AccountId: 011433970860
ContactId: 01004c41-97d1-41d5-9738-54c70aae4721
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525880 ms
Total Talk Time (AGENT): 274777 ms
Total Talk Time (CUSTOMER): 103760 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/01004c41-97d1-41d5-9738-54c70aae4721_20250107T20:34_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] Doing alright thank you. Actually have a provider on the line uh calling regarding a claim. Uh, she's stating that for two procedure codes that the information doesn't match what they have submitted. I think she just wants to take a look at that.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] It is 02410980.
[AGENT][NEUTRAL] The patient's name?
[AGENT][NEUTRAL] Is this dental?
[CUSTOMER][NEUTRAL] The patient is, uh, yes.
[AGENT][NEUTRAL] I don't. OK, what's the claim number?
[CUSTOMER][NEUTRAL] Oh, OK, um, it's uh 354-418-6.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] Oh Lord, I have no idea.
[AGENT][NEUTRAL] Uh, 3, OK, um, which one is it? 3544 for which patient? 354-4186. OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And she's saying, uh, two of the procedures don't match?
[CUSTOMER][NEUTRAL] So yeah, the top two, the 0274 and 1110 she's talking about that it doesn't match, she's looking at the EOB we sent versus what she sent um and she's saying that the information and the amounts are different.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, yeah, it looks like they mixed it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, OK, so it's the [PII], let me highlight it.
[AGENT][NEUTRAL] Uh, I don't do dental, so I can't even say 274 and 220.
[CUSTOMER][NEUTRAL] Uh, 274 and the 1110.
[AGENT][NEUTRAL] 1110.
[AGENT][NEUTRAL] OK, so 274 should be.
[CUSTOMER][NEUTRAL] I keep looking back. I called dental key, right?
[AGENT][NEUTRAL] 65. Yeah, they've mixed it, um.
[CUSTOMER][NEUTRAL] Oh, no, oh no, I'm sorry.
[AGENT][NEUTRAL] Yeah, they, that's OK. No, that's I'm just like, I don't know how to answer these questions, but I mean, I'll just, it looks like.
[AGENT][NEUTRAL] 111 0 21. Yeah, it looks like they put the wrong.
[AGENT][NEGATIVE] Amounts, which is weird.
[CUSTOMER][NEUTRAL] OK, so it might just need to be reprocessed.
[AGENT][NEUTRAL] Yeah, I'm just gonna send it to dental and have them reprocess it, take a look and reprocess it, but you can send them over. I'll just let him know that.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] OK, um, the provider we're talking to, her name is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you have a callback number?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[AGENT][NEUTRAL] OK, you can send her over.
[CUSTOMER][POSITIVE] All right I appreciate your help thank you bye bye.
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for calling American Public Life. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, [PII]. Um, so I'm looking here, it looks like you're calling on data service [PII], um, regarding
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The uh procedure code and and amounts based that they're not matching what was submitted on the claim, correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, OK, let me see, so the 1110 should be for $95.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So it's the procedure uh D0274 and D1110?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Charge amount 21 and 24.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It looks like possibly the amounts were entered incorrectly. Um, I will send this one back to the, hold one moment, let me just make sure.
[AGENT][NEUTRAL] Let me take a look here something.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To
[CUSTOMER][NEUTRAL] I mean, I
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold one moment for me, if you don't mind.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII]. This is [PII]. I had a question. I want to see if you didn't mind looking at this claim for me cause I don't do dental, so I don't know if it's done correctly or not. Uh, uh, so the policy number is 241.
[AGENT][NEUTRAL] 0980.
[AGENT][NEUTRAL] The claim number is 354-418-6.
[AGENT][NEGATIVE] Oh girl, it's been, you know what, it ain't been that bad while I'm about to breathe hard like it's been terrible.
[AGENT][NEUTRAL] What about you?
[AGENT][NEUTRAL] Yeah. Where, where are you located?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK. Yeah. I'm in [PII], so it is sunny, but it's supposed to be icing and snowing by Thursday.
[AGENT][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. So the procedure code 274.
[AGENT][NEUTRAL] And uh 1110.
[AGENT][NEUTRAL] So, she's saying it's not matching and it's not, but I don't, I don't know if, if that's how y'all process the dental because I don't know anything about processing dental. I wasn't sure. So,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So when it's the allowed amount, is that what you would use for the charge? Cause I think that's where she's getting confused.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, if there's additional payment due?
[AGENT][NEUTRAL] OK. I will
[AGENT][NEUTRAL] OK, I'll let her know.
[AGENT][NEUTRAL] No problem. I just want to make sure cause I don't wanna tell her that if it was done correctly. Uh, but uh I'll let her know it'll be reprocessed.
[AGENT][NEUTRAL] Oh, OK. You too. Bye-bye.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding, [PII]. I do apologize for the wait. Um, I did speak with the examiner uh for this uh claim, and she will, um, she is going to get the claim reprocessed correctly, uh, and if there's any additional allowed amount or payment that should be, um, issued, it will go out in 8 to 10 business days.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm, uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um what is your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] OK, thank you very much um.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with? OK. Well, you have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] That's all I need.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thanks bye.
[AGENT][NEUTRAL] Bye bye.