AccountId: 011433970860
ContactId: d6da1bd6-2ad2-4599-b6d4-da6d81d5ef5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280160 ms
Total Talk Time (AGENT): 74889 ms
Total Talk Time (CUSTOMER): 181366 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/d6da1bd6-2ad2-4599-b6d4-da6d81d5ef5b_20250203T21:42_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] in the care team. I've got um Miss [PII] on the phone. She's with the provider's office for Doctor [PII]. She is calling and she's called several times about um claim number 3546093.
[CUSTOMER][NEUTRAL] For policy number 243-9172.
[CUSTOMER][NEUTRAL] Um, she's talked to several different people.
[CUSTOMER][NEUTRAL] And she said that she has spoke with benefits and a card and that the patient is eligible.
[CUSTOMER][NEUTRAL] But the remarks on the claim is still stating that the patient we're waiting for eligibility from benefits and a card.
[CUSTOMER][NEUTRAL] And she just needs some further assistance than what I can give her because there's I can only read the remarks to her I can't see anything else.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have her callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. It is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're very welcome. You have a good day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] This is [PII]. May I help you?
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling to check on the status of a patient's dental claim.
[AGENT][NEUTRAL] OK, what data service?
[CUSTOMER][NEUTRAL] Uh, date of service was [PII].
[AGENT][NEUTRAL] OK, and she told you it was pending?
[CUSTOMER][NEUTRAL] Um, so basically we received an EOB, um, at the beginning of January. It's dated, um, [PII] saying we are waiting information to confirm eligibility for benefits in a card. Upon receipt of this information, we will continue processing. If you have questions, call benefits in a card. So a couple weeks ago, um, since we still hadn't received payment, I called Benes in a card. They said he was eligible on the date of service and said I needed to speak to somebody at APL, so I called APL.
[CUSTOMER][NEUTRAL] Um, and spoke to somebody saying that like eligibility is checked on a daily basis and once eligibility can be confirmed that, you know, it will be processed and so I don't know where to go from here because um benefits in the card keep saying he was eligible on the date of service.
[AGENT][NEUTRAL] OK, hold on, let me look at it for you.
[CUSTOMER][NEUTRAL] Um, and it just seems like it should be.
[AGENT][NEUTRAL] So it was [PII].
[AGENT][NEUTRAL] OK, we still have not received the eligibility. They pay their premiums weekly. So for that week, for that date of service, we do not have the premiums for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's OK, so you're, so.
[CUSTOMER][NEUTRAL] Are there, I mean, is that typical for a premium for, you know, 12-19 to not be paid yet for you guys not to receive that check yet? I don't know how long something like that would take.
[AGENT][NEUTRAL] I'm not sure. We're just waiting on, um, benefits in a card.
[CUSTOMER][NEUTRAL] To get to
[AGENT][NEUTRAL] Uh, their employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] We have we have premium for uh services before and after but not just that particular week.
[CUSTOMER][NEUTRAL] Oh, you do.
[CUSTOMER][NEUTRAL] OK, and not just him, like just, I mean, not just this patient like is this kind of in general any, any pay, OK, so basically you just haven't received the check for any um.
[AGENT][NEUTRAL] It could be any of them, yeah.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] I can't think of the word, but subscribers whatever patience for that date for the week of [PII]. OK, yeah, because I've previously been told by somebody at APL that you do get checks weekly and then once you know the premium check for his dated services received, OK, so that is has still not been received yet.
[AGENT][NEUTRAL] For, for that data service. Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, just as soon as we receive it, we'll get a report saying to release it, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, and, and again I'm just trying to confirm I mean it sounds like it's not just like he's not the only person it's just in general you haven't received a check for the date of service [PII] or for eligibility. OK, what is your name again?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK. Great. Thank you, [PII]. I appreciate your help today.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You're welcome and have a good afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.