AccountId: 011433970860
ContactId: 2e610791-663a-4827-87f3-356dd8506ba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2533010 ms
Total Talk Time (AGENT): 729708 ms
Total Talk Time (CUSTOMER): 537857 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/2e610791-663a-4827-87f3-356dd8506ba7_20241231T16:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yes, I have a.
[CUSTOMER][NEUTRAL] 9 claims.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII].
[AGENT][NEUTRAL] OK, and um may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member policy number is 02251400.
[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] Yeah, sure. The patient name is uh
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And do you have multiple dates of service for this member or just one?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello? Yes.
[AGENT][NEUTRAL] For this member, do you have multiple dates of service or just one?
[CUSTOMER][NEUTRAL] No, just one.
[AGENT][NEUTRAL] And what's that data of service?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII]. The bill amount is $4,396 even.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Office address, the provider name is Matthew Porri. The address going to be, OK.
[AGENT][NEUTRAL] OK, that's it.
[AGENT][NEUTRAL] Oh, I just need the name, that's all. Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You said 4000?
[AGENT][NEUTRAL] Hold on one moment. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is 981.
[AGENT][NEUTRAL] Is there any other claims on that day?
[AGENT][NEUTRAL] Oh, here goes one hold on.
[AGENT][NEUTRAL] There's more for this day.
[AGENT][NEUTRAL] 327-7162.
[AGENT][NEUTRAL] Oh my God.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. Um, would the provider come up with any other name, like any, what's the name of the dentistry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check. Give me one moment.
[CUSTOMER][NEUTRAL] Is actually
[CUSTOMER][NEUTRAL] The facility provider name is Doctor [PII]. Actually, the facility name is SC Smiles LLC.
[AGENT][NEUTRAL] OK, so they're all for your provider. Um, there is no one claim that totals $4,396. There's multiple claims. Um, I can see if it gives the total bill of your total, but what procedure codes on the claim that you're calling in reference to?
[CUSTOMER][NEUTRAL] Yes, actually, we need uh, what is 4000 build amount procedure code like 7240 tooth number 1 and uh 7240 tooth number 1 and 7210 tooth number 2, 7140 tooth number 7, tooth number.
[AGENT][NEUTRAL] Hold, hold on, hold on, hold on. I have to write this down.
[AGENT][NEUTRAL] Because I have to go through the claims to decipher which claim you're calling in reference to. So it was 72402 number.
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] And what were the others?
[CUSTOMER][NEUTRAL] 72102 number 2.
[AGENT][NEUTRAL] OK, so it's not this claim.
[AGENT][NEUTRAL] Because that's 2 number 10 and number.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So this is it, OK.
[AGENT][NEUTRAL] So we received claim number 349.
[AGENT][NEUTRAL] 6264.
[AGENT][NEUTRAL] On August
[CUSTOMER][NEUTRAL] What is this?
[AGENT][NEUTRAL] This is the claim status?
[AGENT][NEUTRAL] I just gave you the claim number.
[CUSTOMER][NEUTRAL] No, you said 3. OK. Could you please repeat again? 349?
[AGENT][NEUTRAL] 6264.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEGATIVE] And it was denied.
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. The claim is uh
[CUSTOMER][NEGATIVE] Denied patient not eligible on data of service.
[AGENT][NEUTRAL] Right, this policy was effective from [PII]. So on this date of service, the policy was not active.
[CUSTOMER][NEUTRAL] [PII] and the termination date?
[AGENT][NEUTRAL] So it was active from [PII].
[CUSTOMER][NEUTRAL] OK. The patient doesn't have any active policy, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Effective date. OK.
[CUSTOMER][NEUTRAL] Could you please uh send me the copy of you before this claim?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes, my fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do I need to put attention to Esther?
[CUSTOMER][NEUTRAL] Uh, no need. You can send.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The next member policy is 02421017.
[AGENT][NEUTRAL] 24, I'm sorry, 02421017.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 02421017, yes.
[AGENT][NEUTRAL] Correct. OK, thank you. Hold on one momen[PII]
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And um can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII]. The date of birth is [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 for this claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. The bill amount is $162 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] $162.
[AGENT][NEUTRAL] That's 121, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would it be the same provider on this claim?
[CUSTOMER][NEUTRAL] Mm, no, it's a different one.
[AGENT][NEUTRAL] OK, and what's the provider's name?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The individual provider name is [PII].
[CUSTOMER][NEUTRAL] The name
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 3155.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider a total of $64.80.
[CUSTOMER][NEUTRAL] Payment method.
[AGENT][NEUTRAL] Um, it was a check, hold on, let me get that check information.
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] May I know the check number?
[AGENT][NEUTRAL] And I'm getting the check information for you now. Hold on one moment.
[AGENT][NEUTRAL] The check number is 2001165.
[AGENT][NEUTRAL] It was issued on
[CUSTOMER][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] Issued on September.
[AGENT][NEUTRAL] It was issued on [PII], and it cleared on October.
[AGENT][NEUTRAL] 2nd, [PII].
[CUSTOMER][POSITIVE] Yeah on [PII]. Thank you so much. Could you please send me the copy of you before this claim also?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The policy number is 097-721841.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so that one isn't an APO policy number.
[CUSTOMER][NEUTRAL] That is a different department?
[AGENT][NEUTRAL] That's a different company. That's, that's not an APL policy number. Do you have the member's social, maybe I can look and see or the claim number?
[CUSTOMER][NEUTRAL] Let me check. One moment. Maybe we have ID card found.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next patient?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here. We can move to the next patient, if, if you like.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The next member ID is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02042256
[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, sure.
[CUSTOMER][NEUTRAL] The patient name is
[CUSTOMER][NEUTRAL] [PII]. The date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] Yes, the rate of service is 124 2023. The bill amount is $238 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so where was the first one?
[AGENT][NEUTRAL] And is the provider the same on this one or would it be different?
[CUSTOMER][NEUTRAL] No, it would be different. The provider name is [PII].
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 339.
[AGENT][NEUTRAL] 8249.
[CUSTOMER][NEUTRAL] OK, claim number, OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $168.60.
[AGENT][NEUTRAL] It was sent with a single check, and I'm getting that information for you now. Hold on one moment.
[AGENT][NEUTRAL] Check number is 182-7344.
[CUSTOMER][NEUTRAL] Issued on
[AGENT][NEUTRAL] The check
[AGENT][NEUTRAL] The check was issued on [PII].
[AGENT][NEUTRAL] And it cleared on
[CUSTOMER][NEUTRAL] Check is cleared.
[AGENT][NEUTRAL] OK, it cleared on [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the
[CUSTOMER][NEUTRAL] Paid address.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 423 uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. Could you please send me the copy of you before this claim also?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The next number policy going to be 02428057.
[AGENT][NEUTRAL] 024
[AGENT][NEUTRAL] And then can you repeat the rest?
[CUSTOMER][NEUTRAL] 02428057
[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] Yes, the patient name is uh [PII]. The date of birth is going to be uh [PII].
[AGENT][NEUTRAL] Thank you. And again, 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?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is [PII]. The bill amount is $161 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Let me see if this is it, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing we received this claim on [PII].
[AGENT][NEUTRAL] The claim number is 354-0268.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim, a total of $83.
[AGENT][NEUTRAL] That was also sent with a single check.
[AGENT][NEUTRAL] The check number is 201.
[AGENT][NEUTRAL] 8005.
[AGENT][NEUTRAL] The check was issued on [PII]?
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] If the check is not
[CUSTOMER][NEUTRAL] Cleared on
[AGENT][NEUTRAL] If the check is not received by January.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] You all can call back and we can check on the check and reissue it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please send me the copy of your before this claim also?
[AGENT][NEUTRAL] Yes, so you need the EOB for all the claims?
[CUSTOMER][POSITIVE] Yes, I need all I need a client for all the clients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK. And the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Next member policy going to be.
[CUSTOMER][NEUTRAL] 02068960
[AGENT][NEUTRAL] OK and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, 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?
[CUSTOMER][NEUTRAL] Yes, the rate of service is [PII]. The bill amount is $44 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And you said it was for, hold on one moment.
[AGENT][NEUTRAL] You said it was for [PII], correct?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Is the claim for [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Sure. The date of birth is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] $44.
[AGENT][NEUTRAL] And the name of the provider on this claim?
[CUSTOMER][NEUTRAL] Yes, uh, the provider name going to be [PII]
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 324.
[AGENT][NEUTRAL] 096 5.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the policy does not provide benefits for any procedure or service not listed in the schedule of covered dental services.
[CUSTOMER][NEUTRAL] OK, the claim is denied for non-covered service.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the
[CUSTOMER][NEUTRAL] The date you gave me. OK. Claim number, we got it.
[CUSTOMER][NEUTRAL] Could you please send me the copy of you before this claim also?
[AGENT][NEUTRAL] Yes, I'll send them for all the claims we go over.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is process your claim number.
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Um, hold on one moment, I'm just noting this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The next policy number is 02073603.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. The patient name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bills?
[CUSTOMER][NEUTRAL] Yes, uh, the rate of service is 11-10-2023. The bill amount is $194 even.
[AGENT][NEUTRAL] $194 even?
[CUSTOMER][NEUTRAL] $194 even.
[AGENT][NEUTRAL] 569.
[AGENT][NEUTRAL] This is a different day.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 338.
[AGENT][NEUTRAL] 892 6.
[AGENT][NEUTRAL] And on [PII], you paid out on the claim $69.
[AGENT][NEUTRAL] Um, let me get the check information. Hold on one moment.
[AGENT][NEUTRAL] Then it was sent again and it was 0. Hold on one moment, let me look at this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we paid out on the claim.
[AGENT][NEUTRAL] $69 but why it's coming up. Hold on one second.
[AGENT][NEUTRAL] We mailed it out or it was issued on [PII], which check number 1823574.
[AGENT][NEUTRAL] But the check was voided on [PII].
[CUSTOMER][NEUTRAL] The check is wider on?
[AGENT][NEUTRAL] It was voted on [PII].
[CUSTOMER][NEUTRAL] [PII]. What does it mean by voided?
[AGENT][NEGATIVE] Voided as in the check, you can't use the check. It, it was like a stop payment. The check is void, um, because it was an outstanding check.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So what is the current process, uh, what is the current, uh, check, uh, claim status?
[CUSTOMER][NEUTRAL] It is now paid?
[CUSTOMER][NEUTRAL] Or the night.
[AGENT][NEGATIVE] It was paid, but the check was voided because it wasn't.
[AGENT][NEUTRAL] Used. So let me check with claims to see what we would do in this case. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I'm doing good. Can you look at this claim with me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, it's policy number 207.
[AGENT][NEUTRAL] 3603.
[CUSTOMER][NEUTRAL] OK, for which part?
[AGENT][NEUTRAL] It's um part one.
[AGENT][NEUTRAL] And it's claim 3388926.
[AGENT][NEGATIVE] So we paid out on the claim, but the check was voided and then they resubmitted and it was denied as a duplicate.
[AGENT][NEUTRAL] I'm not, what should I do to get the claim, the payment to them?
[CUSTOMER][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] 537.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wait, where do you see where it was voided?
[AGENT][NEUTRAL] Uh, I looked the check number up in ouch, O U T C H.
[CUSTOMER][NEUTRAL] That's odd because they didn't void it in the system.
[CUSTOMER][NEUTRAL] They didn't void the check in the system. That's crazy.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] What you mean?
[CUSTOMER][NEGATIVE] Meaning they didn't go in under the claim, they voided it in the accounting system but they didn't go in on the claim and void it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, so that's why I was denied as a duplicate because it's like.
[CUSTOMER][NEUTRAL] Right, because when she looked at it, she was like, we already paid this because they, they have to go in under the claim and void it out under the claim and then issue. So, uh, give me a second, I'll send some screenshots to [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And ask her to look into that.
[CUSTOMER][NEUTRAL] And who's calling the provider or the insured?
[AGENT][NEUTRAL] Um, the provider.
[CUSTOMER][NEUTRAL] OK, I've emailed [PII] with the screenshots asking her to take a look at that.
[AGENT][NEUTRAL] OK, so just let them know it's being reprocessed.
[CUSTOMER][NEUTRAL] Let the provider know to allow us um 7 to 10 business days for an updated EOB.
[AGENT][POSITIVE] OK, I'll just tell her. OK, thank you so much.
[CUSTOMER][POSITIVE] Alright thank you you have a good day.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I spoke with claims and they're reprocessing that so that the check can go back out to you. Um, she said to give it about 7 to 10 days, um, so that they can reprocess the claim and send the check out.
[CUSTOMER][NEUTRAL] 7 to 10 days.
[AGENT][NEUTRAL] Business days.
[CUSTOMER][NEUTRAL] reprocess.
[CUSTOMER][NEUTRAL] Request.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After that only you, you'll be generator, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The requesting. OK. Shall we move to the next question?
[AGENT][NEUTRAL] Yes, hold on one moment. I'm just trying to note this policy.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, sir, the next member policy is 02134438.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is uh [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, 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?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is [PII]. The bill amount is $1,345 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] D.
[AGENT][NEUTRAL] OK, so we received this claim twice and what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The providers, the provider name is Maria Teresa Maccare. The office name going to be.
[CUSTOMER][NEUTRAL] The office name is Aspen Dental. The facility name is BC Johnson, D D S P LLC.
[AGENT][NEUTRAL] So the first time we received the claim was on [PII].
[AGENT][NEUTRAL] That claim number is 349.
[AGENT][NEUTRAL] 3074.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the calendar year maximum for the dental benefits has been exhausted.
[CUSTOMER][POSITIVE] Maximum benefit reached.
[CUSTOMER][NEUTRAL] Uh, patient responsibility.
[AGENT][NEUTRAL] Uh, we don't determine. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Did you need the claim status from the 2nd time it was received, it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need that information too or just?
[CUSTOMER][NEUTRAL] May I know the patient response?
[AGENT][NEUTRAL] I'm asking the question so that I can pull up both of the explanation of benefits. Did you need just the original claim or would you like both?
[CUSTOMER][NEUTRAL] Uh, original.
[AGENT][NEUTRAL] OK, so hold on one moment. I'm looking up the explanation of benefits to see if there was an
[AGENT][NEUTRAL] A patient responsibility on there.
[AGENT][NEUTRAL] It's pulling up now. Hold on one moment.
[AGENT][NEUTRAL] So the patient responsibility listed on the explanation of benefits is $1,345.
[AGENT][NEUTRAL] Because we didn't pay out on the claim.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Could you please send me the copy of you before this claim also?
[AGENT][POSITIVE] Yes, I'll be sending them for all the claims we go over.
[CUSTOMER][NEUTRAL] Uh, actually we finished the clients. Uh, may I know the call reference number once you're done, EOB.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you, Ena. Thank you so much for your kind information. I think I received enough information from this time. Thank you so much for your kind service. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you also and thanks for calling APL and Happy New Year.
[CUSTOMER][POSITIVE] Happy New Year. Bye-bye.
[AGENT][NEUTRAL] Bye bye.