AccountId: 011433970860
ContactId: ec7db715-7722-467d-a146-184d0df68065
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402529 ms
Total Talk Time (AGENT): 196474 ms
Total Talk Time (CUSTOMER): 160057 ms
Interruptions: 3
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ec7db715-7722-467d-a146-184d0df68065_20250108T16:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I was calling to get, um, I have some questions about an EOB we received.
[AGENT][NEUTRAL] OK, yeah, I can take a look at that EOB with you. Uh, let's see, [PII], can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you, and then do you have the policy number or the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, policy number is 02563566.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. All right, so let's take a look here.
[AGENT][NEUTRAL] Is this for the Duluth Dental smile?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, OK, the only claim we have for him, so that was easy. Alright, bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it was prior to the effective date. Let me take a look.
[CUSTOMER][NEUTRAL] Yeah, because even the data service, it says 121 2024, and we didn't send out a claim with that data service.
[AGENT][NEUTRAL] Oh, is that not correct?
[CUSTOMER][NEUTRAL] No, and then our name is spelled it [PII], so there's a couple errors on here that I'm just.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got you, yes, OK, I completely understand. All right, bear with me just what was the correct date of service? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII], um, yeah, we've never seen them [PII].
[AGENT][NEUTRAL] Like they just might have missed a uh looks like they might have missed a 2 or something.
[AGENT][NEUTRAL] All right. OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, that could be that mhm.
[AGENT][NEUTRAL] Alright, so if you would um appreciate the information bear with me just a moment I'm going to put you on a brief hold and reach out to our claims specialist. I'll get right back with you.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm good, [PII], thanks for asking. How are you?
[AGENT][NEUTRAL] Doing well thank you so I've got a provider on the line calling about a claim um it denied as stating that the date of service was prior to the effective date and she said that the date of service is incorrect um looks like it might have just been input wrong so I don't know if it might need to be reprocessed.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Policy number is 02563566.
[CUSTOMER][NEUTRAL] For what part?
[AGENT][NEUTRAL] Uh, part one, and there's just the one claim on file. It's the one, ending in 647.
[CUSTOMER][NEUTRAL] This is for dental
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Let me verify, pull up the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she said that the correct date of service was [PII].
[CUSTOMER][NEUTRAL] Do you know how to do an error document?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Do you do error through hub.
[AGENT][NEUTRAL] No, I do not, um, but yeah, if you wouldn't mind tell I.
[CUSTOMER][POSITIVE] Great, it's supposed to be a doctor.
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] 121 24168 because if it's incorrect, it's supposed to be an error documents sent to the adjuster who processed the claim.
[AGENT][NEUTRAL] OK, is that something that I'm able to do?
[CUSTOMER][NEUTRAL] Yes, cause I received the error, an error from um [PII] saying that I had processed the claim incorrect and I needed to reprocess it. It came from.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You guys, but it was through herb.
[AGENT][NEUTRAL] Got you, OK, um.
[CUSTOMER][NEUTRAL] Let me see. 1212. Uh, it's not incorrect. That's not, it's not incorrect. She processed it right.
[AGENT][NEUTRAL] Sorry, I've not had one like this before.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] is the date of service, right?
[AGENT][NEUTRAL] Yes, um, on the EOB though and on the EOBI it does say 121 2024.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] They do like [PII] on the claims service date.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEGATIVE] Yep, it is incorrect.
[CUSTOMER][NEGATIVE] I can let her know, but you have to make a request for it to be um for error.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine um
[AGENT][NEUTRAL] Sure, how do I just put in the user code um on Teams and that's where I see who processed it?
[CUSTOMER][NEUTRAL] Yup, the um the person who processed it is [PII]. She processes claims. I mean, um, [PII] processes dental, yup, it was her.
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], OK, OK, that's fine. Alright, I appreciate you letting me know.
[CUSTOMER][NEGATIVE] Now, I don't know how you do it through her cause I've never done it before.
[AGENT][POSITIVE] I haven't either, but we, it's fine I appreciate it. I just wanted to touch base with you because again I've not encountered that before um so I appreciate your help. uh, I will figure out the hub.
[CUSTOMER][POSITIVE] OK, well, thanks for calling. Have a good day.
[AGENT][POSITIVE] Yeah I appreciate your help thank you bye bye.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] Alright [PII], I'm so sorry about that wait are you still with me?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][POSITIVE] OK, so I'm, I did touch base with them we did verify that yes this information was uh incorrect, so I'm going to have it resubmitted, um, or excuse me, reprocessed, um, and so I'm sorry about that, um, and generally takes 7 to 10 business days might be a bit sooner, um, but we'll let you know. I'm really sorry about the confusion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, no problem. Is there a reference number that we could have?
[AGENT][NEUTRAL] Yes, it would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Nope, that is all thank you so much for your help.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.