AccountId: 011433970860
ContactId: 2c2536b3-5523-4ee8-a602-efedc3326887
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1054439 ms
Total Talk Time (AGENT): 241038 ms
Total Talk Time (CUSTOMER): 333259 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/2c2536b3-5523-4ee8-a602-efedc3326887_20250603T21:12_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] Uh, and uh, this is [PII], and I was checking for the dental claim status for 2 members. If you can please help me out with that.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. It will be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have, is it two claims for the same member or they're different members?
[CUSTOMER][NEUTRAL] Oh no, they are different members.
[AGENT][NEUTRAL] OK, may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Let me add that. 02576415.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, this is for [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 bills for the claim?
[CUSTOMER][NEUTRAL] Yes, uh, date of service I'm looking is uh [PII].
[CUSTOMER][NEUTRAL] Uh, total bill amount or charge amount was $1,123.
[CUSTOMER][NEUTRAL] And uh this is uh already processed and they are saying that they did receive the payment for $372 on this one.
[AGENT][NEUTRAL] OK, hold on one second. You said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That's true.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] A provider office. Let me check just a moment. And that's a dentist of uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I have the claim here and um you said that yes, there was a payment of $372 and then what question did you have about the claim?
[CUSTOMER][NEUTRAL] Yeah. Uh, and this one actually, the provider is saying that uh it has been processed as an out of network provider and uh this shouldn't be processed as an out of network as they were contracted uh with the insurance on date of service. So, uh, uh, on the UBI was not able to find whether it's processed as in or out of network. So if you can just confirm whether it was processed as an out of network.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold while I pull the explanation of benefits?
[CUSTOMER][POSITIVE] Oh, sure, no problem, and I. Take your time.
[AGENT][NEUTRAL] All right, hold on one moment. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why do we keep running into this?
[AGENT][NEUTRAL] Yeah low is big.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes, sir, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. Um, so it wasn't
[AGENT][NEUTRAL] So this policy is on the Carrington PPO network, but if your provider is not a Carrington provider, the benefits are still the same. There's no out of network benefits for this policy. The two codes that were
[CUSTOMER][NEUTRAL] Oh, so whether they are in, OK, OK, got you. So, uh, you are saying that whether they are in-network or out of network, uh, there would be no difference in the payment. It's gonna be the same.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Right. Would you like me to continue with the two the two codes that were denied?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, no, actually, I was just checking on the, uh, the payment was processed as in or out of network. I do have rest information with me. So no problem with that. Thank you so much for that. And is there going to be any reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The call reference number for the entire call is going to be my name and today's date.
[CUSTOMER][POSITIVE] OK. Got you. Done. And uh whenever you're ready, let me know. I can provide you the next one.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, that's 02564652.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. The first name is [PII], last name is [PII]. Uh date of birth is [PII].
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Thank you for that and all the information again provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Uh yes, for, yeah, for that's for [PII].
[CUSTOMER][NEUTRAL] Uh, total charge amount was $227.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, 227. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] Yes. Uh, that will be Mission Valley Dentist.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 8824.
[AGENT][NEUTRAL] What's the tax ID because it's coming up something different.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, tax ID is [PII]. They also use the name.
[AGENT][POSITIVE] Thank you for that and I'm showing.
[CUSTOMER][POSITIVE] Mhm, yeah, continue, sorry about that.
[AGENT][NEUTRAL] I'm showing that the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0902.
[AGENT][NEUTRAL] And also on [PII], the um claim was paid out on to the provider, a total of $139.
[CUSTOMER][NEUTRAL] Uh, you said [PII]. OK. I think that that's the new one because uh previously, we had an information that on [PII], they paid 139, but that uh check was been returned to the insurance again. OK. So for this one, I do not have the information. You said 139 was issued on which date? [PII]?
[AGENT][NEUTRAL] Hold on one moment let me.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh what's the check number?
[AGENT][NEUTRAL] And you need to check num OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, it was issued on [PII], check number 20, I'm sorry, 2039737.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was mailed to
[CUSTOMER][NEUTRAL] 2039737. OK, yeah, sorry, continue. Will do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, it was mailed to address [PII].
[CUSTOMER][POSITIVE] Mm, OK. That's the rendering address, correct. No problem.
[CUSTOMER][NEUTRAL] And uh ZIP code [PII], updated that. And uh this is a single check of $139 or like a part of a bulk amount.
[AGENT][NEUTRAL] Correct, it's a single check.
[CUSTOMER][NEUTRAL] Single check? OK. Any patient responsibility on the claim?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility actually, hold on, this is dental. Hold on one moment.
[CUSTOMER][NEUTRAL] I think it it might be $88 because there are only two codes which were built.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] Let me update that.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] And uh yes, and if you don't mind uh if I can request you uh can you just repeat the claim number one more time?
[AGENT][NEUTRAL] Sure, 359-090-2.
[CUSTOMER][NEUTRAL] 02 updated. And, and uh uh for the same patient, actually, I can see [PII], uh, the charge amount was $95 and this was also uh previously issued on [PII] which was been stopped and uh they have uh sent the check back. So if you uh have any update like any payment for $88 has been made now.
[AGENT][NEUTRAL] OK, hold on. This
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And there is one more going for the same date.
[AGENT][NEUTRAL] The $88 was listed as patient responsibility.
[CUSTOMER][NEUTRAL] Uh, that, uh, was for the first game. The second one, which I'm saying for the same date of service, they have billed for $95.
[AGENT][NEUTRAL] OK, you meant to say, OK, you said 88. OK, that's why I was like, hold on, wait a minute. OK, let me go back to it.
[CUSTOMER][NEUTRAL] No, no. Uh, actually, uh, the amount paid was 88. Previously, when, uh when they paid that, uh, claim, uh, they paid 88.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So this one was also on [PII]. Let me see if this check has went out.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Via check.
[AGENT][NEUTRAL] So I'm showing also on the [PII], an $88 check was sent out, um, and it's to the same address, um, that it was a single check.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Check number 203.
[AGENT][NEUTRAL] 973 8.
[CUSTOMER][NEUTRAL] 973 8. And uh last thing is just the claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's 359-0904.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And by any chance, is it possible uh to get this UV from like website or on a fax?
[CUSTOMER][NEUTRAL] For this uh new payment.
[AGENT][POSITIVE] Yes, I can fax it to you.
[CUSTOMER][POSITIVE] Oh, OK. Thank you so much. Uh.
[AGENT][POSITIVE] Yes, what's a good fax number for you? You're welcome.
[CUSTOMER][NEUTRAL] Let me provide you that. Yeah. The fax number will be
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, you can mention my name. No problem, [PII].
[AGENT][POSITIVE] All right, so I will go ahead and send this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, thank you so much, [PII]. Uh, take care, be safe and enjoy the rest of your day.
[AGENT][POSITIVE] Well, you're very welcome.
[AGENT][POSITIVE] You also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yep bye.