AccountId: 011433970860
ContactId: 09cfa1fa-5a9a-4559-be7f-990e4307636b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 404880 ms
Total Talk Time (AGENT): 187897 ms
Total Talk Time (CUSTOMER): 104711 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/09cfa1fa-5a9a-4559-be7f-990e4307636b_20250114T19:33_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental provider's office, and I'm calling in reference to an EOB I received for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the explanation of benefits, and [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number is, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 02502130
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And is this the claim ending in 9393?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment pull that claim.
[AGENT][NEUTRAL] OK, and then what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] Well, it was denied, but I'm not really sure why. So I was just trying to get some information.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] So it looks like code 00220, um benefits have been applied to the $50 calendar year deductible.
[AGENT][NEUTRAL] Let me see if there's more code, yeah, there's one more. Hold on one second.
[AGENT][NEUTRAL] And then for code 02920, um, the policy doesn't provide benefits for any procedure or service not listed in the schedule of um covered services or procedures.
[CUSTOMER][NEUTRAL] OK, so for the for 02200220, which is a um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00 my god, an X-ray, so the.
[CUSTOMER][NEUTRAL] Deductible applies to the X-rays?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Because it doesn't say anything here about a deductible, it just says patient responsibility and the full amount.
[AGENT][NEUTRAL] OK, hold on one second, let me pull up the explanation of benefits so I can see what you see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, of course, it's taking its time. Hold on one moment, it's coming up now.
[CUSTOMER][NEUTRAL] Of course. Mhm.
[AGENT][NEUTRAL] expressing.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Patient responsibility.
[AGENT][NEUTRAL] So on that, do you have, um, does your explanation of benefits have one page or two?
[CUSTOMER][NEUTRAL] It's one page, but it's double sided.
[AGENT][NEUTRAL] OK, on the back of it, um, you'll see, well, you'll see the um remarks and what each remark means.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right, and all it says is we are awaiting information to confirm eligibility from benefits in a card. Upon receipt of this information, we will continue processing your claim.
[AGENT][NEUTRAL] Oh, wait a minute.
[CUSTOMER][NEUTRAL] So that's why I was calling because I don't understand what that means exactly.
[AGENT][NEUTRAL] I don't even know why that's on there. That's a completely different reason. Um.
[AGENT][NEUTRAL] So this is what I'll do. Let me fax you a copy of the explanation of benefits on that where where you just read that off of on our on our copy, it, it says that the benefits have been applied to the $50 deductible. So let me send you this copy so you'll have that. I'm not sure why that shows that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But yes, um, $50 well,
[AGENT][NEGATIVE] For part one, the benefits were applied to the $50 deductible and then the second part is not, is not a covered, uh.
[AGENT][NEUTRAL] Code. So what's a good fax number for you so that I can make sure that you have this description?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, [PII]?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so I'm sending this over to you now.
[AGENT][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] X-rays are not considered preventative, but let me just double check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] What type of policy does she have?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEGATIVE] $6.06 dollars. Not a color.
[AGENT][NEUTRAL] No, what is the code? Hold on one. I'm going between screens. I'm sorry, hold on one moment.
[CUSTOMER][NEUTRAL] Sure, it's OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] You need a receipt?
[AGENT][NEUTRAL] So, code 00220 is under basic, which is why the deductible was applied.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And I just faxed over the explanation of benefits to you, so you should be receiving that shortly. I just clicked send.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, great. And what was your first name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah, and is there a um reference number to this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][POSITIVE] You're welcome [PII]. Well, thanks for calling APL and I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.