AccountId: 011433970860
ContactId: ea91a925-2bb5-4f57-870c-a2f82de1bb46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443630 ms
Total Talk Time (AGENT): 205597 ms
Total Talk Time (CUSTOMER): 109220 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/ea91a925-2bb5-4f57-870c-a2f82de1bb46_20241231T14:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with First Choice Dental, and I'm just calling to check up on a couple of claims for a patient.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with claim status today. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, what's that?
[AGENT][POSITIVE] A good callback number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is 0227.
[CUSTOMER][NEUTRAL] 1976
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, thank you. Let me get Mr. [PII] pulled up and I can check those claims for you. What's the first date of service?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah, the first one is [PII].
[AGENT][NEUTRAL] What's the uh general provider name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] For the 00120 and the 01 110.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we actually received that claim twice.
[AGENT][NEUTRAL] The original claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get that original claim. Is that First Choice Dental?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So the original claim we received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim was denied as.
[AGENT][NEUTRAL] Our records indicate the premium for that service date was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] I'm sorry, what was the reasoning?
[AGENT][NEUTRAL] Our records indicate the premium for that service date was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so is that like the patient didn't pay for the plan?
[AGENT][NEUTRAL] For that data service we have not received the premium so he was not eligible for that specific data service.
[CUSTOMER][NEUTRAL] So that means
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha, I got you.
[CUSTOMER][NEUTRAL] Do you have a term date for this plan?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK, so premium was not received for the state of service.
[AGENT][NEUTRAL] That's correct. And I can give you the claim number if you would like, the original, and I can give you the duplicate as well, but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I would think that.
[AGENT][NEUTRAL] The
[CUSTOMER][POSITIVE] Perfect, I'll take it.
[AGENT][NEUTRAL] The original claim number is 346.
[AGENT][NEUTRAL] 9242.
[CUSTOMER][POSITIVE] OK, perfect. Would you be able to fax me that?
[AGENT][NEUTRAL] And then they do it.
[AGENT][POSITIVE] Actually we have a provider portal if you're interested I can assist you with creating a portal and you can get those EOBs directly online just a little bit quicker than fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, we can do that.
[AGENT][NEUTRAL] OK. If you will go to
[AGENT][NEUTRAL] Um, secured, that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna choose going in as a new user and then choose the last option. You are a dental or medical provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then it'll take you to the next screen and you'll put in your tax ID number.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And when it gets to the patient account number you if you'll tell me I'll give you that so you don't have to look it up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I am there.
[AGENT][NEUTRAL] Patient account number is 83142.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] This is quicker than having to wait for a fax.
[CUSTOMER][NEGATIVE] Yeah, that is so untrustworthy anyways, I feel like half the time it never shows up.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh, that was easy.
[AGENT][NEUTRAL] And then you can just, there's two options one if you have a claim number, the other if you don't have a claim number, you can look up. You can also submit claim documents online.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome. Thank you so much for helping me with that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And then I just have one other claim I wanna check on.
[AGENT][NEUTRAL] Same patient.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's that next date of service?
[CUSTOMER][NEUTRAL] This is for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking on it. I'm checking on it. Sorry, my, my voice went away.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Who is that dental provider?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] Perfect. OK. So it looks like we received that one twice as well.
[AGENT][NEUTRAL] The original claim we received on [PII] and processed on [PII]. That claim number.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Is 349.
[AGENT][NEUTRAL] Sorry, 9751.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 349-975-1
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then what did that one pay or deny?
[AGENT][NEUTRAL] If denied, um, the policy does not provide benefits that are not listed within the schedule. This is a limited dental policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And so it's non-covered.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right, that was all I needed. I really appreciate your help.
[AGENT][NEUTRAL] Do you want the duplicate claim number for that date?
[CUSTOMER][NEUTRAL] No, I don't need it.
[AGENT][POSITIVE] All right. Well, it has been a pleasure to assist you with that claim status. Anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, that'll do it. I appreciate it.
[AGENT][POSITIVE] And thank you for calling APL Molly. Hope you have a great day and a very happy new year.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.