AccountId: 011433970860
ContactId: 3dec17e9-4020-4060-9610-0f62353584bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1248640 ms
Total Talk Time (AGENT): 392942 ms
Total Talk Time (CUSTOMER): 583500 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/3dec17e9-4020-4060-9610-0f62353584bf_20250116T19:34_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Aspen Dental regarding a claim status.
[AGENT][NEUTRAL] OK, I can help with the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Yes, it is 01936966.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and last name will be spelled as [PII], and date of birth of the patient is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The callback number is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What is that data service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] Is the date of service is on?
[CUSTOMER][NEUTRAL] [PII] of [PII] and total bill amount is $608 even.
[AGENT][NEUTRAL] OK, let me just check.
[AGENT][NEUTRAL] Give me just a moment here.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, looks like there was a periodontal scaling.
[CUSTOMER][NEUTRAL] OK, it looks like there was a.
[AGENT][NEUTRAL] Uh, and other, uh, things done. It looks like you're
[CUSTOMER][NEUTRAL] It looks like you're
[AGENT][NEUTRAL] Um, claim number is 35.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] 06725.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh sorry it's 3506.
[AGENT][NEUTRAL] 725
[CUSTOMER][NEUTRAL] 725.
[AGENT][NEUTRAL] And let me just find.
[CUSTOMER][NEUTRAL] May I know the received date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it looks like we received that claim on the [PII]. We processed it on the [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Process it on the [PII].
[AGENT][NEUTRAL] It looks like there was a check.
[CUSTOMER][NEUTRAL] You received on?
[AGENT][NEUTRAL] OK, it looks like we received it on the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we process it on the [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] It looks like there was a check.
[AGENT][NEUTRAL] In the amount of $76.40.
[AGENT][NEUTRAL] That was uh sent out.
[CUSTOMER][NEUTRAL] OK. Can you please help me with check number?
[AGENT][NEUTRAL] It's 2002.
[AGENT][NEUTRAL] 847.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] That was sent to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Country
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it looks like that check was, was cashed on [PII]. Oh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and may I know the pay date when it was paid?
[AGENT][NEUTRAL] It would have gone, it, well, the, the, the check itself, uh, would have been paid out on [PII]. It went out in the mail on [PII].
[CUSTOMER][NEUTRAL] The check itself
[AGENT][NEUTRAL] [PII]. So the pay date is the same, it's going to be the same as the cash date, which is [PII].
[CUSTOMER][NEUTRAL] so the.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, thank you so much. May I know what is the allowed amount?
[AGENT][NEUTRAL] OK, that, the, uh, total allowed amount would be $76.40.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There were 2 charges.
[CUSTOMER][NEUTRAL] $76.46. OK. How much has been paid?
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] $76.40. That, that is the only amount that will be paid out.
[CUSTOMER][NEUTRAL] amount
[CUSTOMER][POSITIVE] OK, thank you so much. That was any patience responsibility?
[AGENT][NEUTRAL] Well, I can't tell you that. The only thing I can tell you is that it's, uh, our contractual obligation with this has been met with this claim. So, uh you may want to get with the, with the uh insured.
[CUSTOMER][NEUTRAL] I can't tell you that
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And that is any providers right off?
[AGENT][NEUTRAL] No, it's not a provider's write-off. It's just that their uh their uh policy didn't cover the other charges.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] Other charges.
[CUSTOMER][NEUTRAL] OK. And which CDT code is not covered here, uh, I will tell one by one, and with CDT code does not covered, can you please help me with that?
[CUSTOMER][NEUTRAL] And um I have 4342.
[AGENT][NEUTRAL] Uh, that was covered.
[CUSTOMER][NEUTRAL] OK. 4342 is covered and the payment has already processed?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] That's correct. OK.
[CUSTOMER][NEGATIVE] One second, my system is totally hanged.
[CUSTOMER][NEUTRAL] [PII] 7
[CUSTOMER][NEUTRAL] It's covered.
[CUSTOMER][NEUTRAL] And process.
[CUSTOMER][NEUTRAL] The payment. And the next code is [PII].
[AGENT][NEUTRAL] Uh, that was not covered.
[CUSTOMER][NEUTRAL] that was not covered. It's non-covered?
[AGENT][NEUTRAL] That's correct. It was not covered.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Uh, this is non-covered code, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. Next code is [PII].
[AGENT][NEUTRAL] Uh, that was, that was not covered.
[CUSTOMER][NEUTRAL] It's non-covered code.
[CUSTOMER][NEUTRAL] OK. The next code is
[CUSTOMER][NEUTRAL] Yes, that's all. Only 4342 is covered and uh they process the payment for that and [PII] and 9630 is non-covered charges, right? You will not pay for this bill. Need to contact the patient, right?
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Well, I, that's, I can't tell you that. It's, I can just tell you that we don't cover it.
[CUSTOMER][NEUTRAL] But I can't tell you that.
[CUSTOMER][NEUTRAL] OK, you don't cover, you don't pay for that. OK, thank you so much. And can you please fax the EOB? I do have a fax number from my end.
[AGENT][NEUTRAL] OK, and what is that fax number, please?
[CUSTOMER][NEUTRAL] OK, and what is the? Yes.
[CUSTOMER][NEUTRAL] The fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. Is there anything else that I can do?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Uh, yes, uh, can you please help me with effective and termination date for this policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it looks like the uh the policy is, um,
[AGENT][NEUTRAL] The effective date on the policy.
[AGENT][NEUTRAL] is uh [PII], and it turned on [PII].
[CUSTOMER][NEUTRAL] October
[CUSTOMER][NEUTRAL] [PII]. And my date of service is on uh [PII]. The policy is covered. OK. Thank you so much. And uh I do have one more claim. Can you please help me with that too?
[AGENT][NEUTRAL] Sure. What's the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Yes, the policy number is 097721841.
[AGENT][NEUTRAL] OK. Um, that's not one of our policies, um.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, do you have, uh, maybe a social security number or?
[CUSTOMER][NEUTRAL] Yes, yes. I do have a social security number. It is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][POSITIVE] Thank you and the patient's name.
[CUSTOMER][NEUTRAL] The first name is [PII] and last name is [PII]. It's [PII] and date of birth of the patient is uh [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Uh, by the way, can you please spell out your name for me?
[AGENT][NEUTRAL] It's [PII] And uh what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Sorry, sorry, uh, can you please repeat your name one second slowly?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII] OK, [PII]. The date of uh date of service or date of birth?
[AGENT][NEUTRAL] Uh, no, the, the data service.
[CUSTOMER][NEUTRAL] Yes, the date of service is on [PII] and total bill amount is $211 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, it looks like the claim number for this.
[CUSTOMER][NEUTRAL] OK, it looks like the claim number for this.
[AGENT][NEUTRAL] It's 354.
[AGENT][NEUTRAL] 1356.
[CUSTOMER][NEUTRAL] 356.
[AGENT][NEUTRAL] And it looks like uh
[CUSTOMER][NEUTRAL] And it looks like uh.
[AGENT][NEUTRAL] See if I can find it. Excuse me just a moment please.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[AGENT][NEUTRAL] OK. It looks like the uh claim was
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] The uh.
[AGENT][NEUTRAL] Received on [PII], 2024.
[CUSTOMER][NEUTRAL] 2024 received on and processed on December.
[AGENT][NEUTRAL] And processed on December the.
[AGENT][NEUTRAL] [PII], 2024.
[CUSTOMER][NEUTRAL] 16 2024.
[AGENT][NEUTRAL] A check in the amount of $80.40 was sent out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please help me with the check number?
[AGENT][NEUTRAL] The check number
[AGENT][NEUTRAL] Yeah, OK. Excuse me just a moment, please. Let me look that up. I'll be right back.
[CUSTOMER][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, I'm sorry I clicked the wrong button. I didn't mean to hang up on you. Um, the lion came back up, so I, yeah, I'm fine. Yes, yes, sir, it did.
[AGENT][POSITIVE] OK, I appreciate it thank you very much.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] OK, it looks like the check number for this.
[CUSTOMER][NEUTRAL] OK. Sorry?
[AGENT][NEUTRAL] Was um 201.
[AGENT][NEUTRAL] 844-43.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] Uh, that was sent to, uh, the check number is 201.
[CUSTOMER][NEUTRAL] The check number?
[CUSTOMER][NEUTRAL] Uh, the check number is 201.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 443
[CUSTOMER][NEUTRAL] 44343.
[AGENT][NEUTRAL] And it was $80.40.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It is paid amount?
[AGENT][NEUTRAL] The paid amount is $80.40.
[CUSTOMER][NEUTRAL] The amount is $80.
[CUSTOMER][NEUTRAL] Paid amount is $80.40.
[AGENT][NEUTRAL] It was sent to 250.
[CUSTOMER][NEUTRAL] Uh, the check, uh, one second, the check number is 1218443. Is that right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. And paid amount is $80.40. Uh, may I know the pay date?
[CUSTOMER][NEUTRAL] Paid on?
[AGENT][NEUTRAL] It's the, yes, it was the [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And what is the allowed amount?
[AGENT][NEUTRAL] The allowed amount is $80.40.
[CUSTOMER][NEUTRAL] OK, $80.40. That is any patient's responsibility?
[AGENT][NEUTRAL] Well, it's, I can only tell you that that's the only thing that we will pay, uh, if there's anything else that will be between the.
[CUSTOMER][NEUTRAL] I can only tell you that that's.
[AGENT][NEUTRAL] The insured and and the provider. Our contractual obligation was met with the claim, it that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. There is any providers write off?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] No. OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. My total bill amount is $211 and but in that only $80 has been paid. What about the remaining balance?
[AGENT][NEUTRAL] Uh, well, that's the only thing I can tell you is that that was our contractual obligation. That's the most that the policy will pay. So, that's the only thing that I can say, that's, we won't pay the balance of it. That's the most that we're gonna pay, is the, is the $80.40.
[CUSTOMER][NEUTRAL] The only thing I can say
[CUSTOMER][NEUTRAL] That's the only thing I can say.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Who is going to pay the balance?
[AGENT][NEUTRAL] I, well, I guess you would have to get with the insured, um, you know, that's.
[CUSTOMER][NEUTRAL] Uh well I guess you would have to get my insurance.
[AGENT][NEUTRAL] This is the most that we would pay on it.
[CUSTOMER][NEUTRAL] OK. Only $80.40 will be paid by you and balance uh will be paid by a contractual something you do like that. What is that contract?
[AGENT][NEUTRAL] I, I don't know. I'm sorry.
[CUSTOMER][NEUTRAL] It was something contractual obligation, something like that.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, I, yeah, the only thing I can tell you is that this is the most that we would pay for it. This is, this is the most that we would pay for it.
[CUSTOMER][NEUTRAL] Uh yeah, the only thing I can tell you is that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh if
[CUSTOMER][NEUTRAL] Hello, can you please help me with the effective date?
[AGENT][NEUTRAL] The effective date of the policy, um.
[CUSTOMER][NEUTRAL] Effective date
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It went into effect.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it turned
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But my date of service is on [PII]. The patient is not, OK, OK, sorry, it's uh [PII].
[CUSTOMER][NEUTRAL] The patient is active for the date of service. OK, OK.
[CUSTOMER][NEUTRAL] OK, can you please fax the this EOB also to the same fax number?
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] Or 2
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Is there anything else
[CUSTOMER][NEUTRAL] I have one last claim. This is the last one. Can you please help me with that too?
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The policy number is?
[CUSTOMER][NEUTRAL] Once again.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's 05, sorry, it's 02564941.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Patient name and the date of birth? Yes.
[CUSTOMER][NEUTRAL] The patient's first name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh the middle name is uh [PII] and last name will be spelled as [PII] and date of birth of the patient is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the bill amount?
[CUSTOMER][NEUTRAL] It's $2,298 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your claim number.
[AGENT][NEUTRAL] It's 354.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 0002.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know when did you receive the claim?
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And we processed it on [PII].
[CUSTOMER][NEUTRAL] And we process it on [PII].
[CUSTOMER][NEUTRAL] So is on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] It process on
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. This claim was paid?
[AGENT][NEUTRAL] No, there are none of the charges. None, none of the charges were covered.
[CUSTOMER][NEUTRAL] None of the charges, none none of the charges.
[CUSTOMER][NEUTRAL] OK. Uh, it, uh, seems like uh denied the claim got denied due to the policy does not have any coverage. It's non-covered charges.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] That's correct. OK. And what is the denied date? Denied on?
[AGENT][NEUTRAL] The the die date.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. OK. Denied reason, denied us?
[AGENT][NEUTRAL] The charges are not covered by this policy.
[CUSTOMER][NEUTRAL] The charges are not
[CUSTOMER][NEUTRAL] Charges.
[CUSTOMER][NEUTRAL] If charges or not.
[CUSTOMER][NEUTRAL] Covered by the policy.
[CUSTOMER][NEUTRAL] OK. And can you please help me with the effective date?
[AGENT][NEUTRAL] The effective date of the policy?
[CUSTOMER][NEUTRAL] Yeah that is the, yes.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it is current.
[CUSTOMER][NEUTRAL] I'm still active.
[CUSTOMER][NEUTRAL] OK. My date of service is on [PII]. The patient is active for the date of service. Why the benefit is not uh covering uh
[AGENT][NEUTRAL] Because the policy doesn't.
[CUSTOMER][NEUTRAL] The code?
[AGENT][NEUTRAL] Because the policy doesn't cover any of these charges.
[CUSTOMER][NEUTRAL] OK, the policy does not.
[CUSTOMER][NEUTRAL] Covered.
[CUSTOMER][NEUTRAL] Any of these charges.
[CUSTOMER][NEUTRAL] Oh this.
[CUSTOMER][POSITIVE] Charges. OK. Thank you so much, [PII] and uh
[CUSTOMER][NEUTRAL] Can you help me with the claim number, received it, denied it. Mhm. OK, thank you so much. There is any call reference number for our conversation.
[AGENT][NEUTRAL] It's just my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. That's all for the day. Have a great day. Bye.
[AGENT][POSITIVE] Thanks for contacting AP