AccountId: 011433970860
ContactId: 83f9adfc-f252-4f20-be41-71fcf05872d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 938270 ms
Total Talk Time (AGENT): 259690 ms
Total Talk Time (CUSTOMER): 396486 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/83f9adfc-f252-4f20-be41-71fcf05872d3_20250220T20:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I am calling from a dental office in regards to a pre-authorization we received back from a patient and I'm just a little confused on it.
[AGENT][POSITIVE] Sure, I'll be happy to assist you.
[AGENT][NEUTRAL] What is your name please, ma'am?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And what is a good callback number, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name?
[CUSTOMER][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[AGENT][NEUTRAL] Thank you. And with the policy number?
[CUSTOMER][NEUTRAL] 01603081
[AGENT][NEUTRAL] Thank you. And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And this is under claim 3,562,260?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one second, I'm trying to get that pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let's look at it together.
[CUSTOMER][POSITIVE] Sounds good
[AGENT][NEUTRAL] Slowly but surely bear with me.
[CUSTOMER][NEUTRAL] I get it.
[AGENT][NEGATIVE] It's like today is just, it's just, it's just not being nice today.
[AGENT][NEUTRAL] I think it's cold weather.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, in the summertime, we'll say it's cause all this heat, but right now it's because of all this cold.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] It's the only thing we have to go off of.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] See, it's, oh my goodness.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it didn't pull up the. OK, let me do it another way.
[CUSTOMER][POSITIVE] good
[AGENT][NEUTRAL] Go ahead if you, you said you've got some questions regarding it while I'm trying to get this pulled up if you wanna go ahead and ask them.
[CUSTOMER][NEUTRAL] Yeah, so it was for a crown on number 30, um, but on this form that we received back at the service description, there's only the crown seat listed on here.
[CUSTOMER][NEUTRAL] But under total bill charges, it has 1435 and 1 cent, and 1435 is our fee on that crown, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's saying the patients responsibility is the one cent.
[CUSTOMER][NEUTRAL] But I mean like the crown isn't listed on here. There's a remark on the back about um not being able to provide benefits for procedure service not listed.
[AGENT][NEUTRAL] OK, so the, what that means.
[AGENT][NEUTRAL] Is that, that procedure is probably not listed on the fee schedule.
[CUSTOMER][NEUTRAL] OK, so is that why the crown is just not showing on there?
[AGENT][NEUTRAL] So it would be a non-covered.
[AGENT][NEUTRAL] Yeah, let me see if that is a listed benefit. Do you have a breakdown for him?
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] 279-6. Let me check and see if that is listed.
[CUSTOMER][NEUTRAL] Yeah, because the 2796 is just seeing the crown like it's a zero charge in our office, um, it's the 2740 that we were really looking on the cost for.
[AGENT][NEUTRAL] Yeah, the 2
[AGENT][NEUTRAL] Yeah, the 2740 is covered under major at 40%.
[AGENT][NEUTRAL] I'm still trying to get this thing to come up.
[AGENT][NEUTRAL] OK, 2 11:25. So that's.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So with this policy and of course there's no repricing or anything we have paid a percentage of the usual customary rate in your area and if the procedure is not listed then it would not have um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It would, it would not be covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Now the 2740 is covered under 40%. Let me check that. Yeah, he's satisfied his 12 month waiting period.
[AGENT][NEUTRAL] And I would have to check for history, cause it's one for 7 year period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me check that and that's on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just trying to give you all the information I can while I'm waiting for this computer.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And there's no history of a crown on tooth number 30.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I mean we have like a we have a breakdown from like this last June and we have some notes and whatnot but I was just confused on this.
[CUSTOMER][NEGATIVE] This EOB received back just because it only lists the code for the crown seat, not the crown.
[AGENT][NEUTRAL] I'll tell you what I can do. Let me get you to our dental department.
[AGENT][NEUTRAL] And they can go over that.
[AGENT][NEUTRAL] Uh, pre-treat estimate with you in further detail. OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That sounds good.
[AGENT][POSITIVE] Um, all right. Well, hold just one moment, [PII], let me get a representative for you. Hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Good, how are you?
[AGENT][POSITIVE] I'm doing good thank you. I have a dental provider on the line on policy number 160.
[AGENT][NEUTRAL] 3081.
[AGENT][NEUTRAL] She's calling on part one for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she's calling regard that um pre-treat estimate on claim number 3,562,260.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] I cannot get that pre-treat to come up. I, in on base. I.
[CUSTOMER][NEUTRAL] I don't even know. What, what is she just trying to see what the decision is?
[AGENT][NEUTRAL] Yeah, she's asking why the crown is not listed on here it just says one cent.
[CUSTOMER][NEGATIVE] Oh, I don't know anything about dental. I don't know why they put us all in the queue.
[CUSTOMER][NEUTRAL] Have these questions we don't.
[CUSTOMER][NEUTRAL] We don't know. Uh, let me, mm.
[CUSTOMER][NEUTRAL] OK. What is her name?
[AGENT][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] And her call back?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 4922.
[CUSTOMER][NEUTRAL] OK, I'm gonna have to transfer her again.
[AGENT][NEGATIVE] And I just cannot locate the.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The pre-treat EOB.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] So it goes out like a ELD. I'm sorry, I'm asking you that. Is that how it works? I don't know anything about this.
[AGENT][NEUTRAL] Well, it
[AGENT][NEUTRAL] It has, so I'm not sure.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Crown.
[CUSTOMER][NEUTRAL] So the crown is the.
[CUSTOMER][NEUTRAL] 2796 is the, is that what she's asking about? The seat crown 2796?
[AGENT][NEUTRAL] Um, 279-6, yeah.
[CUSTOMER][NEGATIVE] Well, there's a 0.
[CUSTOMER][NEUTRAL] See on the.
[CUSTOMER][NEUTRAL] The image
[AGENT][NEUTRAL] You see the pre-treat EOB?
[CUSTOMER][NEUTRAL] Well, not the ELB what they actually sent in the claim. Yeah. So that code is, the fee is only, it, there's no fee for it.
[AGENT][NEUTRAL] Oh, the claim, yeah.
[AGENT][NEUTRAL] And then for the other one is alternate procedure not applicable?
[CUSTOMER][NEUTRAL] The 1435.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK, wait, wait, wait.
[CUSTOMER][NEUTRAL] So, uh, additional actions.
[CUSTOMER][NEUTRAL] The, I don't know. I don't know anything. OK, I, I mean, I'll just have to transfer to someone in dental.
[AGENT][NEUTRAL] I just
[AGENT][NEUTRAL] This is on the, the 2740, yeah. I see it shows as a listed benefit.
[CUSTOMER][NEUTRAL] OK, yeah, I don't, I don't process dental, so I, I have no clue. I'll just have to turn around and transfer to uh someone in dental.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] You want to just hang up and let me do it that way she doesn't see look like she's getting bounced around?
[CUSTOMER][MIXED] I think that's best, but I, you know, I don't know how what you guys are taught for it, you know.
[AGENT][NEUTRAL] Let
[AGENT][POSITIVE] Let's do that. Let's do that. I think that's best instead of.
[CUSTOMER][NEUTRAL] Let me look here because I normally ask, let's see if she's available.
[CUSTOMER][NEUTRAL] OK, she's not.
[CUSTOMER][NEUTRAL] OK, yeah, um, I, but I don't know, did you, what, what queue did you go in because we're all in the queue.
[AGENT][NEUTRAL] Dental, dental.
[CUSTOMER][NEUTRAL] Yeah, they've put us all in the queue to answer the phone, but.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I don't have the answers or [PII]'s not here.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Before you go back, let me see.
[CUSTOMER][NEUTRAL] Let me see who processes dental.
[AGENT][NEUTRAL] [PII], maybe?
[CUSTOMER][NEUTRAL] She does. Now if I have any questions, I, I do reach out to her. She's the only person that I know. Oh no, no, no, I don't know. I, I, I reach out to [PII]. I've never reached out to [PII], but she's available.
[CUSTOMER][NEUTRAL] Yeah, see, [PII] said [PII]. That's the only person I know.
[CUSTOMER][NEUTRAL] Let me, let me see what Angel.
[AGENT][NEUTRAL] Is [PII] available?
[CUSTOMER][NEUTRAL] She's available.
[CUSTOMER][NEUTRAL] Yeah, I would say reach out to her, her.
[CUSTOMER][NEUTRAL] She's at [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, I only know [PII]. I reached out to her and she's not showing available right now.
[CUSTOMER][NEUTRAL] If nothing else, I would say take her number down and, and let her know that someone will call her back.
[CUSTOMER][NEUTRAL] If [PII] doesn't know, well, now [PII]'s not available.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Or you can send her over and I'll just tell her I'll have to have someone call her back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I see that OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, thank you, [PII], let me get her on the line.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] [PII], thank you for your patience. I have [PII] in our claims department. She's gonna try to assist you and thank you for calling APL. Hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][POSITIVE] Hi hi thank you for holding I do apologize for the wait. I was trying to um get a dental examiner.
[CUSTOMER][NEUTRAL] Uh, someone that can explain because I see here, let me take a look at something really quick.
[CUSTOMER][NEUTRAL] So your question is about the crown, correct?
[CUSTOMER][NEUTRAL] Are are both procedures.
[CUSTOMER][NEUTRAL] Yeah, mostly just the crown. The only code that's listed on what we received back was the crown seat which is at 2796, but that's it's a no charge code anyway. We were really just looking at the crown. OK.
[CUSTOMER][NEUTRAL] Let me look here.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The procedure not applicable. Let me check their fee schedule maybe this.
[CUSTOMER][NEUTRAL] Let me make sure this procedure.
[CUSTOMER][NEUTRAL] It's on their fee schedule.
[CUSTOMER][NEUTRAL] That may be.
[CUSTOMER][NEUTRAL] Yeah, one we had from June had the 2740 listed on there. OK, let me see frequencies and everything to make sure if it's there.
[CUSTOMER][NEUTRAL] Yeah, let me look at let me see.
[CUSTOMER][NEUTRAL] OK, so that is the.
[CUSTOMER][NEUTRAL] 2740.
[CUSTOMER][NEUTRAL] So they looks like they.
[CUSTOMER][NEUTRAL] Maximum one per.
[CUSTOMER][NEUTRAL] 6 months
[CUSTOMER][NEUTRAL] One person too let me see if it's been.
[CUSTOMER][NEUTRAL] If we receive a.
[CUSTOMER][NEUTRAL] OK. So it looks like uh
[CUSTOMER][NEUTRAL] No, that's not.