AccountId: 011433970860
ContactId: 20cf39ab-1a26-4fb8-a740-dbbcfee17078
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 623309 ms
Total Talk Time (AGENT): 193497 ms
Total Talk Time (CUSTOMER): 110972 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/20cf39ab-1a26-4fb8-a740-dbbcfee17078_20250422T15:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I wanted to check on um how much is being paid for a procedure that you guys have already been notified for.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, I can check and see if there's something I can determine. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and it's [PII].
[AGENT][NEUTRAL] OK. Thank you. Do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, 421-355.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Yes, it's 0304-1960512C [PII] and [PII].
[AGENT][NEUTRAL] OK, thank you. All right. And um so this is for dental, correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Do you have the code?
[CUSTOMER][NEUTRAL] No, um, it's, um, an implant with Doctor [PII]. And I could have sworn that you guys had told me, um, for the crown, y'all are paying around $500 but they told me only about $300. So I wanted to check on that.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] Yeah, it depends on the code, um, but you said it's something that they already sent over to us.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that code. Um, bear with me just a second.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know when they send in that information?
[CUSTOMER][NEUTRAL] It would have been the very last procedure.
[CUSTOMER][NEUTRAL] Implant.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if I can find that say we pay 300.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] OK, let me check and see if it's this pre-treat, um.
[AGENT][NEUTRAL] It was towards the end of January?
[CUSTOMER][POSITIVE] That sounds about right.
[AGENT][NEUTRAL] OK, let me go ahead and put this.
[AGENT][NEUTRAL] Um, let me pull the image of the documents.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so this is not it. Let me put the next one.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And and call for providers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's gonna be this one right here, [PII].
[AGENT][NEUTRAL] OK, so let me check that procedure based on your policy. Um, so the procedure they used was 00364.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] This is option A.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I don't see a payment. Uh, did they say they received a payment or that was just benefit information?
[CUSTOMER][NEUTRAL] No, I don't
[CUSTOMER][NEUTRAL] It was just a pre-authorization.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I don't think y'all been billed for it yet.
[AGENT][NEUTRAL] Mm, yeah, and it doesn't look like we have um
[AGENT][NEUTRAL] Approve it. Let me check one more time.
[AGENT][NEUTRAL] OK, so I'm just going by what I see here in the notes, but based on the information that was, um, it looks like [PII] is the person that called to get the benefits for the date of service. Let's [PII], which it looks like that was the pre-treat information. Um, but it was denied, stating that it's not covered.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Are you able to see in the system the most recent letters that were sent to me?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I sworn I got one that said 500 and something.
[AGENT][NEUTRAL] OK. So let me go over the most recent ones. Um, the most recent ones that we received was, um, the one we pay $75 which this was for airing bearer for date of service [PII] of $25. Um, and then before that we received some pre-treatment.
[AGENT][NEUTRAL] Information
[AGENT][NEGATIVE] Um, which they were all denied.
[AGENT][NEGATIVE] So there is no payment and there is no approval of any of those codes that they send in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, um, OK, well thank you.
[AGENT][NEUTRAL] You're welcome. Yeah, it looks like it was denied. It's not something that is covered under the policy.
[CUSTOMER][POSITIVE] OK, all right, thanks so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Miss [PII]? Any other questions or concerns?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And that's it. No, thank you.
[AGENT][POSITIVE] All right. You're welcome and thank you for calling EPO. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] OK, bye.