AccountId: 011433970860
ContactId: 60816714-7dc9-4338-ad84-a7abc4c6cba5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1683560 ms
Total Talk Time (AGENT): 437346 ms
Total Talk Time (CUSTOMER): 371661 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/60816714-7dc9-4338-ad84-a7abc4c6cba5_20250529T15:34_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII], and I'm calling on behalf of the dental office to check claim status. Can you please help me with that?
[AGENT][NEUTRAL] I can help you with dental claim status. Can I get a good callback number in case we get disconnected, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much. And do you have the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, policy number is.
[CUSTOMER][NEUTRAL] 253-923-1.
[AGENT][NEUTRAL] OK, one moment while I look it up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII], [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, yeah, date of service is [PII].
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] And the bill amount is 921.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] $921.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 895, 0, go ahead.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK. Uh, can you please repeat the claim number?
[AGENT][NEUTRAL] 35.
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] 569.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And it looks like we paid $486.80 towards that.
[CUSTOMER][NEUTRAL] $486.80. OK, thank you. Uh, claim was processed in or out of network?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I do not know.
[AGENT][NEGATIVE] It looks like the only thing that we didn't cover was the one X-ray procedure.
[AGENT][NEUTRAL] Um, but I don't see.
[AGENT][NEUTRAL] We don't do networks um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] We, we honor this, we honor the policy, um, wherever they go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the payment was issued on?
[AGENT][NEUTRAL] OK, give me just one moment and I will look that up.
[AGENT][NEUTRAL] It looks like we issued that payment through check. It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And the check is outstanding, so no one has processed it yet.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or cleared it.
[CUSTOMER][NEUTRAL] OK, what's, what's the tech number?
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 38993.
[CUSTOMER][NEUTRAL] Single or optic.
[AGENT][NEUTRAL] Uh, one single payment of $486.80.
[CUSTOMER][NEUTRAL] Single payment.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And I believe the check was mailed out to [PII] with the zip code [PII], right?
[AGENT][NEUTRAL] Um, no, sir. It looks like, what's the provider's name?
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Uh, provider's name is Doctor [PII].
[AGENT][NEUTRAL] Yeah, it looks like we sent it to a different address.
[AGENT][NEUTRAL] We send it to the address that they put in the claim.
[CUSTOMER][NEUTRAL] OK, uh, let me check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is uh.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, sir, in [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] And how much is the total allowed amount on this claim?
[AGENT][NEUTRAL] And it would be that 486.
[AGENT][NEUTRAL] The only thing that we didn't cover was the X-ray because they had already gotten one done, um, within their allotted time.
[CUSTOMER][NEUTRAL] So total allowed amount is also $486.80. uh, can you provide me the specific procedure code which was not approved?
[AGENT][NEUTRAL] OK, the code that was not approved, give me just a moment.
[AGENT][NEUTRAL] It's procedure 0330.
[CUSTOMER][NEUTRAL] A panoramic.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, and uh the reason?
[AGENT][NEUTRAL] Uh, they had already had one done within their allotted time.
[CUSTOMER][NEUTRAL] Oh, you mean due to frequency. So what would be the frequency?
[AGENT][NEUTRAL] You pulled it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] It's once every 5 years.
[CUSTOMER][NEUTRAL] OK, and history?
[AGENT][NEUTRAL] OK, give me just a moment and I'll look at their history for that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Looks like they had two of them done in [PII].
[CUSTOMER][NEUTRAL] Uh, can you give me the exact date?
[AGENT][NEUTRAL] Um, they were both in [PII] and [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII], correct.
[CUSTOMER][NEUTRAL] And 2
[CUSTOMER][NEUTRAL] OK. And how much is the total patients responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] So apart from panoramic, everything was approved, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK. And uh can you please fax the UB copy for this service?
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what's a good fax number?
[CUSTOMER][NEUTRAL] 302.
[CUSTOMER][NEUTRAL] 709.
[CUSTOMER][NEUTRAL] 2408.
[AGENT][NEUTRAL] Right, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I just sent that fax over.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] OK, perfect. And what will be the?
[CUSTOMER][NEUTRAL] Yeah, um, I have one more patient.
[AGENT][NEUTRAL] OK, give me just a moment. Um, I'm gonna go ahead and finish the notes on this patient. Mhm.
[CUSTOMER][NEUTRAL] Sure. And do you have
[CUSTOMER][NEUTRAL] Uh, do you have a reference number for the first patient?
[AGENT][NEUTRAL] So we don't do call reference numbers, but you can use my name and last initial in today's date. So [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII].
[AGENT][NEUTRAL] OK give me just a moment.
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. It's uh 02.
[CUSTOMER][NEUTRAL] 554
[CUSTOMER][NEUTRAL] 118.
[AGENT][NEUTRAL] Alright, let me look that up for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the uh claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] And what's the date of service?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, thank you, [PII], for patiently waiting. Sorry about that. Uh, the date of service is [PII], and the bill amount is 1100.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total charge amount is $1,124.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] OK, it looks like we received that claim on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] It was processed on the same day, [PII]. Claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 51.
[AGENT][NEUTRAL] 495.
[CUSTOMER][NEUTRAL] 3551495. OK, thank you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Is there a payment issued on the state of service?
[AGENT][NEUTRAL] OK, it looks like we paid $210.60 towards this claim.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] $210. Uh, you said 60 cents, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] And it looks like there were 4 procedures that were done. They were denied because they're not on the schedule of benefits, so they're not listed on the schedule as something that is covered.
[CUSTOMER][NEUTRAL] OK. Uh, what are these codes?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK. It looks like code 0367.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0350.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like that was done twice.
[CUSTOMER][NEUTRAL] So 2 units of D 0350.
[AGENT][NEUTRAL] Uh, 3 times.
[AGENT][NEUTRAL] There's actually 3 of 0350.
[CUSTOMER][NEUTRAL] 3 times.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So 3 of that, so.
[CUSTOMER][NEUTRAL] What else?
[AGENT][NEUTRAL] Uh, so 3 of the 0350.
[AGENT][NEUTRAL] And then the last one was just at 0367. So that was all of the four that got denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's non-covered service. OK. And uh what are the procedure codes included in this payment of $210.60?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It looks like we paid towards procedure codes 0210 and 0150.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. And what's the check number?
[AGENT][NEUTRAL] The check number is 2023549.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Single check, right?
[AGENT][NEUTRAL] And let me see, it looks like we paid in one check the amount of $210.60.
[CUSTOMER][NEUTRAL] OK. And I believe it was mailed out to [PII].
[AGENT][NEUTRAL] Yes sir, so we have that issue date of being [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] I'm sorry, [PII], and it looks like the check cleared on [PII], so it looks like they cleared the check.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And no patients responsibility?
[AGENT][NEUTRAL] Uh, again, we don't, we don't determine that.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Section to the um.
[CUSTOMER][NEUTRAL] Yes, on [PII].
[CUSTOMER][NEUTRAL] OK, I just need to verify this check number.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 2023549.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK, thank you. Uh, great. So yes, I see the payment of $210.60 sorry in cash. Uh, I believe here for the fact that you'll be copy for the first patient.
[AGENT][NEUTRAL] Um, yes, it looks like it went through.
[CUSTOMER][NEUTRAL] It went through. OK. Uh, did you put attention to [PII]?
[CUSTOMER][NEUTRAL] With uh
[AGENT][NEUTRAL] Oh, I'm so sorry. I thought your name was [PII]. Is it [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Uh, OK, I'm so sorry. I put it as [PII].
[CUSTOMER][NEUTRAL] [PII]. Oh, no, it's fine, uh, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I just need to uh verify something else.
[AGENT][NEUTRAL] For this patient or a different patient?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, this patient, give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so initially what happened is that uh this claim was processed out of network.
[AGENT][NEUTRAL] And again, we don't do networks. This plan does participate in the Carrington network, but it's not a requirement as long as the services that were done are services that are covered under their policy, we honor that policy. Uh, it just looks like they had a few that weren't covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So yeah, we, we will pay whether it's in network or out of network.
[CUSTOMER][NEUTRAL] But you are sure this uh this claim is processed on the Carrington fee schedule?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, but you also said that it doesn't matter, you're going to process it anyway, right? Uh whether the provider is in or out of network?
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Right, we will honor it as long as it's a procedure that's covered under their policy.
[CUSTOMER][NEUTRAL] You mean for this type of policies?
[AGENT][NEUTRAL] Um, for this policy, yes.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much is the total allowed amount on the claim?
[CUSTOMER][NEUTRAL] Is it the same uh payment, 2 $10.60?
[AGENT][NEUTRAL] Yes, so they go by the fee schedule, so it's percentage of allowable, um, and it looks like.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me pull it up.
[AGENT][NEUTRAL] For the FMX and basic and basic restorative expenses, it's at 80%. If it's a preventative expense, it was up to 100%.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh, FMX and comprehensive exam are covered under the basic.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Under the 80%.
[CUSTOMER][NEUTRAL] 80%. OK, but they should have been covered at preventative service, right? Uh, because there are preventative services, preventative procedure codes.
[AGENT][NEUTRAL] Right, those are at 100% of what Carrington, their fee schedule.
[CUSTOMER][MIXED] OK. But they process 80% basic, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Is it uh because it's covered at 80% initially or uh because the provider is out of network?
[CUSTOMER][NEUTRAL] Uh, that is the original coverage of the of the quotes.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] It would be percentage of what was under that network. So let me see.
[AGENT][NEUTRAL] So the one that was.
[AGENT][NEUTRAL] So the procedure code.
[AGENT][NEUTRAL] Uh 0150, it looks like we paid 80% of that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0210 we paid 80% of that.
[AGENT][NEUTRAL] that expense.
[AGENT][NEUTRAL] And then the other codes were not.
[CUSTOMER][NEUTRAL] OK. Is this the original?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. Uh, so is 80% the original coverage of these two quotes, comprehensive exam of FMX, uh, under the Carrington fee?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. uh, thank you so much, [PII], but uh I haven't received the fax copy for the first patient though.
[CUSTOMER][NEUTRAL] Uh, but you said it went through, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it did go through. Let me double check. Yes.
[CUSTOMER][NEUTRAL] OK. Uh, just to be sure, can you send it one more time?
[AGENT][NEUTRAL] Give me just a moment. Um, I will need to pull that back up, so give me just a moment.
[CUSTOMER][NEUTRAL] OK, my desktop and my in the same.
[CUSTOMER][NEUTRAL] What time it be.
[AGENT][NEUTRAL] OK, give me one moment while I look that up.
[CUSTOMER][NEUTRAL] The soon that office and with workers. This so you are locked in at [PII] in my practice stay consistent.
[CUSTOMER][NEUTRAL] I have been discussing with this.
[AGENT][NEUTRAL] Uh, it looks like I just resent that fax and I put attention [PII] and the policy number on it.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. That'll be all for today. Bye-bye and take care.
[AGENT][POSITIVE] Great, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.