AccountId: 011433970860
ContactId: 27866683-346b-4bca-87af-9e7d9bfe8b3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1168140 ms
Total Talk Time (AGENT): 403959 ms
Total Talk Time (CUSTOMER): 327697 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/27866683-346b-4bca-87af-9e7d9bfe8b3a_20250611T20:18_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, good good afternoon. This is [PII]. I'm calling on behalf of specific Dental Services, checking on some claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim statuses and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[AGENT][NEUTRAL] OK, may I have the first member's policy number?
[CUSTOMER][NEUTRAL] 603
[CUSTOMER][NEUTRAL] 996.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. The data service is 428-2025 in the amount of 8 $88.
[AGENT][NEUTRAL] [PII] for $88.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment. And you said this is for [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] The only reason I'm asking is because I'm not showing any claims on file for [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] But the policy was active.
[CUSTOMER][NEUTRAL] OK, so there is no claim on that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. Can I get, can I get the payer ID?
[AGENT][NEUTRAL] I pay ID is 60801.
[CUSTOMER][NEUTRAL] Thank you. With the claim mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] Oklahoma City.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Thank you. And the patient group number?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Group number
[AGENT][NEUTRAL] Oh, let me do it this way.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Group number is L like Larry, A like apple, 0225.
[CUSTOMER][POSITIVE] Thank you. And effective date will be?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you. And the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing limit. You can file at any time as long as the policy was active on the data service.
[CUSTOMER][NEUTRAL] Thank you. And uh on this policy, the patient is a subscriber, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Thank you. Can I verify the patient's home address, is that fine?
[AGENT][NEUTRAL] Yes, you can um verify it with me.
[CUSTOMER][NEUTRAL] Thank you. The address we have on file is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, that's what we have on file as well.
[CUSTOMER][POSITIVE] Thank you so much. And are you able to check the providers in network or out of network?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Um, let me take a look and see if this policy has a network. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That is wonderful
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So the 101.
[AGENT][NEUTRAL] Hold on one moment. I'm just waiting for the documents to pop up here.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, so this policy is not on a network. This is, um, it's a
[AGENT][NEUTRAL] Well, how can I put, it's a fee schedule, so there's a list of codes here and then a dollar amount that would be applied to that code.
[CUSTOMER][NEUTRAL] OK, fine with that. So, can you please help me with providing uh
[CUSTOMER][NEUTRAL] OK, so there is, I mean, there is no claim on file and there is no rejection from your end for this data service, right?
[AGENT][NEUTRAL] Right, there's no claim on file.
[CUSTOMER][NEUTRAL] Uh, thank you. And can you please help me with providing spelling your name?
[AGENT][NEUTRAL] My name is [PII] The first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I, can I get the call reference?
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date. Did you have another claim that you wanted to go over?
[CUSTOMER][NEUTRAL] Thank you, [PII]. I will provide you that information. Can I uh provide you the next patient member ID?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] All right, and I'm ready when you are.
[CUSTOMER][POSITIVE] Thank you so much. The next ID number is 02466115.
[AGENT][NEUTRAL] 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].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] 320, sorry, uh it's uh, I mean, date of service is [PII] and the total charge of 1 $1,973.
[AGENT][NEUTRAL] [PII] for $1,973.
[CUSTOMER][NEUTRAL] Yes. And we, they submitted this claim on [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I go through these claims?
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 344-731-0.
[AGENT][NEUTRAL] Oh my Lord.
[AGENT][NEUTRAL] 344-7307.
[AGENT][NEUTRAL] So 10 is the first one.
[AGENT][NEUTRAL] This is only 608.
[AGENT][NEUTRAL] 307.
[AGENT][NEUTRAL] 947.
[AGENT][NEUTRAL] 367.
[AGENT][NEUTRAL] D [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] It's OK I previously submitted claim. OK, so.
[AGENT][NEUTRAL] That one was.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] With this one.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Duke of 307.
[AGENT][NEUTRAL] Zo of 310.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So we've received two claims, um, both of the, well, first, let me ask you this, what's the name of the provider on the claim?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, so we've received two claims from you all, um, they're they're both the same um provider, but neither of the claims total $1,973.
[AGENT][NEUTRAL] They're both smaller amounts. So if that's the only total bill, then we have not received that claim.
[CUSTOMER][NEUTRAL] So, uh, is, do you have a claim like uh $1,244 or $729?
[AGENT][NEUTRAL] No, we have claim number 3447307.
[AGENT][NEUTRAL] That total bill is $947.
[AGENT][NEUTRAL] And claim number 3,447,310, that total bill is $608 but those are the only two that we have.
[AGENT][NEGATIVE] And then they were resubmitted and they were denied as duplicates.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one moment. I'm checking that claim number.
[CUSTOMER][NEUTRAL] I'm sorry, I'm checking on that claim number. One moment, sorry for that.
[AGENT][POSITIVE] Sure, take your time. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Coverage-related whites move to go by.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the claim number you said was 3,447,310?
[AGENT][NEUTRAL] 344-7307 and 7310, yes.
[CUSTOMER][NEUTRAL] Yeah, 7310. That's the claim. So, uh, that's the claim we last we resubmitted that via paper on [PII] as an
[CUSTOMER][NEUTRAL] Uh, appeal like, uh, there was a payment.
[CUSTOMER][NEUTRAL] was issued on 424-2024 via check. 1848129, 192. The check was uh
[CUSTOMER][NEUTRAL] Notes sent to the correct address. So we uh attach the 9 and
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] timely filing limit and uh
[CUSTOMER][NEUTRAL] Proof of timely filing limit.
[AGENT][NEUTRAL] OK, hold on one second. I, I need to, hold on, I'm sorry, I need to make sure I'm following you. So are you saying that with the claim ending in 310, the check that was received was, I mean the check that was sent was sent to the wrong address?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And you sent in the W-9 with the correct address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment, let me go to that claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the check number that you have for that claim?
[CUSTOMER][NEUTRAL] Uh, that check number we have from previous call is 1848192.
[AGENT][NEUTRAL] For claim number 3,447,310?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] No, that is incorrect.
[CUSTOMER][NEUTRAL] OK, so there was, no, no, the check payment was.
[AGENT][NEUTRAL] So that claim number?
[CUSTOMER][NEUTRAL] Mhm. Go ahead.
[AGENT][NEUTRAL] Thank you. So that check number um belongs to the opposite claim ending in 307.
[CUSTOMER][NEUTRAL] Yeah, 307. That's the payment was uh not cash. I mean, uh issued to a wrong address. So that's why we submitted the W9.
[AGENT][NEUTRAL] OK, so you said 3:10 earlier. So which one has the was sent to the incorrect address? 307 or 310?
[AGENT][NEUTRAL] Or both.
[CUSTOMER][NEUTRAL] Uh, actually, uh, 3.
[CUSTOMER][NEUTRAL] I mean both because the claims split into two, I guess.
[AGENT][NEUTRAL] OK, so hold on one moment.
[CUSTOMER][NEUTRAL] We had 2 claim form on this one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so check 1848192 was voided.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And 1,848,190 was voided also.
[AGENT][NEUTRAL] OK, do you mind if I place you on just so you're, you're calling because you haven't received the payments for these two checks that were voided.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct? OK.
[CUSTOMER][NEUTRAL] Yeah, voided. And that's why, yeah, that's why we, one more thing, that's why we submitted the W9 also with the correct address.
[AGENT][NEUTRAL] OK. What is the correct address that the check should go to?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Can you repeat the zip code, please? I'm typing that as you speak. I'm sorry.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, then, then, uh, then it's fine. I'm really sorry. I will, uh, I mean, uh, repeat it again slowly. It's [PII].
[AGENT][NEUTRAL] Thank you. Hold on. And is it all right if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah, sure, go ahead.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right, now let's see what's happening.
[AGENT][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Now, if this was ketene, we wouldn't hear the end of it.
[AGENT][NEUTRAL] Where is the hub? Where are you?
[AGENT][NEUTRAL] OK, no that's not it.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So what I'm gonna do is send this back to the claims department because I do see back on [PII], um there was a request sent over to them, um which the checks were voided, but it doesn't look like they were reissued.
[AGENT][NEUTRAL] So I'm going to have claims look into this and um give us an update on the reissued checks or or let us know where they are in that process. And then um if you like, I can have for them to give you a call back directly so that they can let you know of the next steps.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, go ahead with the, I will provide you the call reference if you like.
[AGENT][NEUTRAL] OK, and then is the [PII] I'm sorry, [PII] the the best number to reach you back at?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and uh what call reference number should I give for them?
[CUSTOMER][NEUTRAL] You can uh give this number itself.
[AGENT][NEUTRAL] Are you ready for our call reference number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I, I can take your call reference.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Thank, thank you, [PII]. And how many days we need to allow for this one to be processed and get that update?
[AGENT][NEUTRAL] I'm
[AGENT][NEUTRAL] I'm making this urgent, um, so 24 to 48 hours you should at least receive a call back with an update.
[CUSTOMER][POSITIVE] OK, fine. And uh thank you. And yeah, that will be today. I really appreciate your help.
[AGENT][POSITIVE] You're very welcome, and again, I apologize for this inconvenience. Was there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] Uh, no, that will be great. Thank you, [PII].
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Bye. Thanks.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.