AccountId: 011433970860
ContactId: 650ccc19-5314-4f33-b91f-0041ff94cae0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 899429 ms
Total Talk Time (AGENT): 261312 ms
Total Talk Time (CUSTOMER): 182674 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/650ccc19-5314-4f33-b91f-0041ff94cae0_20250326T17:12_UTC.wav
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[AGENT][POSITIVE] Hello, good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from Northern Oral Surgeons, um, regarding a mutual patient looking to see if you could help me with his claim that we had or a preestimate that we had sent off.
[AGENT][NEUTRAL] OK, so you're needing to check claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, my name's [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh one second 1580719.
[AGENT][NEUTRAL] I'm sorry, did you say 0719?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], any information that I do for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Um, for, it's for the Prius, so there's no one.
[CUSTOMER][NEUTRAL] In a service yet for that one. The total amount was $8,137.
[AGENT][NEUTRAL] 8,137.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this wasn't for a claim status this was to check for a predetermination that you all sent in.
[CUSTOMER][NEGATIVE] Yeah, we had sent one in and I got it back, but it was only parts of it. There's only two service lines and they were sent separately.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Alright, no worries.
[AGENT][NEUTRAL] And do you have the client number?
[CUSTOMER][NEUTRAL] Um, let's see here.
[AGENT][NEGATIVE] [PII], the worst kind.
[CUSTOMER][NEUTRAL] Yeah, so it's 356-32006.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the other one I have is 3563202.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can't see. OK, let me, give me just a moment.
[AGENT][NEUTRAL] OK, so I can see that on the 3563202.
[AGENT][NEUTRAL] The remark on this states this policy does not provide benefits.
[AGENT][NEUTRAL] That or any procedure or service not listed in the schedule of covered dental services and procedures.
[CUSTOMER][NEUTRAL] OK, so the.
[CUSTOMER][NEUTRAL] Predeterminations that I have gotten back only have so the codes that I have on that like the 353 uh 3563202, it only lists Decaron on there and there's no like procedure codes on there and then the other one that's the 3206, it only has the.
[CUSTOMER][NEUTRAL] Like additional 15 minutes of IV nothing else and there's no procedure codes. Are you able to fax me over like the pre-estimate that you are able that you're looking at that has all of the like the total amount that we had submitted off to you guys for?
[AGENT][NEUTRAL] OK, so give me just a moment just so that I can um
[AGENT][NEUTRAL] Mm, give me, if you don't mind, just give me a couple of moments to look at a few more things.
[CUSTOMER][POSITIVE] Absolutely, yeah, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm going to look at
[AGENT][NEUTRAL] This EOB to see uh what was sent.
[AGENT][NEUTRAL] What I can see on it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's just taking a moment to load.
[CUSTOMER][POSITIVE] No worries at all.
[AGENT][NEUTRAL] OK, so what I can see shows the remark, the same remark, uh, because I can see where those EOBs were faxed to you on [PII]. Those are the same remarks that I see on here.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm just wondering, so the
[CUSTOMER][NEUTRAL] Like, so I guess, yeah, we sent over a pre-estimate and it should have had all of the lines of services on there so like everything that he is getting done there's a decent amount here one second.
[CUSTOMER][NEUTRAL] And there's
[CUSTOMER][NEUTRAL] 4 teeth that looks like they're getting extracted and there's
[CUSTOMER][NEUTRAL] 5 units of IV and then a couple of codings here um I only have the two that when they're they're separated and I didn't know if you had something that had a breakdown of everything that we had sent over to you or if you wanted me to resubmit that to you guys.
[CUSTOMER][NEUTRAL] Had it correctly. I was trying to take.
[AGENT][NEUTRAL] Now I can transfer, I can transfer you to um a different division that may be able to provide you some additional information as to what I can see but I have looked.
[AGENT][NEUTRAL] And I'm not able, that's.
[AGENT][POSITIVE] That's the only thing that I can see as well, but I will tell them what you were needing to see if that is possible if you would like for me to do that, I'll be happy to.
[CUSTOMER][POSITIVE] Yeah, that would be great.
[AGENT][NEUTRAL] OK. Well, is there anything else, and you already have these EOBs and I don't know if you already have our web.
[AGENT][NEUTRAL] Site, um, as well, [PII], but in the future if to check claim status for our members you can also go to our portal.
[AGENT][NEUTRAL] And should be able to check claim status, and for that is [PII].
[CUSTOMER][POSITIVE] Alright, sounds good well thank you so much for your help.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Well, you are certainly very welcome. So again, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, that is OK, thank you.
[AGENT][POSITIVE] Well, you're certainly welcome and thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. How are you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Oh hey, I'm good how are you?
[AGENT][NEUTRAL] [PII], OK, yeah, I'm good. I'm good. It's Wednesday. It's all good. I can, yeah, so I have a provider's office on the line and she's called a couple of times regarding a pre um treat estimate that.
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Within in
[AGENT][NEUTRAL] And the EOBs, you know, they don't have anything but like one line item a piece.
[AGENT][NEUTRAL] And she's inquiring about the other codes.
[AGENT][NEUTRAL] For the
[CUSTOMER][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] The other procedures.
[AGENT][NEUTRAL] It is 158-0719 for [PII].
[AGENT][NEUTRAL] And the lady that I have on the line, her name is [PII].
[AGENT][NEUTRAL] And her callback number, [PII] is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] And the two claim numbers they gave to 35, OK, 3563202.
[AGENT][NEUTRAL] And 356326.
[AGENT][NEUTRAL] Just wanting to know if there's something that we can send them that has.
[AGENT][NEUTRAL] The other line items, she said because there were quite a few.
[AGENT][NEUTRAL] For the treatment that he's having.
[CUSTOMER][NEUTRAL] OK, I'll look that up.
[AGENT][NEUTRAL] And they don't reference, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But, um, I have verified his information and is there anything else you need from me?
[CUSTOMER][POSITIVE] Alrighty thank you so much.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, [PII]. Well, thank you so much and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] Thank you. Bye-bye.