AccountId: 011433970860
ContactId: e57d3911-b614-4e95-b5ee-9b36d40718fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503980 ms
Total Talk Time (AGENT): 160157 ms
Total Talk Time (CUSTOMER): 170825 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/e57d3911-b614-4e95-b5ee-9b36d40718fb_20250107T22:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Oh, this is [PII]. I got cut off.
[AGENT][NEUTRAL] OK. Yeah, I tried calling you back. Um, I'm not sure what happened.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, well I was asking you for your policy number.
[CUSTOMER][NEUTRAL] Oh yeah, so my policy number is 02261126.
[AGENT][NEUTRAL] OK, and if you can please verify your mailing address and date of birth for me.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] Thank you for that information. um, so what was the date of service that you needed an explanation of benefits for?
[CUSTOMER][NEUTRAL] You get
[CUSTOMER][NEUTRAL] Um, several, but, uh, [PII] for Moser.
[AGENT][NEUTRAL] [PII], um.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] I don't show we have a, I don't show we have that on file.
[CUSTOMER][NEUTRAL] I don't know if
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Probably because you don't pay for innoondas.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEGATIVE] Right, that's not covered.
[CUSTOMER][NEUTRAL] Yeah, so, um, let me move to the next one. Hang on just a second.
[CUSTOMER][NEUTRAL] I'm trying to find it, uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] September.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] I need explanation that we don't cover that, actually, the explanation of benefits because it's Medicare and Medicare won't pay anything until they say you won't pay it.
[AGENT][NEUTRAL] OK, what's gonna have to happen is the providers or either you or the provider will have to file the claim to get the denial. We can't just send it, we can't generate a, you know, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Well, they said they did.
[CUSTOMER][NEUTRAL] Uh, they said they did send you something and then that, that you had said on the phone that.
[CUSTOMER][NEUTRAL] You know, you don't do that. You don't, you don't cover that. And so they rebuild, but they
[CUSTOMER][NEGATIVE] They still need a, a paper explanation of benefits to them stating you don't cover it. That's all I need is a letter stating that you do not cover and toda us or surgeries.
[CUSTOMER][NEUTRAL] And I just need it sent to uh.
[CUSTOMER][NEUTRAL] To, uh, select help.
[CUSTOMER][NEUTRAL] They're uh
[CUSTOMER][NEUTRAL] Carrier or whatever for Medicare.
[AGENT][NEUTRAL] OK, well, I don't see where we, we were sent a claim for those dates and that we denied them.
[AGENT][NEGATIVE] There's nothing for me to to to print off to send.
[CUSTOMER][NEUTRAL] OK, how about do you have, uh, sorry, I need to.
[AGENT][NEUTRAL] Now what I could do is have them send you another copy of your policy because it does state in there that it's not covered if they need to look over your policy but in terms of a particular data service and a particular code, they'll have to you have to file and be denied before we can send you a denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That makes total sense. So why I do.
[CUSTOMER][NEGATIVE] It's all the hoops you have to jump through, I'm afraid.
[CUSTOMER][NEGATIVE] They don't do it, so I try to do it and then I can't do it.
[CUSTOMER][NEUTRAL] Oh [PII], OK, so.
[CUSTOMER][NEUTRAL] Explanation of benefits. They can just bring that up online or can you call?
[CUSTOMER][NEUTRAL] Uh, or fax them or do something.
[AGENT][NEUTRAL] OK, so let me explain an explanation of benefits is what is generated after we process a claim. So in order to get an explanation of benefits we need a claim whether we're gonna pay it or deny it, we can't generate the explanation of benefits without having a claim. So what I'm saying is if you want an explanation of benefits with a specific denial for a civic procedure code.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then either you or your dentist office will have to send the claim even though you know we're not gonna pay it, you just want us to say, hey, we're not paying it, but that's the only way we can say that now if you just wanna show them that it's not covered, we can send you your policy and you can submit a copy of your policy to them and they can see what's covered and what's not.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] But they're not the issue. It's uh select help that is
[CUSTOMER][NEUTRAL] It says, no, you guys have to pay.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] So I don't know if you can fax the explanation of my benefits or what you said my plan and send it to the, the select Health.
[AGENT][NEUTRAL] In terms of your policy, uh, we would have to send the policy to you and then whoever you decide to send it to, you can send it to, but we can't send anyone your policy, we can only send it to you.
[CUSTOMER][NEUTRAL] Could you please
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, can you send me an email then?
[AGENT][NEUTRAL] Um, we can't email, we have to send it by mail. I'm sorry.
[CUSTOMER][NEUTRAL] OK, well, my address.
[CUSTOMER][NEUTRAL] You have
[AGENT][POSITIVE] Yes, I have it um give me one moment so I can pull up that um information and get that processed while I have you on the line.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK, I've submitted that request for a copy of your policy to be sent out. If you can please allow 7 to 10 business days.
[CUSTOMER][POSITIVE] Oh great. OK. All right, hey, thank you for your help.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, well thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye now.
[AGENT][NEUTRAL] Bye bye.