AccountId: 011433970860
ContactId: 0d231607-d601-460b-bee7-22ef5df2868d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561969 ms
Total Talk Time (AGENT): 218927 ms
Total Talk Time (CUSTOMER): 208795 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/0d231607-d601-460b-bee7-22ef5df2868d_20250214T23:34_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] calling on behalf of dental office to check the claim status for 2 patients. Can you please submit that?
[AGENT][NEUTRAL] Of course I could check those claims for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Uh-huh. So that would be [PII]. So it is [PII].
[AGENT][POSITIVE] Got it thank you and then although can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, so the callback number will be [PII].
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, so the member ID number would be 02564652.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yes, so the patient and uh subscriber will be the same. So the patient name is [PII], and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII], um, and I know you said we had a couple of claims to look at are they both for this member or are they for different members?
[CUSTOMER][NEGATIVE] I have two claims for the same member same date of service, and one is.
[AGENT][NEUTRAL] OK, they're both for the same member got you OK.
[AGENT][NEUTRAL] And what was that date of service, please?
[CUSTOMER][NEUTRAL] Yes, so the date of service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, one moment please.
[AGENT][NEUTRAL] OK, and what were both of those amounts please?
[CUSTOMER][NEUTRAL] Yes, so the first amount would be $95 even, uh, for another one it is $227 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So, uh, the claim for $95.
[AGENT][POSITIVE] That one we paid a benefit of $88 for that claim and I can get that uh claim number and check information for you whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so it has been paid to check. OK, let me know this, uh, OK, please send me the check number and the claim number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, so the check number for this one that is 20.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 23
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 571.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that claim number is 35 0 sorry.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Mhm. It's a single or a bulk check.
[AGENT][NEUTRAL] It is a single check.
[CUSTOMER][NEUTRAL] OK, not that, uh, what would be the claim number?
[AGENT][NEUTRAL] That is 354-713-5.
[CUSTOMER][NEUTRAL] 135. OK, noted that. And can you also please help me with the issue date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so I've got that issue date at [PII]. I am showing that it has not yet cleared. Um, once it has reached a point of 30 days after that issue date, if I, it still has not cleared, uh, then we can get that voided and reissued.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh what would be the patient responsibility in this claim?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider. We pay the benefit of $88 though of that $95.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, not that. Uh, let's move to the next one.
[AGENT][NEUTRAL] Sure, OK, give me just a moment.
[AGENT][NEUTRAL] OK, and then for this other claim that was the T27, uh, we paid a benefit of $139. So it looks like there was one we were unable to pay. Give me just a moment. Let me take a look.
[CUSTOMER][NEUTRAL] I'm looking for the code 11:10.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So I'm looking for the single code 1110 so it has been paid in this claim.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that's the only code that we were well excuse me, that we were able to pay. Uh, the other procedure code was not a covered, uh, procedure under this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no problem, this, and what would be the check number and the issue date?
[AGENT][NEUTRAL] Yes, so that check number is 2023572.
[AGENT][NEUTRAL] And give me just a moment let me get that issue date.
[CUSTOMER][NEUTRAL] Mhm, note of that.
[AGENT][NEUTRAL] And this check was also issued [PII].
[CUSTOMER][NEUTRAL] OK, noted that, and what would be the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 354-712-0.
[CUSTOMER][NEUTRAL] OK, noted that. And what would be the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK. Can you please help me with one more patient, it is uh.
[AGENT][NEUTRAL] This for a different patient?
[CUSTOMER][NEUTRAL] The same.
[CUSTOMER][NEUTRAL] Yes, it is a different patient.
[AGENT][NEUTRAL] OK, yes, give me just a moment I'll let you know when I'm ready for that information.
[CUSTOMER][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I am ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah, so the next member ID number is 02450886.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Yeah, so the patient name is [PII]. One second, let me check that. The last name is different.
[CUSTOMER][NEUTRAL] So that will be
[CUSTOMER][NEUTRAL] So it is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you for that and then what was the date of service for this one?
[CUSTOMER][NEUTRAL] Yes, so the date of service is [PII].
[AGENT][NEUTRAL] OK, and that bill them out mhm.
[CUSTOMER][NEUTRAL] And the bill amount would be $4,047 and I'm looking for a single code that would be.
[CUSTOMER][NEUTRAL] 3330 for the number 31.
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Was this from a different provider than the previous one, Aldo?
[CUSTOMER][NEUTRAL] Yes, I can see that. Yes, it is a different provider.
[AGENT][NEUTRAL] What was this provider?
[AGENT][NEUTRAL] Or who was it?
[CUSTOMER][NEUTRAL] So the provider that would be the.
[AGENT][NEUTRAL] Or if you've got the tax ID that's easier.
[CUSTOMER][NEUTRAL] OK, so the tax ID number will be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there is for the 3330. Looks like we were unable to pay a benefit on that procedure. Give me just a moment, let me check that.
[AGENT][NEUTRAL] OK, so that's not a covered procedure code under this policy.
[CUSTOMER][NEUTRAL] We know of this, it's not covered benefit and uh what would be the last process date for this claim?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, when this claim was processed?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see, that was [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, note that and.
[AGENT][NEUTRAL] Yes, that's when this claim was processed.
[CUSTOMER][NEUTRAL] Uh, no, and, uh, can you also please help me with what would be the claim number.
[AGENT][NEUTRAL] That is 354 4.
[AGENT][NEUTRAL] 569.
[CUSTOMER][POSITIVE] 569. OK, note that. And uh the reference number will be the same. OK, it is the same. Thank you, [PII], for all the information you provided and I'm done with all my patis. So take care. Bye for now and have a great day.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Of course thank you I hope you have a great weekend bye bye.
[CUSTOMER][NEUTRAL] Bye.