AccountId: 011433970860
ContactId: b8ca8882-4f03-4a90-90a5-9dff61df4733
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416720 ms
Total Talk Time (AGENT): 162469 ms
Total Talk Time (CUSTOMER): 146604 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/b8ca8882-4f03-4a90-90a5-9dff61df4733_20250203T21:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to check on the status of the patient's claims.
[AGENT][NEUTRAL] OK Ms. [PII], I can help you with the claim. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient is [PII].
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh date of birth is [PII].
[AGENT][POSITIVE] Thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] 02439172
[AGENT][NEUTRAL] OK, let me pull the policy up for us real quick.
[AGENT][NEUTRAL] OK, thank you. And then what is um the date of service, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] My total bill amount was 1320.
[AGENT][NEUTRAL] Thank you. And what is the name of the facility that you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] OK. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Miss [PII]. So looking um at the date of service that you gave me, we're waiting uh uh eligibility for the date of service. Once we reconfirm that the patient was eligible on that day, we will process the claim.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I called actually on [PII] regarding the same man um matter. Actually spoke to you, I think, because I have a note that I spoke to someone named [PII], um, was told the same information. When I, when I called, um, benefits in a card, I was told that he was eligible on that date of service.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah, that's me
[CUSTOMER][NEUTRAL] Um, then someone from your from APL actually called me back after I spoke to you and said that they, um, like every week they get a check from like a what do you call it a do, you know, a premium check and um once they got the check for his premium for the month of December that, you know, then our claim would be processed so it just seems that was 3 weeks ago it seems like if checks come every week. I don't know, it just seems like it's taking a long time to get this claim processed um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, I understand. And I'm looking.
[CUSTOMER][NEUTRAL] And he and he was eligible on the date of service but then I was told by the person that I spoke to after you that it actually has nothing to do with being eligible on the date of service that has to do with getting like the premium check from wherever the check comes from, you know, that covers his monthly premium.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am. I understand. Um,
[AGENT][NEUTRAL] I am looking at it right now and that is the remark that was on the claim.
[CUSTOMER][NEUTRAL] Right. Yeah, I know that that is.
[AGENT][NEUTRAL] Is that we're still waiting, we're still waiting for eligibility for him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So where does that come from? I mean how do we get, how do we get that information to you so that our claim can be processed?
[AGENT][NEUTRAL] That comes from benefits and a card. They have to send us the eligibility for him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The funny thing is when I spoke to somebody there, I don't know if they just had information they're like, nope, that's not something we send out. And then when I spoke to somebody also at APL after I spoke to you, she says, yeah, that's not something that they.
[CUSTOMER][NEUTRAL] That that we received from APL it's something about a benefit check or a premium check. I don't know, but um.
[AGENT][NEUTRAL] OK, I mean I can transfer you on over to the dental claims department.
[AGENT][NEUTRAL] And maybe they have more information that I can't see and see if they can help you further. OK. All right, Miss [PII], it's gonna be a brief hold. You're very welcome. It'll be a brief hold.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] OK, that would be great.
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much for calling APL you have a blessed day.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] This is [PII]. May I help you?
[AGENT][NEUTRAL] Hi, this is [PII] in the care team. I've got um Ms. [PII] on the phone. She's with the provider's office for Doctor [PII]. She is calling and she's called several times about claim number 3546093.
[AGENT][NEUTRAL] For policy number 243-9172.
[AGENT][NEUTRAL] Um, she's talked to several different people.
[AGENT][NEUTRAL] And she said that she has spoke with benefits and a card and that the patient is eligible.
[AGENT][NEUTRAL] But the remarks on the claim is still stating that the patient we're waiting for eligibility for benefits and a card.
[AGENT][NEUTRAL] And she just needs some further assistance than what I can give her cause there[PII], I can only read the remarks to her. I can't see anything else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you have a callback number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. It is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. You have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] This is [PII]. May I help you?