AccountId: 011433970860
ContactId: 0f6a9555-5ae3-419a-be4f-031b80207f7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 707409 ms
Total Talk Time (AGENT): 263695 ms
Total Talk Time (CUSTOMER): 295037 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/0f6a9555-5ae3-419a-be4f-031b80207f7d_20250603T16:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with the care team. I can't tell if we have a if we need claim assistance for UTBA dental, would that go through UTBA or would it still go through you guys?
[AGENT][NEUTRAL] Do they have a dental policy with us?
[CUSTOMER][NEUTRAL] Yes, it's a dental policy with us, but it's, uh, but they're UTDA so whenever I try to look at it like through the, the data service, it says that it's not ours it's we have to contact UTDA, but if it's just they're wondering why the UCR, the 100%, it wasn't even paid at 100% and I checked on our UCR screen, so would that go to UTBA?
[AGENT][NEUTRAL] I believe it would. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Policy number is 217.
[CUSTOMER][NEUTRAL] 853 8.
[CUSTOMER][NEUTRAL] Because I only see that it should be transferred if it's like a DI claim, so I didn't know if it would still go through UTA UTBA or if it would go through.
[AGENT][NEUTRAL] And what's the
[CUSTOMER][NEUTRAL] Oh boy, where am I at?
[AGENT][NEUTRAL] Data service is it the claim we process because if it's a claim we process and I think.
[CUSTOMER][NEUTRAL] Yeah, it's 5225.
[AGENT][NEUTRAL] OK, claim number 3600836?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and is it uh a provider on the line or is it the insured?
[CUSTOMER][NEUTRAL] It's the provider.
[AGENT][NEUTRAL] And they're inquiring about the.
[AGENT][NEUTRAL] UCR user uh that's the.
[CUSTOMER][NEUTRAL] Yes, it said it pays at 100% for a cleaning, and we didn't pay that because I was looking at 90% off of our UCR screen in lion and 90% was $66 and it showed that we paid $62 so it's not even at 100%.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Because we just looked at a procedure code and it's a procedure code 0120.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I think we would um address it since we process the claim that would be um.
[AGENT][NEUTRAL] Let me see if I can find any of this.
[CUSTOMER][NEUTRAL] OK, I didn't know if you were getting an error message like I was, um, because when I tried to look at the data service it said.
[CUSTOMER][NEUTRAL] That I couldn't even though I saw it right there, but then I saw that it was processed and paid.
[CUSTOMER][NEUTRAL] By us, so that's why I didn't know if it would still go to them or if it would go to us.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, like I said, I believe my understanding is that we would, we process it then it would be uh uh.
[AGENT][NEUTRAL] It would be us.
[AGENT][NEUTRAL] So I'm not really sure, so they're asking about the reimbursement amount and and not being correct, is that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, because it's a, it's a preventative cleaning and their, their dental code shows that it should be paid at 100%, so the $81.
[AGENT][NEUTRAL] Basically.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it's showing $62 was paid towards it when at 90 90%.
[CUSTOMER][NEUTRAL] It was $66.
[CUSTOMER][NEGATIVE] So it should have been at least.
[CUSTOMER][NEUTRAL] $70 or something dollars.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, I'm getting a few UCR thing. I had someone ask me what that means I like, uh, let me Google search it real quick.
[AGENT][NEUTRAL] Um, it's the, what do you call it, it's um.
[AGENT][NEUTRAL] Um, reasonable and.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's something in customary.
[CUSTOMER][NEUTRAL] Amount
[AGENT][NEUTRAL] It's like a fee fee schedule and they call it usual usual customary reasonable is what it's kind of stands for but it it's like the dental care, it's the standard cost for dental procedures set by insurance companies, so it's like the um.
[AGENT][NEUTRAL] Their reimbursement based on um like I said that the UCR fee so that's what the reimbursement is basically from now um.
[AGENT][NEUTRAL] I can't answer why.
[CUSTOMER][NEUTRAL] And I typed in their zip code.
[AGENT][NEUTRAL] Yeah and I was gonna say.
[CUSTOMER][NEUTRAL] Why it didn't, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not sure which fee schedule we use.
[AGENT][NEUTRAL] Um, cause I don't do dental and I'm not.
[CUSTOMER][NEUTRAL] For this one it was UCR. OK, that's fine.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What I would probably do, I guess you can transfer the caller to me and who am I speaking to?
[CUSTOMER][NEUTRAL] Um, her name is [PII].
[AGENT][NEUTRAL] And what's a good call back number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. I can't even find the UTDA.
[CUSTOMER][NEUTRAL] Like what it goes under so.
[CUSTOMER][NEUTRAL] Let me see who it would be.
[CUSTOMER][NEUTRAL] Oh, I should have an
[CUSTOMER][NEUTRAL] Yeah, they don't even have an edit messages, so it goes through.
[CUSTOMER][NEGATIVE] I'm confused why it wouldn't even let me look up that date of service.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, I'm not sure either because I can pull it up when you click on the claim itself, the 360-0836.
[CUSTOMER][POSITIVE] Yeah, I can do that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But it doesn't
[CUSTOMER][NEGATIVE] But CLHQ it won't let me. I was so confused. It says this is not an A and H product. oh, that's why cause I'm dumb as nuts and I didn't use CLI and Q.
[CUSTOMER][NEUTRAL] It's been a day. People have been asking me questions. I just, I'm like uh.
[CUSTOMER][NEUTRAL] I didn't know that I was on trial today.
[AGENT][NEUTRAL] Yeah, I get that. I, I, I have those kind of days myself. Today was definitely a Monday, Tuesday, Monday.
[CUSTOMER][NEUTRAL] Um, but still, let me see.
[AGENT][NEUTRAL] And we used to always talk about.
[CUSTOMER][NEUTRAL] Well, with the OSC and all that stuff.
[AGENT][NEUTRAL] Yeah, it's crazy, right?
[CUSTOMER][NEUTRAL] I my brain can't take anymore, but yeah, I am showing it now, but yeah, I'm not showing that we paid the 100% and that's the question she has.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see if I can um get some help from the uh.
[AGENT][NEUTRAL] Adjuster that process the claim, but if you wanna go ahead and transfer and I'll try to assist her as best I can.
[AGENT][NEUTRAL] Um, of course, she's out to lunch, I think, so I can't reach out to her at this time, but what I can do is just uh.
[CUSTOMER][POSITIVE] All right, thank you so much, [PII].
[AGENT][POSITIVE] Research it and call her back, so go ahead and transfer pay you down over and I'll take care of it as best I can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome [PII].
[CUSTOMER][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] I have [PII] from claim support. She's gonna try and help you with this, OK?
[CUSTOMER][POSITIVE] OK, thank you, thank you so much.
[AGENT][NEUTRAL] Hi [PII], um, my name is [PII]. I'm on the claim support team. How are you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Mhm. Good, how are you?
[AGENT][NEUTRAL] Good thanks. So um if I'm understanding this correctly, you are inquiring about the amount paid on the claim for data service 52-2025?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm looking at that information now and I'm trying to determine um.
[AGENT][NEUTRAL] It looks like it was processed with the UCR, but um.
[CUSTOMER][NEUTRAL] It was only like a different percentage, is that right?
[AGENT][NEUTRAL] Right, and let me take a look at.
[AGENT][NEUTRAL] Some information.
[CUSTOMER][NEUTRAL] On the other hand.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let me submit it.
[CUSTOMER][POSITIVE] I know it's great.
[CUSTOMER][NEUTRAL] I was sending on the check.
[CUSTOMER][NEUTRAL] For your next um cleaning or let's see.
[CUSTOMER][NEUTRAL] Looks like we have you scheduled for [PII] at [PII]. That's fine, yeah, otherwise you can even send it in the mail or you can call me whatever you wanna do. OK, sounds good thanks, [PII], bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know for that and then you know right and then if.
[AGENT][NEUTRAL] OK, um, if you don't mind [PII], I'm gonna, um, I'm trying to reach out to the um adjuster that process this claim to inquire, um, and apparently she may be at lunch because she's not responding at this time and I'm trying to determine.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I believe she may be at lunch, so if it's OK, would it, would it be all right if I take a good call back number and give you a call back?
[CUSTOMER][POSITIVE] Yeah definitely
[AGENT][NEUTRAL] And um [PII] gave me uh [PII]. Is that a good call back?
[CUSTOMER][NEUTRAL] Yes, that is, and um we go from to lunch from [PII] so it's if it's between there, um, of course we won't be here but otherwise [PII] we are open.
[AGENT][NEUTRAL] [PII] and you're on are you on Central time or Eastern time?
[CUSTOMER][NEUTRAL] Oh, that's a good question. Let me see.
[AGENT][NEUTRAL] Where are you located?
[CUSTOMER][NEUTRAL] [PII] is.
[AGENT][NEUTRAL] I think you're on uh Central time, the same time I am, I believe.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] I think you're right, yes, I, is it [PII] there?
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, so [PII], you're at lunch.
[CUSTOMER][POSITIVE] Yep yep perfect we're good then.
[AGENT][NEUTRAL] So I can call you probably, yeah.
[CUSTOMER][NEUTRAL] 1 to 2 we're at lunch, yeah, but anything after.
[AGENT][NEUTRAL] Yeah, so if, um, if I get a response back before then I'll give you a call back otherwise it will be after [PII] when you return from lunch.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] OK sounds perfect I appreciate your help.
[AGENT][NEUTRAL] You're welcome, [PII] and did you have any other questions other than uh this particular claim?
[CUSTOMER][NEUTRAL] Nope, just this one patient, yep, this one claim.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] OK, alright, I'll call you back shortly. Thank you for your patience I appreciate it. Alright, bye bye.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Sounds good thank you thank you uh huh bye bye.