AccountId: 011433970860
ContactId: 8fce42d5-0ab3-4c24-bfc7-960e8d38de5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2231459 ms
Total Talk Time (AGENT): 547608 ms
Total Talk Time (CUSTOMER): 458695 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/8fce42d5-0ab3-4c24-bfc7-960e8d38de5c_20250605T16:45_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 [PII], this is [PII] calling from Pacific Dental Services to check on a claim sheet. Is waiting to [PII]?
[AGENT][POSITIVE] I'm doing fine and I am so sorry though. What did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII]. I will be spelled as [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] Thank you and [PII], um, you said that you're needing to check claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Exactly. That's right.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Um, that would be 434-534-692.
[AGENT][NEUTRAL] OK, I'm sorry, you said 434 534-692?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, now that, um, thank you, [PII], but that is not an APL policy number. Is that a social security number?
[CUSTOMER][NEUTRAL] Um, I think that's the social security number. Is it possible to check with the name and date of the occupation?
[AGENT][NEUTRAL] One moment and let me see if I can locate anything with that number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] What is your patient's name?
[CUSTOMER][NEUTRAL] Name of the patient is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what type of claim are you trying to check status on for him?
[CUSTOMER][NEUTRAL] Dental claims?
[AGENT][NEUTRAL] Dental
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. So that number that you gave me is the social security number for him, the policy number for this member.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] was [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, well, just give me, just give me a moment. It's [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and just one moment, please.
[AGENT][NEUTRAL] And what is your data service and total bill amount?
[CUSTOMER][NEUTRAL] Um, the date of servers is on [PII] with a build amount of $415 and even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I think that the claim was pending for the 29 form for the provider.
[AGENT][NEUTRAL] What is the name of the provider please, [PII]?
[CUSTOMER][NEUTRAL] Provada name is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And do you already have the claim number for this number for this data service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is that a 346-7966?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let me get that claim pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Give me just a moment to look at some information because I see that there was a benefit issued on this claim in the amount of $195.40 according to the records that I can see, but I need to look at a couple of other things.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I can see that that claim, but what is the correct address?
[CUSTOMER][NEUTRAL] Um, is that for the provider or a patient?
[AGENT][NEUTRAL] Yes, provider.
[CUSTOMER][NEUTRAL] That's uh um you're, you're asking about the billing address or the training location?
[AGENT][NEUTRAL] Uh, the billing address where we would have sent payment to?
[CUSTOMER][NEUTRAL] That should be [PII].
[AGENT][NEUTRAL] OK, so I see that you had called and spoken to someone back in February regard or we had received a call on this claim, and that we were supposed to be receiving an updated claim with the correct address so that we can have the payment reissued.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, we have submitted a W9 on [PII] with an N number. I do have an NA number which was attached to the W9. Can you please check with the any number?
[AGENT][NEUTRAL] Let me look at a couple of other claims, so give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] Let me look at, uh, yeah, it's gonna take me a few minutes to look at a few things, please.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Wow
[AGENT][POSITIVE] Thank you for your patience, [PII], while I'm looking at some information.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I do not see that that has been received and the claims information that we have received for this member because we've received another claim that was denied as a duplicate but it does not show that that address that you're indicating.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So can I have the process you agree?
[AGENT][NEUTRAL] I'm so sorry, [PII]. What was your question?
[CUSTOMER][NEUTRAL] Can I have the processed date of the claim?
[AGENT][NEUTRAL] On the claim number that you provided for me?
[CUSTOMER][NEUTRAL] Um, yeah, the one which you're looking at the [PII] plan.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] That claim
[AGENT][NEUTRAL] The claim number ending in the 966 that you gave me, that claim was processed on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. And the, the payment amount is $195.40 right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct. Uh-huh.
[CUSTOMER][NEUTRAL] And, and the check number which was initially issued is 18570306, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] 185. I'm sorry, did you?
[CUSTOMER][NEUTRAL] When was the finish?
[AGENT][NEUTRAL] The issue date would have been the same date as the process uh-huh, same date as the process date.
[CUSTOMER][NEUTRAL] Yeah, uh, the 185.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the check is not clear, so that's the reason why we are requesting to shop and reissue you need the updated W9 to reissue the address, oh sorry, reissue the check to the added, right.
[AGENT][NEUTRAL] Along with the correct, yes, along with the correct claim, with the correct address on there because we received the same claim again that has a different address on it and it was denied as a duplicate. So, yes, sir.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I know to which address the check was sent you initially?
[CUSTOMER][NEUTRAL] Is it a [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, now you can send it, send the check to the same address. That's fine for us. We can collect it from the provider. That's uh that's not an, uh, incorrect location. That's, uh, just some treating location, but, uh, we always suggest our office to, uh, we always suggest an insurance company to send the payment to the billing address. So that's why we are requesting it to be sent to that address. Uh, for the future cases for the same office, we can update the address for updating the line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're stating that the [PII] is a valid address that the payment can be issued to because that is what we're getting on the claim forms.
[CUSTOMER][NEUTRAL] That's not [PII].
[CUSTOMER][NEUTRAL] That's 1 [PII].
[AGENT][NEUTRAL] I mean, [PII]. I'm sorry, that is what we have.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, that's the character that is, that's, uh, that's just in treating location you can just send the um same check to the uh.
[AGENT][NEUTRAL] Yes, sir, but that is showing, yes sir, that is also showing as the billing address.
[AGENT][NEUTRAL] It's showing as billing and trading on our information that we're receiving on the claim forms.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's fine. You can send the check to the same address. We can collect it from the provider. Um, but, uh, for the future cases, we just need to update the address. So, on that case, uh, may I know what can we do to update the address? Do we need to submit the W9 to the, to some fax number or to the provider relations or something else?
[AGENT][POSITIVE] Yes, you can, um, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if an address needs to be updated, you would fax the W9.
[AGENT][NEUTRAL] 2 844.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5393507.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the next claim that is filed will need to be submitted listing the correct mailing address also.
[CUSTOMER][NEUTRAL] OK, through whomation?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, uh, ma'am, can you, uh, reissue the new check to the same address? Or else we need to update the address as well?
[AGENT][NEUTRAL] Would you, if you're going to continue to submit claims with the [PII] address.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean, the claims that we're receiving have that as the trading location and the, the billing location.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, no, my question is, um, will you reissue the data of service, uh, for [PII]? Will you reissue a new check to the same address?
[AGENT][NEUTRAL] Yes, it will go to the [PII]. It will go to [PII]. I'll, I can send that request, uh, so you're just gonna need to give me a few minutes in order to do that and remain on the line with me.
[CUSTOMER][NEUTRAL] We can get the payment from them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] And uh may I know to whom that patient will be while attending the W-9?
[AGENT][NEUTRAL] I'm sorry, what did you say, [PII]?
[CUSTOMER][NEUTRAL] A mayor to whom attention will be while we submitting the.
[AGENT][NEUTRAL] Uh, just send it to that fax number and just put on there uh for updating of W9 for provider information.
[CUSTOMER][NEUTRAL] W. 94.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And your phone number again is [PII]. And if someone were to call you on that number, they would be able to reach you directly. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, that's my direct line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] And again thank you for your patience [PII] because it does take a few minutes for me to do this request.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That's fine, that's fine. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome. And uh how long it will take to uh reissue a new payment? What's the time frame for that?
[AGENT][NEUTRAL] Uh, it will take a few days. I would say approximately 5 to 7 business days.
[CUSTOMER][NEUTRAL] 5 to 7 business days, OK.
[AGENT][NEUTRAL] And then you would need to allow at least 10 business days for it to be received.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So I have faxed you the W9 form to the fax number which you have given.
[AGENT][NEUTRAL] Yes, sir, so you would need to allow approximately 48 hours for that to be received and processed.
[CUSTOMER][NEUTRAL] If you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so [PII], I have gotten this request submitted for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So again, just give us a little time to get that processed and if there are any questions, you again, you said that you could be reached at that number that you gave me. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, sure, yeah.
[AGENT][POSITIVE] OK. Yes, sir. Well, thank you so much um for your patience today. Is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] Um, will that the reference number be your name on today's date?
[AGENT][NEUTRAL] Yes, sir, it would be. And if you need a copy of that explanation.
[CUSTOMER][POSITIVE] OK, I do well.
[AGENT][NEUTRAL] Uh, if you need one more thing, if you need a copy.
[CUSTOMER][NEUTRAL] Oh, go ahead, go ahead, sorry.
[AGENT][NEUTRAL] Of the explanation of benefits for that you can use that claim number and print it from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK, sure. Um, I do have one more patient, so can you please uh help me with that as well?
[AGENT][NEUTRAL] I can, just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], just a moment, uh, having something going on with my system. One second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, check it out.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And [PII], the same thing will apply for this one. Any information provided will be a verification of benefits and not a guarantee of payment. What is the policy number for the next patient?
[CUSTOMER][NEUTRAL] Um, that will be.
[CUSTOMER][NEUTRAL] 0216289.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, maybe I misheard you. You said 0216289. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEGATIVE] So that's not a valid policy number, [PII]. You're missing a number somewhere.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Can you add a 00 Marhe?
[AGENT][NEGATIVE] No, sir, that's not gonna work. 0021628. No, sir, that's not valid. I don't believe. Just one moment. I can try it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you please check with the name yeah.
[AGENT][NEUTRAL] Do you have the full social?
[CUSTOMER][NEUTRAL] Uh, I don't have social. Can you please check with the name and date of the location?
[AGENT][NEUTRAL] I can't search my date of birth so I can try by the name, but if it's a very common name and I'm unable to find it, you would just have to obtain the correct information, [PII], and then call us back. So what is the patient's last name?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] [PII], which is Bravo Yankee, and Oscar, E Echo.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] That's [PII] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Well, check it out.
[AGENT][NEUTRAL] OK. And uh what is the patient's date of birth, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So the correct policy number that you should have is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 21.
[AGENT][NEUTRAL] 62.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 189.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 621-89. OK, it's 216-2189, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 216-218-9.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information.
[AGENT][NEUTRAL] Mhm. And what is the date? You're welcome. What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] That will be number [PII], with the amount of $2,191 and even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And the name of the provider?
[CUSTOMER][NEUTRAL] Your name was [PII].
[AGENT][NEUTRAL] And the address?
[CUSTOMER][NEUTRAL] Um, the address to the location or the treating location, right? Or the, uh, billing address?
[AGENT][NEUTRAL] The provider. Mhm.
[AGENT][NEUTRAL] That the check would be
[CUSTOMER][NEUTRAL] Um, that's 2708.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, um, that will be [PII].
[AGENT][NEUTRAL] And that is not what's on the claim form, yes, so that's not what is on the claim form.
[CUSTOMER][NEUTRAL] Is the check was sent to
[CUSTOMER][NEUTRAL] OK, the check.
[CUSTOMER][NEUTRAL] OK, the check was sent to [PII], right?
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct and
[CUSTOMER][NEUTRAL] OK, so, uh,
[CUSTOMER][NEUTRAL] Yeah, um, it seems like it was also sent to the trading location. That's fine. Um, still, still, we haven't received the payment, so can you please stop the payment and reissue it to the same address as well? I can, uh, parallel I can send the job 9 form to update the address for that office as well.
[AGENT][NEUTRAL] Yes, and then you would also have to update now if if I have it voided and reissued, it would go to the same address that it was sent to on [PII]. So that is, OK, valid. OK. So what I will have to do, this one will be a little different because it's still outstanding. So I will have to send it to have it verified that it is indeed still outstanding and approved to have it voided and reissued.
[CUSTOMER][POSITIVE] That's right. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So just one moment. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, that's fine.
[CUSTOMER][NEUTRAL] So the same fax number right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] To send the UB OK. Oh, thank you.
[CUSTOMER][NEUTRAL] To not you.
[CUSTOMER][NEUTRAL] 99.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so again, you're gonna have to just give me a few minutes to do this for you.
[CUSTOMER][NEUTRAL] That's fine. Take it down.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] And send it out 9 on the same time.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Almost finished, [PII].
[CUSTOMER][POSITIVE] Yeah, sure, that's fine, take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] OK, so I have also submitted that request our finance department to have it verify that it is still outstanding and also to if so to approve to void and have it reissued.
[AGENT][NEUTRAL] So that has been done. So is there anything else that I can help you with? And the same as far as the portal goes, is do you need a copy of that explanation of benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Sure, sure, sure, I see. Thank you so much for your wonderful assistance, [PII], and I hope you'll have a great day and uh take care.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Well, I hope, yeah, I hope you have a great day too, [PII] and if that is all I can help you with, thank you so much again for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.