AccountId: 011433970860
ContactId: 1de3cc4f-a29c-4799-94ee-b289e7a31a19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 888909 ms
Total Talk Time (AGENT): 242762 ms
Total Talk Time (CUSTOMER): 297526 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/1de3cc4f-a29c-4799-94ee-b289e7a31a19_20250213T13:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the provider's office. I'm calling regarding a um claim.
[AGENT][NEUTRAL] OK, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And uh, do you have a phone number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, um, you can do [PII].
[CUSTOMER][NEUTRAL] Sorry, um [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] I do. Um, it is.
[CUSTOMER][NEUTRAL] 02344903
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Um, [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you, and, and you were just needing claim status?
[CUSTOMER][NEUTRAL] Um, yes, so I actually, this is gonna be like my 3rd or 4th time calling. I had previously called um regarding a corrective claim, um.
[CUSTOMER][NEGATIVE] The data service was incorrect, the one from the EOB that we received, so, um, they're gonna go ahead and fix that with the correct data service and mail it out to us, but we never got it and it's been, oh, since December I wanna say.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] Oh, I lost it. Hold on.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think it's, it was a mix like they combined the services, the [PII] and [PII]. Um, I don't know if you can see there's two fillings, 3 and 4, those belong to [PII] and the rest belongs to [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on just a second. Let me write this down. [PII].
[AGENT][NEUTRAL] So on [PII], did they have a cleaning?
[AGENT][NEUTRAL] Well male.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] And a 150 exam, and that is correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, on [PII]. Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And did they have anything else done on [PII]?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Which data service was supposed to be corrected?
[CUSTOMER][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Was [PII] supposed to be corrected or?
[AGENT][NEGATIVE] I'm confused.
[CUSTOMER][NEUTRAL] Um, it was supposed to be, let me pull up my notes. Hold on I'm so sorry.
[CUSTOMER][NEUTRAL] Oh, it's right here. OK. Yes, so, um, the services you on the exam, full of mouth and cleaning were supposed to be, um, detached from the 15 because the initial the EOP that we received.
[CUSTOMER][NEUTRAL] Um, the exam, FMX cleaning, and those two fillings were included in 15.
[CUSTOMER][NEUTRAL] Um, but the exam, X-rays and cleaning belong to 13.
[AGENT][NEUTRAL] OK. 1, OK, on 15, they had two fillings.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Number 4, DO 3, MO.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. We have that in the system, which was done on 123-24.
[CUSTOMER][NEUTRAL] 123 24, no that was done on 1524.
[AGENT][NEUTRAL] Is 15 the correct date of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII]. Mhm.
[AGENT][NEUTRAL] OK, 152-239224 DO.
[AGENT][NEUTRAL] And 152-392-3 MO. Is that correct?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, that's what we have in the system for 15, those two, so that should be correct, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was done on 123 24.
[CUSTOMER][NEUTRAL] No, that was done in 15-2024 [PII].
[AGENT][NEUTRAL] Right, I'm saying we processed it on 123, 24.
[CUSTOMER][NEUTRAL] Oh, OK, OK. So you meant the data service, OK.
[AGENT][NEUTRAL] Right, so 15 in our system looks correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That was processed on 123-24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have that one?
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][POSITIVE] Yes, I do have that one.
[AGENT][NEUTRAL] OK, and 1320.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You are saying you had an exam.
[AGENT][NEUTRAL] I mean, they had an exam, full mouth, and
[AGENT][NEUTRAL] X-ray.
[AGENT][NEUTRAL] So what are you trying to say? They're supposed to be on a separate check or what?
[CUSTOMER][NEUTRAL] Uh exam
[CUSTOMER][NEUTRAL] No, separate data of services. The, the EOB that I have.
[CUSTOMER][NEUTRAL] Include all the services for data service 15 of 2024.
[AGENT][NEUTRAL] Cause I'm showing in the system it is correct. So what claim number do you have on that EOB?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the only claim number that I have is.
[CUSTOMER][NEGATIVE] 3408703. Every time that I've been calling to request a new one, the new process you will be, we haven't, we, we haven't received it.
[AGENT][NEUTRAL] 3408703. Let me pull up the EOB and look at it because I'm showing in the system it's correct.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's just on the same claim number, but it's the correct dates of service you're asking about.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check the EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing the EOB in the system has 13 and 15 as well.
[CUSTOMER][NEUTRAL] OK. Um, so we
[AGENT][NEUTRAL] I'm not sure what what you're looking at, but I can, uh, fax you this one.
[CUSTOMER][NEUTRAL] OK, yes, please, if you can fax it to me, or is there a way to send to get it by email, emai[PII]?
[AGENT][NEGATIVE] Our email is not secure enough. I can fax it to you.
[CUSTOMER][NEUTRAL] OK, give me just a second, let me get the fax number.
[AGENT][NEUTRAL] Let me look at this other EOB. I may know what you're looking at. OK. I see, I see where they corrected it. OK, I, I see what you're seeing now on the 15. It looks like they did correct it and there's, there is another EOB.
[AGENT][NEUTRAL] In there
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] So I can fax this EOB that is correct to you.
[CUSTOMER][NEUTRAL] OK. Yeah, that's the one that.
[AGENT][NEUTRAL] Because in the system, in our system is correct.
[AGENT][NEUTRAL] And this is the one that you need. It says 15 and 13.
[CUSTOMER][NEUTRAL] Mhm. OK. Let me just get that back.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what's your fax number?
[CUSTOMER][NEUTRAL] Give me a second, hold on.
[CUSTOMER][NEUTRAL] You see.
[CUSTOMER][NEUTRAL] I don't know my memory, so I have to go look it up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because we usually do um
[CUSTOMER][NEUTRAL] He knows here hold on.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Bear with me, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am, I'm so sorry I'm going to the other printer because it doesn't have the number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK, I got it. 214.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 272
[CUSTOMER][NEUTRAL] 8552.
[AGENT][NEUTRAL] OK, that was 2.
[AGENT][NEUTRAL] Hold on, I'm sorry, [PII]. I'm gonna send it right now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 214272-8552. Mhm.
[AGENT][NEUTRAL] I sent it. I don't know how long it will take to come through.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. I'll be here and see if hopefully I do get it cause it's, it's been a while since we've been um requesting it, waiting on it.
[AGENT][NEGATIVE] Right. It, it looks like they sent it, but I'm not sure why you're not getting it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. And did they send it to the [PII]? Was it the [PII]?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or was it [PII], the address?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm yeah, that's our address. I'm not sure why we haven't received it. Um, but yeah, uh, that's fine. I'll, I'll wait on it. Um, if not, I'll call back again.
[AGENT][NEUTRAL] I'm not.
[AGENT][NEUTRAL] OK, I faxed it, so maybe it'll come through this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All righty. um, OK. What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, is there a reference number, [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. That, that'll be all.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day and if you don't get it, just give us a call back.
[CUSTOMER][POSITIVE] OK. I will. Thank you.
[AGENT][POSITIVE] OK. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Bye-bye.