AccountId: 011433970860
ContactId: 3e63981d-77b6-4d56-8b86-a922c0888065
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232500 ms
Total Talk Time (AGENT): 52072 ms
Total Talk Time (CUSTOMER): 104128 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/3e63981d-77b6-4d56-8b86-a922c0888065_20250226T15:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling to provide office and how are you doing today?
[AGENT][POSITIVE] I'm good how are you [PII]?
[CUSTOMER][POSITIVE] I'm doing good as well thank you so much for asking. Uh, actually I have a inquiry regarding a claim if you can assist me for that one.
[AGENT][POSITIVE] I'd be happy to assist with the claim and if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Absolutely it's going to be [PII]. Just let me know if that was too fast.
[AGENT][NEUTRAL] Oh no, that's fine and what is the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, just give me a moment.
[CUSTOMER][NEUTRAL] Going to be.
[CUSTOMER][NEUTRAL] Just give me one minute, it's loading up. OK.
[CUSTOMER][NEUTRAL] And it's 02408611.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's uh end of June and date of birth is [PII].
[AGENT][NEUTRAL] Now is this for a dental claim?
[CUSTOMER][NEUTRAL] It's for dental, yes.
[AGENT][NEUTRAL] OK, and what's that date of service?
[CUSTOMER][NEUTRAL] It's for [PII]. It has billed amount for $22,796 and we have received an uh UB.
[CUSTOMER][NEUTRAL] From your office and the thing that I'm confused is that the total patient responsibility is not mentioned in that UP. Could you please uh check and let me know how much is the patient responsibility?
[AGENT][NEUTRAL] Um, so do you have a claim number?
[CUSTOMER][NEUTRAL] Uh yes, I do have it. It's claim number is 3562903.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, so we don't.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We don't um determine the patient responsibility we just pay what we're gonna pay and I guess what whatever the balance is would be the patient responsibility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. That's why I'm calling you because uh there was no total patient responsibility and the patient charges amount was a total of $8,732.40. And I was confused if that is the correct patients responsibility or not, you know, we have to build the, bill it to the patient.
[AGENT][NEUTRAL] Right, well, anything that we're not gonna pay is gonna be considered patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and, and do you know what is the allowed amount for this claim?
[AGENT][NEUTRAL] Um, we go by UCR, the usual and customary.
[CUSTOMER][NEUTRAL] All right and.
[CUSTOMER][NEUTRAL] Uh your name is [PII] spelled as [PII] Is it uh two S or only a single one?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yes, two S's.
[CUSTOMER][POSITIVE] Oh thank you so much for confirming that and if you could provide me the reference number for this call.
[AGENT][NEUTRAL] The reference is just my name and today's date and time. Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much, [PII], for your kind assistance. I really appreciate it. Have a great, wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye for now.