AccountId: 011433970860
ContactId: 4ae9f5af-e824-4c37-8e55-844d45b36f52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417079 ms
Total Talk Time (AGENT): 173231 ms
Total Talk Time (CUSTOMER): 73592 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/4ae9f5af-e824-4c37-8e55-844d45b36f52_20250306T20:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes ma'am, um, my husband had insurance through you guys and I have a bill for the dentist, uh, with family dentistry for [PII].
[CUSTOMER][NEGATIVE] Uh, the services was on 415-24 and I received the bill today and they said that y'all did not pay none, so I'm trying to find out why because it should have.
[AGENT][NEUTRAL] OK. Uh, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And my name is [PII].
[CUSTOMER][NEUTRAL] My husband was [PII].
[AGENT][NEUTRAL] Do you have the policy number Mister [PII]?
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] He's not working with that with those guys no more so.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It was for an X-ray, a PA, and then.
[CUSTOMER][NEUTRAL] Uh, for a feeling
[AGENT][NEUTRAL] OK. May I have your date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have the mailing address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said the claim was for yourself?
[CUSTOMER][NEUTRAL] Yes ma'am, on 4-15-24.
[AGENT][NEUTRAL] 415.
[AGENT][NEUTRAL] OK, let me look at this claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And you said this was for family dentistry?
[CUSTOMER][NEUTRAL] Reidsville Family Dentistry.
[AGENT][NEUTRAL] Um, let me see if that's done.
[AGENT][NEUTRAL] OK, now I'm have to pull the usual document.
[AGENT][NEUTRAL] One moment, it looks like we did send the payment.
[AGENT][NEUTRAL] Bear with me just a minute for more details.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] How much they're charging for?
[CUSTOMER][NEUTRAL] Um, they're saying it was $109.
[CUSTOMER][NEUTRAL] They're still charging me 109.
[CUSTOMER][NEUTRAL] And I paid my part that the insurance didn't pay.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That may be the difference. Let me, let me add this up.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, that is the difference of what um was, what was applied towards the responsibility because of your deductibles, um.
[AGENT][NEUTRAL] We pay $507.80 to the provider.
[CUSTOMER][NEUTRAL] And so I still owe 109.
[AGENT][NEUTRAL] It seems like it, yes, um, because we pay the maximum that is allowed by the policy.
[AGENT][NEUTRAL] Um, you can call them and see exactly what are they charging you for, but, um, again, the charge, the total charge amount for the bill was $624. We pay $507.80.
[AGENT][NEUTRAL] And then you had a deductible of $50 that you need to meet and then there is um.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] A deductible of how much?
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] And um then there is one code that we pay 80% and he was responsible for the other 20% which is for the, let's see, the filling.
[CUSTOMER][NEUTRAL] What charges does it show that they filed on?
[AGENT][NEUTRAL] Um, let's see. So it was an examination which is 100% pay and then we have um some X-rays.
[CUSTOMER][NEUTRAL] Uh-huh. How much was the charge for that?
[AGENT][NEUTRAL] Bite wings
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] The X-ray that was the one that was applied towards the deductible of $37. And then, um, which that is the total charge amount on that. And then we have a bite wing which does cover 100%, we already paid for that 1, 100%, then a pro fee which it was paid $105 that was fully paid as well. And then there's a um filling.
[AGENT][NEUTRAL] The filling amount, um, let's see, it looks like the charge amount was 344, um, we pay 80%.
[AGENT][NEUTRAL] And so we paid 26,480 and then $13 went to the $50 deductible together with the other charge for the X-ray. So that was the whole $50. And then there is a um it looks like 7920 that was um under your responsibility.
[AGENT][NEUTRAL] For the filling.
[CUSTOMER][POSITIVE] Alright, thank you for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you. Bye.
[AGENT][POSITIVE] OK. You're welcome