AccountId: 011433970860
ContactId: 45123095-ec51-41bc-b810-c6ff75ee3c20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238169 ms
Total Talk Time (AGENT): 64385 ms
Total Talk Time (CUSTOMER): 103832 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/45123095-ec51-41bc-b810-c6ff75ee3c20_20250318T19:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Spar Dental, and I was just calling regarding a claim that we had for a patient that got denied.
[AGENT][NEUTRAL] OK, what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um, it is 01016583.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Um, well, let me see, it is 357-479-1.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and her date of birth, let me just pull it up real quick because I don't know if she has it.
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][POSITIVE] Alright, thanks for that information, [PII], so let's take a look.
[AGENT][NEUTRAL] At claim number 357-4791.
[CUSTOMER][NEUTRAL] Yeah it looks like it was.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have the ELB in front of you?
[CUSTOMER][NEUTRAL] Yeah, so it was denied because we were a week early and we were wondering if like we didn't know it had to be 6 months we thought it was 12 months or like twice per year so we're wondering if we could have a one-time allowance and we process this claim and get it paid for the patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, are you referring to a particular ADA code?
[CUSTOMER][NEUTRAL] Yeah, yes, um, for the cleaning it would be, um.
[AGENT][NEUTRAL] Which one?
[CUSTOMER][NEUTRAL] The code is gonna be D1110.
[AGENT][NEUTRAL] OK, the cleaning, OK. Let's see.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey you too.
[AGENT][NEUTRAL] OK, so the frequency for a pro fee is once every 6 months.
[CUSTOMER][NEUTRAL] Yeah and I think we were like a week early.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] This time.
[AGENT][NEUTRAL] So this was this one was on [PII] of this year?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the last one was.
[CUSTOMER][NEUTRAL] Yeah, it should have been like on [PII] and we didn't catch or realize that she was early that um yeah, she had the last clean in [PII] and so we should did it [PII], but we didn't realize it had to be exact or 6 months apart.
[AGENT][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] Yeah, I know no exception can be made. Our system won't allow us to pay it if it's not, you know, if that, you know, if it hasn't been 6 months.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That makes sense.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well that was all that we were wondering.
[AGENT][NEUTRAL] OK, wish I could.
[CUSTOMER][NEUTRAL] Cause that's OK.
[AGENT][POSITIVE] All right, did you have any other questions? You're welcome. You're welcome, [PII], and thank you for thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Well thank you for your help. No, that's it.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.