AccountId: 011433970860
ContactId: 697a4eeb-a62e-45d8-a513-cc9b49928207
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176720 ms
Total Talk Time (AGENT): 87842 ms
Total Talk Time (CUSTOMER): 72774 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/697a4eeb-a62e-45d8-a513-cc9b49928207_20250124T16:03_UTC.wav
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[AGENT][NEUTRAL] For contacting APR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from a provider's office and I have a question about a claim.
[AGENT][NEUTRAL] I can certainly help with the claim and I'm sorry, uh, I didn't catch your name.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] [PII], thank you. What is that? My name is [PII]. [PII], what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 614-11117
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like there's an intraoral x-rays, permitted oral examination.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. Yes, I do have that uh that pulled up and, and you said that you had a question about it?
[CUSTOMER][NEGATIVE] Well, we received a payment and the payment was only $25 and it looks like we should have gotten more than that for that payment.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so it looks like
[CUSTOMER][NEGATIVE] Unless it was due to the frequency.
[AGENT][NEUTRAL] Well, it looks like, um, OK, so we had the intraoral x-rays on uh 21 and 2, and it looks like the benefits that um
[AGENT][NEUTRAL] That would have normally have been paid went towards the deductible. So I think that's probably what has happened here is that the, the benefits that would normally have been paid, looks like they have all gone to the deductible.
[AGENT][NEUTRAL] With the exception of that, of that uh limited oral examination.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The limited exam.
[AGENT][NEUTRAL] Right, yeah, so it looks like, yeah, it looks like there was 30.
[CUSTOMER][NEUTRAL] Cause I was
[CUSTOMER][NEUTRAL] OK, because it says here the deductible does not apply to exams or profies, but I guess it does apply to X-rays.
[AGENT][NEUTRAL] Uh yes, ma'am, it does. That is correct. So that is what has happened uh with these, uh, is it that most of that benefit went towards the deductible.
[CUSTOMER][NEUTRAL] Is that correct? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, that is what I needed to know. I was looking at it and I haven't been here that long, so I'm looking back. The first time I've seen a polo not a fee, a fee policy like this, but one from here. So I just wanted to, you know, I've been trying to clarify so I have write notes in their breakdown in their chart, but um, OK, well, [PII], thank you so much. I appreciate your help, yes, yes.
[AGENT][NEUTRAL] Yes
[AGENT][NEGATIVE] No, it's, it's confusing sometimes.
[AGENT][POSITIVE] Well, there's nothing else I can help with and thanks for contacting APL. You have a good day. Have a good weekend too.