AccountId: 011433970860
ContactId: addfe938-8521-4fe2-9568-dfbc372c5ad1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676650 ms
Total Talk Time (AGENT): 247591 ms
Total Talk Time (CUSTOMER): 274199 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/addfe938-8521-4fe2-9568-dfbc372c5ad1_20250507T21:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Doctor [PII]'s office. Um, I need to, uh, get a little bit of information on a claim please.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02465258
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK, and I'm calling about a dependent.
[AGENT][NEUTRAL] All right, and may I have the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, date of service is [PII] and total is 178.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] 178 here it is.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3590164.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[AGENT][NEUTRAL] A total of $178.
[AGENT][NEUTRAL] Um, let me get that check information for you. Hold on one second.
[AGENT][NEUTRAL] Alright, so it looks like um it was a single check.
[AGENT][NEUTRAL] Check number 2039217.
[AGENT][NEUTRAL] And um it was mailed to [PII].
[CUSTOMER][NEUTRAL] OK, we don't have a male receptacle.
[CUSTOMER][NEUTRAL] Um, which means that never made it to us, um, everything, um, that is mailed has to go to our PO box.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, hm.
[AGENT][NEUTRAL] So, let me check this. Hold on one second.
[CUSTOMER][NEUTRAL] You don't show it clearing right? OK.
[AGENT][POSITIVE] No, it's still outstanding.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Let me hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I'm checking to see, oh, it's kind of taking its time here. This is for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] He
[CUSTOMER][NEGATIVE] That's, that's the only the bad thing about us not having a mail receptacle where our business is we, we can't have a mailbox because we're on a major highway and so we do a PO box and unfortunately we have to put our physical address on almost everything and there's nowhere to put the PO box so a lot of times if you know if the company doesn't know any better um they put our physical address on there and um.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Some, it depends on who's sorting the mail at the post office sometimes we receive it and sometimes we don't.
[AGENT][NEUTRAL] You don't. OK, let me ask you this. Hold on, let me go back to the check, because I think I see what happened here. We're gonna need a corrected claim, but we can void or.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but let me just make sure this is right.
[CUSTOMER][NEUTRAL] Well, that's what I was gonna ask you.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] That's what I was gonna ask you next because this is actually secondary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEGATIVE] So it shouldn't have
[AGENT][NEUTRAL] On the claim form on box 48, where it has the billing information, it has both, so it has the name Rainesville Pediatric Dental and then it says 371 McCurdy and then under that it has the PO box. So take that first line out and just put the PO box.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, but um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I think also they um.
[CUSTOMER][NEUTRAL] American Public Life, um, they, they're secondary on this uh on this, uh, patient. So they, they would have, they should have only paid secondary, not primary. Do you show that they have a different insurance?
[CUSTOMER][NEUTRAL] They have United Healthcare Dental as their.
[AGENT][NEUTRAL] Other than us.
[CUSTOMER][NEUTRAL] Yes, yes, they also have a.
[AGENT][NEUTRAL] So there's no
[AGENT][NEUTRAL] For our policies, there's no like coordination of benefits. So whether you send it to their UnitedHealthcare first or us first, it, whenever we receive it, we're gonna process it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but when you give me all that information you said that it paid 178 when it should have paid a lot less because it's secondary. Does that make sense?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Um, hold on, let me go back to the claim.
[CUSTOMER][NEUTRAL] I just wonder
[CUSTOMER][NEUTRAL] If I need to
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] When I very first sent this claim in, I sent an attachment showing where UnitedHealthcare paid $91 on this claim.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Does it show an attachment or can you see that?
[AGENT][NEGATIVE] Hold on, I'm waiting for the 2nd page to pop up now from what was received.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So how can we, we do need to send this, where's the calculator? Hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Because the only thing other than the claim form that's, that's um on here, the only other thing that was received was like,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A copy, it's not a, it's not an explanation of benefits. It's like a
[AGENT][NEUTRAL] It just shows the claim detail information. I mean, I see where it says total patient responsibility is $38 but it also says other insurance pay $0. So, is this, is this what you were
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Um, no, the one that I sent, um.
[CUSTOMER][NEUTRAL] Which I, I looked back and I'm not finding it, um.
[CUSTOMER][NEUTRAL] It when we we use a clearing house to send our clients and um when you go in there is a place where you put primary insurance paid and you put an amount in there and then you can go they've also got a place where you can go to attachments and you can um and so what I do is I pull up the EOB and I screenshot the EOB and put it on the attachment on the electronic claim and then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's supposed to attach it to that claim when it comes to you guys, so you may have not have gotten that part of it.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, that's probably what it is because we only received two pages. It's the one, the first page is the claim form and then the second page is like that screenshot kind of the, it says member information at the top.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but it's telling, but it's saying that that.
[CUSTOMER][NEUTRAL] Primary paid nothing, right?
[AGENT][NEUTRAL] Right, so it has on here, hold on, let me go back to it.
[CUSTOMER][NEUTRAL] OK, our other insurance, OK.
[AGENT][NEUTRAL] Yes, it has other insurance paid and then it has 0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Well first of all we need to find, we need to find your check I guess right? or you're saying they're holding it till they get.
[AGENT][NEUTRAL] Well, no, so.
[AGENT][NEUTRAL] So we
[AGENT][NEUTRAL] So when you send the corrected claim with the address and the documents that you're wanting to send, they're gonna void this this initial check and then reissue.
[CUSTOMER][NEUTRAL] Uh huh OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] to the new address with the new information.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, OK, so.
[CUSTOMER][POSITIVE] Alright, so what I can do I will um.
[CUSTOMER][NEUTRAL] I'll go back through and get that and I'll resend it and I'll put on there.
[CUSTOMER][NEUTRAL] The amount of the other insurance, what the other insurance paid.
[AGENT][NEUTRAL] Yes, or, um,
[AGENT][NEUTRAL] Do you have like an explanation of benefits from from UnitedHealthcare?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Because that will give everything in one spot, you know, in that one document.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, yeah, I'll get this um I'll pull this up and um.
[CUSTOMER][NEGATIVE] And I will get this claim resent to you guys.
[AGENT][NEUTRAL] Alright, well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, that's all.
[AGENT][POSITIVE] All right, well thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you [PII] bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.