AccountId: 011433970860
ContactId: 38101bc4-9ab2-48be-93d2-b269773375e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419059 ms
Total Talk Time (AGENT): 147720 ms
Total Talk Time (CUSTOMER): 80499 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/38101bc4-9ab2-48be-93d2-b269773375e5_20250303T23:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm giving you a call from the provider's office of [PII], and I'm sorry, did you say your name was [PII] or [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][NEUTRAL] You're welcome and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, and I was calling from the provider's office about a patient's claim.
[AGENT][NEUTRAL] OK, I can help you with the claim, and can you give me your call back number please, just in case the call gets dropped.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and then what is the policy number please?
[CUSTOMER][NEUTRAL] I have a 02576121.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then what is the data service for the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] for $333.
[AGENT][NEUTRAL] OK and uh you said you were calling from [PII].
[AGENT][NEUTRAL] [PII], OK, alright, I wanna make sure I got that right. I'm gonna put you on a brief hold while I look up this claim, Ms. [PII], and I'll be right back with you in just a sec.
[CUSTOMER][NEUTRAL] And the request? Yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK perfect thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII].
[AGENT][NEUTRAL] Would um the claim be under another name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, you're talking about the patient's name or the doctor's name?
[AGENT][NEUTRAL] The facility name.
[CUSTOMER][NEUTRAL] Uh, Westwood Dental Smiles.
[AGENT][POSITIVE] Yes, that's it. Thank you so much. um, I do show that the claim was paid, let me give you the amount and the check number, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It was paid $275.
[AGENT][NEUTRAL] Uh, to Smiles Inc. Westwood Dental.
[AGENT][NEUTRAL] The check was issued.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And it went to the address [PII].
[CUSTOMER][NEUTRAL] OK, and then leaving the patient, what was her responsibility? Because I know you said that you guys already paid 275.
[AGENT][NEUTRAL] Right, we don't give patient responsibility because that's determined by the provider um let me see what the remarks are.
[CUSTOMER][NEUTRAL] Oh, OK, got you, based on.
[CUSTOMER][NEUTRAL] OK, got you. the difference then.
[AGENT][NEUTRAL] Right, um, the benefits applied to this deductible remaining balance of deductible, this benefit has been applied to the calendar, so part of it was applied to the calendar year deductible.
[CUSTOMER][NEUTRAL] Oh, OK, that's why. So what was their calendar year deductible?
[AGENT][NEUTRAL] Uh, let me look real quick.
[AGENT][NEUTRAL] I'll have to pull up the benefits real quick, so it's gonna be just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment. I'm waiting for it to pull in my computer's just being a little bit slow. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's just spinning, OK.
[AGENT][NEUTRAL] So they have a $50 per covered insured up to $150 per family deductible.
[CUSTOMER][POSITIVE] Oh, OK, got you. OK, dokey, and I believe that was it. Thank you so much for your help, [PII]. You have a good one.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a nice night and thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you bye bye.