AccountId: 011433970860
ContactId: 7cbc70e9-7240-4362-9ece-6c2eec47d980
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 568590 ms
Total Talk Time (AGENT): 164798 ms
Total Talk Time (CUSTOMER): 118345 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/7cbc70e9-7240-4362-9ece-6c2eec47d980_20250616T21:31_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I used to, I'm calling to check, uh, I had filed a claim for a, a patient and, uh, I was just trying to get some information on, check the status or whatever and see if you received it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] OK, uh, the member I the member number?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Uh, it's 02506698.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, [PII]?
[CUSTOMER][NEUTRAL] Uh, the patient is, uh, [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][NEUTRAL] OK, [PII] and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, but it was for pre-authorization.
[AGENT][NEUTRAL] yeah, um.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me see if um we got that. OK, so this is through web TPA uh Miss [PII], um, so more than likely the claim or the pre-authorization went to web TPA. Was this for dental or is it for medical?
[CUSTOMER][NEUTRAL] Let me this phone. I got static up in it. OK, say it again please.
[AGENT][NEUTRAL] Was the pre-authorization for medical or is it for dental?
[CUSTOMER][NEUTRAL] Denture
[CUSTOMER][NEUTRAL] Dent dental on me.
[AGENT][NEUTRAL] Enter, OK, it's OK, um, yeah, let me bear with me, that was the wrong policy number and let me, let me pull the correct one. OK, one moment.
[CUSTOMER][NEUTRAL] Oh that's the wrong number? OK.
[AGENT][NEUTRAL] Yes, um, that was the medical part is bear with me, let me pull the dental. OK, here we go. Right, let me see if we got that pre-op.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, yeah, looks like we did. Let me pull the information on that. One moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this was for Doctor [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. So this is in regards of the code 2330 and 5211?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] Oh, OK. All right. So we did send out the pre-treat estimate, um, and it looks like the 2330 is under 80% of UCR.
[AGENT][NEUTRAL] And the 5211 is gonna be 40% um of UCR.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure they're out of the waiting period. Um, now, she's not out of her waiting period. Um, looks like the waiting it's a 12 month waiting period for any major service.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she's gonna be out on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, oh, so they, they sent the, you said they sent the paper?
[AGENT][NEUTRAL] Yes, on [PII].
[CUSTOMER][NEGATIVE] OK, I never didn't received. I received one, excuse me, but they, I put the wrong code and they had, they had said that, uh, they didn't do that code and so I looked and I said oh that was the wrong code and so that's why I resent it like you said a 5211 so I received the first one where they said uh they didn't do that code so that's why I wrote it again.
[AGENT][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But you said they they only do, uh, you said 40%?
[AGENT][NEUTRAL] OK, that's for the code 5211. It's 40%.
[CUSTOMER][NEUTRAL] Yes, OK, so it's.
[AGENT][NEUTRAL] He'll use the hour.
[CUSTOMER][NEUTRAL] And the other code he says how much?
[AGENT][NEUTRAL] 80%, the 2330 is 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Do you need me to fax this over to you?
[CUSTOMER][NEUTRAL] Is there
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. What is the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, OK, do you mind holding for me while I send this fax out to you right now?
[CUSTOMER][POSITIVE] Oh OK, thank you, yes ma'am.
[AGENT][POSITIVE] You're welcome. Thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Miss [PII]. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, ma'am, that was it. Thank you for your help.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you, you're welcome. Bye-bye.