AccountId: 011433970860
ContactId: 06213f98-1272-45cb-9b47-29e1fdff0cc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1292170 ms
Total Talk Time (AGENT): 343208 ms
Total Talk Time (CUSTOMER): 424485 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/06213f98-1272-45cb-9b47-29e1fdff0cc2_20250213T13:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good day. This is [PII] calling from provider office checking for the dental claim status for a member.
[AGENT][NEUTRAL] OK. Can you spell your name for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, this is [PII] Could you please spell your name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial last name is [PII], and [PII], you said you're calling for a claim status?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can I get that policy number?
[CUSTOMER][NEUTRAL] Yes, that is going to be.
[CUSTOMER][NEUTRAL] 96
[CUSTOMER][NEUTRAL] Uh, just a minute, sorry. That's about 96.
[CUSTOMER][NEUTRAL] Uh, it's going to be 02100189 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, give me a good phone number in case we're disconnected please.
[CUSTOMER][NEUTRAL] Is [PII] is a direct line?
[AGENT][NEUTRAL] OK, can you give me a moment to pull up the file?
[CUSTOMER][POSITIVE] Yes, take your time, please.
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] Thank you for holding, [PII]. Can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Yes, that is going to be the first name is spelled as [PII] and the last name is spelled as [PII]
[AGENT][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] The date of birth here is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service of the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the bill amount is $209 and even.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, I'm showing that the claim denied uh due to the maximum outpatient benefit being exhausted. Looks like we received it twice and denied it the same.
[AGENT][NEUTRAL] Um, I'm gonna give you the most recent claim received, um, on [PII] and processed on [PII] under claim number 354.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 7966.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's uh denied on which date? Could you please repeat it again?
[AGENT][NEUTRAL] January
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] [PII], which is the date that it was processed, and can you give me the total charge again?
[CUSTOMER][NEUTRAL] Uh, that is $209 and even.
[AGENT][NEUTRAL] What's the procedure code on the claim?
[CUSTOMER][NEUTRAL] That is 373-521.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so you did get the claim number 354-7966 and the other claim number is 351-832-8.
[CUSTOMER][NEUTRAL] Uh, so that claim number belongs to how many dollars? That is $932.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Which one?
[CUSTOMER][NEUTRAL] No, you're saying uh to claim number, right? So I want to know which is the claim number.
[AGENT][NEGATIVE] We received the claim twice. We received the claim 2 times.
[CUSTOMER][NEUTRAL] 209, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Just for delayed date, could you please confirm?
[AGENT][NEUTRAL] Claim number 354-7966 was processed on the [PII].
[AGENT][NEUTRAL] Claim number 351-8328 processed on the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was uh there was on claim number 354-7966, there were actually two lines on that claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is 70,490, is that right?
[AGENT][NEUTRAL] On date of service, uh, of course [PII], but you said it was 73521. Was there another procedure code on that claim?
[CUSTOMER][NEUTRAL] OK, so, but here I can see it has been submitted as uh uh another claim uh with the different bill amount that is $932 with the CPT code 70,490. So it has been submitted.
[CUSTOMER][NEUTRAL] Separately.
[CUSTOMER][NEUTRAL] So could you please uh double check and let me know the status again, please?
[AGENT][NEUTRAL] So what I'm showing for date of service 99 is a procedure code of 73521 and 93,970 totaling 1200 as the build out.
[CUSTOMER][NEUTRAL] OK, thank you. So, can I, can I also uh let me know that uh how much is the maximum limit uh for allocated for this patient?
[AGENT][NEUTRAL] Hey, before we move to that question, can you confirm that the code on this claim is correct because you gave me a different procedure code.
[CUSTOMER][NEUTRAL] So, let me check again with the claim form, just a few seconds, please.
[CUSTOMER][NEUTRAL] No I.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I have here uh one bill amount that is $1200 and even with the two CPT codes that is 73521 7 93,970. You're saying about this claim?
[AGENT][NEUTRAL] OK, so that that's the same code that I show you gave me a different code earlier, so I'm gonna move to the maximum outpatient benefit which is up to $2500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you have any other questions I could help out with today, [PII]?
[CUSTOMER][NEUTRAL] Can you have
[CUSTOMER][NEUTRAL] Uh, no, for the same member, uh, for the same data service and the bill amount is $932 and even. Can I have the uh claim status?
[AGENT][NEGATIVE] The maximum benefit is exhausted.
[AGENT][NEUTRAL] And that's claim number 354.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 7970.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I showed that it was processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you so much for that. So, can I have the call reference number?
[AGENT][NEUTRAL] Mhm you'll use my name in today's date as your reference.
[CUSTOMER][NEUTRAL] OK. I have 3 more members to go on. So shall I proceed on with the next member?
[AGENT][NEUTRAL] Give me a moment to document this call and [PII], you can also access our online service center at [PII] to search for claim statuses as well. Would you like for me to help you set up an account?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, let me know when you're ready for that web address.
[CUSTOMER][POSITIVE] It's ready.
[AGENT][NEUTRAL] OK, so the first word is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You are.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let me know when you arrive at the home page and then I'll complete this note.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can let me know when you've arrived.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Have you started creating the account?
[CUSTOMER][NEUTRAL] Yes, uh, but we have already the account, but here we have the challenges it's asking for quick access, right? And then one more option we have here is do not have an API claim number.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So this is the right?
[AGENT][NEUTRAL] So that's a quick option.
[CUSTOMER][NEUTRAL] So we have
[CUSTOMER][NEUTRAL] Yeah, we have already have this portal, but the case we, we are unable to know the claim number to proceed on with. And for the another that one APL claim number we don't find the member's uh SSN number. So that's the challenge we have, uh, we are facing. So that's the reason I reached you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and so for the quick access I can give you the claim number, so go ahead and give me the next policy number that you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The next policy ID is going to be 01836810. M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, the member first name is [PII] and the last name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you and what's the date of service?
[CUSTOMER][NEUTRAL] Is the date of service here is [PII]?
[AGENT][NEUTRAL] And the total build
[CUSTOMER][NEUTRAL] $1,858 and even.
[AGENT][NEUTRAL] Can you verify the, the, uh, procedure codes on the claim?
[CUSTOMER][NEUTRAL] Yes, that is going to be.
[CUSTOMER][NEUTRAL] 74178.
[AGENT][NEUTRAL] It's just the one
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the total charge?
[CUSTOMER][NEUTRAL] The total bill amount is $1,858 and even.
[AGENT][NEUTRAL] OK, so I have the claim number let me know when you're ready.
[CUSTOMER][POSITIVE] It's ready.
[AGENT][NEUTRAL] It's 351.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0695.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if you wanna enter that, the patient's first name, date of birth and that claim number.
[CUSTOMER][NEUTRAL] Yes, please. Just a second. So the next member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the next member ID here is going to be 024.
[AGENT][NEUTRAL] OK, let's, I wanna verify that you're able to pull up that EOB.
[CUSTOMER][NEUTRAL] Yes, let me check. Just a second, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I can able to see.
[AGENT][NEUTRAL] OK. And what is the payment amount on that claim?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] That is $395.18.
[AGENT][NEUTRAL] OK, very good let me document this call and then we can move to the other one.
[CUSTOMER][POSITIVE] Thank you so much, dear.
[AGENT][NEUTRAL] Mhm. And while I'm documenting, you can go ahead is the provider number the same for the other claims? The tax ID number?
[CUSTOMER][NEUTRAL] Let me check
[CUSTOMER][NEUTRAL] Let me check. Yes, that's the same.
[AGENT][NEUTRAL] OK, because it's just, just FYI if you have other claims with a different provider tax ID you'll need to create a new account because it's it's looking for the provider's tax identification number and the patient account number you need to, you know, each, each provider or yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] All right, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] I, the next member ID here is 02446323 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's the first name here uh spelled as uh [PII] and the last name is spelled as [PII], for the date of birth of [PII].
[AGENT][NEUTRAL] Day of service.
[CUSTOMER][NEUTRAL] The date of service here is?
[CUSTOMER][NEUTRAL] Uh, the [PII] and the bill amount here is $5584 and even.
[AGENT][NEUTRAL] Thank you. I show that this claim was processed under claim number 3511.
[AGENT][NEUTRAL] 022 if you want to enter that claim number.
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] No, I will check for after the call. Thank you so much.
[AGENT][NEUTRAL] Alright, did you have any other questions?
[CUSTOMER][NEUTRAL] No, I have one more member to go on. Shall I proceed on?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] This is the last number for today's call?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that number?
[CUSTOMER][NEUTRAL] Yes, the next member ID here is updated as 15524.
[AGENT][NEUTRAL] It's not our, that's not our policy number.
[CUSTOMER][NEUTRAL] Should I say the member ID?
[CUSTOMER][NEUTRAL] So for your member's name?
[AGENT][NEUTRAL] Yeah, so what is that?
[AGENT][NEUTRAL] What's the member ID number?
[CUSTOMER][NEUTRAL] Member name?
[CUSTOMER][NEUTRAL] Uh, so here I don't, uh, find the valid member ID. Sorry for that.
[AGENT][NEUTRAL] Do you have the card?
[CUSTOMER][NEUTRAL] Uh, should I tell the member name? Could you able to pull the member data?
[AGENT][NEUTRAL] You can, but do you have the ID card?
[CUSTOMER][NEUTRAL] Uh, let me check for that. Just a few seconds, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is here the member ID?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I, uh yes. It is going to be 02435183, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's the first name here is [PII] and the last name is spelled as [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The date of birth?
[CUSTOMER][NEUTRAL] The date of birth is going to be?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And if you can have the policy number prepared when you call.
[AGENT][POSITIVE] That would be very helpful.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, so thank you so much for that.
[AGENT][NEUTRAL] And what's the date of service and total charge?
[CUSTOMER][NEUTRAL] The date of service on the claim is going to be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the bill amount is $2750 and even.
[AGENT][NEUTRAL] OK, so I show that the maximum outpatient benefit was matched on this claim.
[AGENT][NEUTRAL] Or prior to this claim it denied for that reason under claim number 351.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 592 8.
[CUSTOMER][NEUTRAL] Mhm mhm
[AGENT][NEUTRAL] And this claim was processed.
[CUSTOMER][NEUTRAL] OK. What is the time?
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The outpatient calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is up to $1750 per calendar year.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Information provided is verification not a guarantee of payment, [PII] and did you have any other questions I can help out with today?
[CUSTOMER][POSITIVE] No, dear. Thank you so much. Yeah, for all the queries. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.