AccountId: 011433970860
ContactId: 6502d793-49ff-465e-8161-87934b99564b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366920 ms
Total Talk Time (AGENT): 124449 ms
Total Talk Time (CUSTOMER): 125260 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/6502d793-49ff-465e-8161-87934b99564b_20250218T19:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling because I'm just trying to find out an invoice we got, but they applied the $50 deductible, but these, um, services are preventative, so I'm a little bit confused. I don't know if you can help me with that.
[AGENT][NEUTRAL] OK, are you the insured? Is that correct?
[CUSTOMER][NEUTRAL] No, no, no, I'm a provider.
[AGENT][NEUTRAL] OK, and so you've received an explanation of benefits from APL. Did you have a question regarding?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes ma'am, so you have a question on claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 01604489
[AGENT][POSITIVE] Thank you. Uh, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alright, give me just one second, [PII] I'm sorry.
[AGENT][NEUTRAL] And excuse me, any information that's provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This is on a dental policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount that you're calling about?
[CUSTOMER][NEUTRAL] Uh, 128 2025 data service, and I believe the total bill charge was 4201.
[AGENT][NEUTRAL] $42 or $4000?
[CUSTOMER][NEUTRAL] No, $42 with 1 cent.
[AGENT][NEUTRAL] OK. And do you, what is the claim number that you have?
[CUSTOMER][NEUTRAL] 3561031.
[AGENT][NEUTRAL] 35, say that one more time for me, please, [PII].
[CUSTOMER][NEUTRAL] 3561031
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Let me see something.
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] I'm still uh waiting for the information to load, so just one moment please and the provider's name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] He like Bay.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So I can see on two of the codes, it states that benefits have been applied to the $50 calendar year deductible and the other code states procedures for which no.
[CUSTOMER][NEUTRAL] That's not it? Checking before the.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEGATIVE] These were charged or not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, 0230 got it.
[AGENT][NEUTRAL] [PII], are you there with me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so how can I help you with that claim? I just went over the remarks.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] Um, the codes, they should be preventative. I don't know why they're charged. I mean, they're saying it's basic and they're charging the $50 deductible.
[AGENT][NEUTRAL] OK, is this on um.
[AGENT][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] Yes, and the D0230.
[AGENT][NEUTRAL] OK, that is OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so 0220 is under basic expenses on this policy?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh I see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm trying to see it here hold on so I can see preventative preventative preventative.
[AGENT][NEUTRAL] And so it's 33.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yes, 23022.
[CUSTOMER][NEUTRAL] Oh, this plan is.
[CUSTOMER][NEUTRAL] Mhm hold on one second, yeah, basic.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Are you talking to me, [PII] or someone else?
[CUSTOMER][NEUTRAL] Yeah, one second, sorry.
[CUSTOMER][NEUTRAL] The basic OK, I'm sorry, ma'am. I'm barely seeing the.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] His thing because I was a little bit confused. Most of the insurance pay that for preventative, so I was just confused on the plan, but I already saw here, yes, they are under basic. OK, I'm sorry about that.
[AGENT][POSITIVE] Yes. Oh, no, no worries and no worries. You are certainly so welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][POSITIVE] No, that's all. Thank you very much, ma'am.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling [PII]. I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] Bye bye you too.
[AGENT][POSITIVE] Bye-bye. Thank