] The same date as the process date that I gave you?
[CUSTOMER][NEUTRAL] the process
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with?
[CUSTOMER][NEUTRAL] Yes, sir. Could you please uh tell me which insurance is the primary insurance?
[AGENT][NEUTRAL] For the employer it shows it to be Aetna.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Ana is the primary insurance, right?
[AGENT][NEUTRAL] That's what it shows for her employer, mhm, but she would have to.
[CUSTOMER][NEUTRAL] May I know the policy number of Aetna?
[AGENT][NEUTRAL] Contact the number to get any detailed information on that information.
[AGENT][NEUTRAL] And again, is there anything else that I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Yes, sir. Could you please provide me your policy number of primary insurance?
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] No, sir. I just explained to you, I don't have that information. You will have to contact the patient to get the details on the primary insurance.
[CUSTOMER][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] OK. May I know the call reference number for this call?
[AGENT][NEUTRAL] My name and my name and today's date.
[CUSTOMER][NEUTRAL] spell your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you for your time and assistance, and I wish you to have a great day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, [PII]. Well, you too. Thank you for calling APL and if that's all I can help you with, I hope you have a nice day as well.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.